The American journal of emergency medicine
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Characterizing respiratory syncytial virus (RSV) infections before and during the COVID-19 pandemic.
Following the onset of the COVID-19 pandemic, RSV infections deviated from a previously reliable epidemiologic pattern of presentation. To investigate whether this change in RSV seasonality resulted in a change in frequency and severity of RSV infections, this single center retrospective study compares demographic and hospital factors during RSV seasons before and after the onset of the COVID-19 pandemic. ⋯ During the first three RSV seasons after the onset of the COVID-19 pandemic, our pediatric emergency departments saw more RSV positive patients than in the last three seasons beforehand. These patients were significantly older and less likely to be admitted, which may be partly due to increased respiratory viral testing during the pandemic. However, shorter LOS and decreased intubations despite increased respiratory support among admitted patients may indicate a paradigm shift in emergency department and inpatient management of severe RSV infections, perhaps encouraged by practice changes and resource limitations due to COVID-19. This information may better guide institutions in predicting resource needs after large-scale infectious disease outbreaks in the future.
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Iron products are widely available over the counter and have the potential to cause serious toxicity. Iron concentrations can be used to prognosticate and guide treatment during acute ingestions. Traditionally, a concentration of 350 μg/dL with symptoms, or 500 μg/dL without symptoms, is considered toxic and will likely need treatment to prevent decompensation. It is generally recommended that an iron concentration is obtained at least 4 h after exposure to provide adequate absorption time and avoid falsely low iron concentrations. Despite this, many iron overdoses have concentrations drawn immediately upon patient presentation. The utility of an iron concentration drawn before 4 h in assessing exposure risk is not clear. The purpose of this study is to determine if patients' symptoms and iron concentrations obtained between 2 and 4 h can predict the development of iron concentrations after 4 h. ⋯ Patients with only minor GI symptoms and an iron concentration of ≤ 300 μg/dL between 2 and 4 h post-ingestion are unlikely to develop further toxicity. In this case series, a concentration of 300 μg/dL or less between 2 and 4 h was the ideal cutoff to predicting subsequent potentially toxic concentrations, with a sensitivity of 100 % and a specificity of 54 %.
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Due to the difficulty in making the decision to discontinue resuscitation efforts, clinicians often perform prolonged cardiopulmonary resuscitation (CPR) in children who have drowned. This study investigated the relationship between out-of-hospital CPR duration and neurological outcomes in children with drowning-induced cardiac arrest. ⋯ Prehospital EMS-initiated CPR duration for children with drowning-induced cardiac arrest was inversely associated with one-month favorable neurological outcomes. Favorable neurological outcomes after >33 min of out-of-hospital CPR were extremely rare, though accurately predicting the outcome remains challenging.
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Central retinal artery occlusion (CRAO) is an ophthalmic emergency characterized by sudden loss of vision with a low chance of spontaneous recovery. This case report presents a 49-year-old female with sudden right eye visual loss, diagnosed as non-arteritic CRAO. Fundoscopic examination revealed retinal pallor, and optical coherence tomography demonstrated edema of the inner retinal layer, consistent with CRAO. ⋯ It also emphasizes the importance of considering cardiac comorbidities, particularly PFO, in younger CRAO patients, and underscores the need for a multidisciplinary approach and comprehensive stroke-etiology workups in CRAO management. This report contributes to the limited evidence on CRAO treatment in Japan, particularly in the context of lower tPA dosing and associated cardiac abnormalities. It underscores the importance of early diagnosis, treatment, and thorough etiological investigation in improving outcomes for CRAO patients.