J Emerg Med
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How much of a role should personal responsibility play in triage criteria? Because voluntarily unvaccinated people are not fulfilling their societal obligations during a pandemic, the ethical principle of justice demands that they reap the egalitarian consequences. These consequences could include lower priority for care, an increasing number of employer and government mandates, and restrictions to entering many entertainment venues. ⋯ A method to balance resource allocation between those patients who refuse vaccination and patients who need the same health care resources is necessary. An ethical solution is to give those who are voluntarily unvaccinated a lower priority for admission and for the use of other health care resources. Current in-hospital triage models can easily be modified to accomplish this. This substantive change in practice may encourage more people to get vaccinated.
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Dr. Patrick Lowe: Our case today is that of a 47-year-old woman who was referred to our emergency department (ED) due to bloody urine, dark tarry stools, red spots on her skin, and bruising throughout her body. Fourteen days prior to presentation, she began exhibiting intermittent fevers, headache, shortness of breath, and a dry cough, and she tested positive for SARS-CoV-2 (the virus that causes COVID-19 pneumonia). ⋯ In addition, she had multiple dark stools described as tar-like when asked. On the day of her ED presentation, the patient noted a red rash throughout her body. In addition, earlier in the day, she had atraumatic self-limited epistaxis. She denied any falls or head strikes, vision changes, focal weakness or numbness, shortness of breath, chest pain, abdominal pain, or peripheral swelling.
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Acute gastrointestinal bleeding is a potentially life-threatening condition that requires rapid intervention. In critically ill patients who are refractory to other therapies, balloon tamponade devices can be lifesaving. ⋯ It is essential for emergency physicians to be familiar with balloon tamponade for acute gastrointestinal bleeding. We review the common balloon tamponade devices, and this article is intended to serve as a resource for those interested in expanding their knowledge of balloon tamponade. © 2022 Elsevier Inc.