# ent

id: cord-256688-yy7abob9
type: ORG
entity:
  Department of Defense U S Army U S Air Force Brooke Army Medical Center or SAUSHEC EM Residency Program


id: cord-300132-lbbibqv3
type: CELL_LINE
entity:
  Coronavirus Disease 2019 COVID 19 Presenting Characteristics Comorbidities and Outcomes Among 5700 Patients Hospitalized With COVID 19


id: cord-297671-3d3gcn6k
type: WORK_OF_ART
entity:
  the Treatment of Croup A Double Blind Study Dexamethasone in Hospitalized Patients with Covid 19 Preliminary Report Centers for Disease C Prevention


id: cord-297671-3d3gcn6k
type: DISEASE
entity:
  rhinorrhea nausea vomiting fatigue diarrhea dehydration abdominal pain headache pharyngitis rash myalgia cyanosis tachypnea tachycardia apnea


id: cord-290684-3f6prlqy
type: ORG
entity:
  Chinese Thoracic Society Society of Critical Care Medicine of Chinese Medical Association Respiratory


id: cord-268526-gh9sy7sl
type: ORG
entity:
  the Healthcare Infection Control Practices Advisory Committee Infection Prevention and Control of Epidemic and Pandemic Prone Acute Respiratory Infections in Health Care Geneva World Health Organization Laboratory


id: cord-257535-v8dwkngi
type: PROTEIN
entity:
  Help U S Healthcare System Address COVID 19 Patient Surge Centers for Medicare Medicaid Services COVID 19 Hospital Capacity Estimates 2020 Harvard Global Health Institute US Department of Health and Human Services Assistant Secretary for Preparedness and Response Administrator


id: cord-311353-ozqfsuh8
type: ORG
entity:
  IHR Emergency Committee on Novel Coronavirus National Health Commission of the People s Republic of China Pneumonia Infected


id: cord-352656-hpuhjbki
type: EVENT
entity:
  Hurricane Harvey Geographic Distribution of Disaster Specific Emergency Department Use After Hurricane Sandy


id: cord-344120-7t5ce2hb
type: WORK_OF_ART
entity:
  A Trial of Lopinavir Ritonavir in Adults Hospitalized with Severe Covid 19 Efficacy and Safety of Lopinavir Ritonavir or Arbidol in Adult Patients with Mild Moderate COVID 19 An Exploratory Randomized Controlled Trial Ruxolitinib


id: cord-286977-330p60oh
type: ORG
entity:
  World Health Organization Violence and Injury Prevention Drowning World Health Organization European Resuscitation Council Guidelines


id: cord-354468-bew35s8q
type: CELL_LINE
entity:
  Hubei China A Descriptive Cross Sectional Multicenter Study Epidemiological clinical and virological characteristics of 74 cases of coronavirusinfected disease 2019 COVID 19


id: cord-268840-m3fp9q3p
type: WORK_OF_ART
entity:
  Clinical Course and Factors Associated with Hospitalization and Critical Illness Among COVID 19 Patients


id: cord-268840-m3fp9q3p
type: WORK_OF_ART
entity:
  A Preliminary Study on the Ultrasonic Manifestations of Peripulmonary Lesions of Non Critical Novel Coronavirus Pneumonia COVID 19 Lung


id: cord-268840-m3fp9q3p
type: DISEASE
entity:
  clavicular line lung zone 3 extended from 4th rib to 12th rib in the mid axillary line and lung zone 4 extended from 4th rib to 12th rib in the scapular line Cell colours


id: cord-349909-hmyv1nep
type: ORG
entity:
  Health Care Use and Access Language Barriers Physician Patient Language Concordance and Glycemic Control


id: cord-349909-hmyv1nep
type: ORG
entity:
  Unequal Treatment Institute of Medicine National Center for Biotechnology Information Cardiovascular


id: cord-349561-4mkiwg9k
type: ORG
entity:
  Hydroxychloroquine Overdose Toxicokinetics and Management Novel Therapies for Myocardial Irritability


id: cord-349561-4mkiwg9k
type: WORK_OF_ART
entity:
  Side Effects of Chloroquine and Primaquine and Symptom Reduction in Malaria Endemic Area Examination of Hydroxychloroquine Use and Hemolytic Anemia


id: cord-322778-a411t2wg
type: WORK_OF_ART
entity:
  A Report of 1014 Cases Chest CT for Typical 2019 nCoV Pneumonia Relationship to Negative RT PCR Testing Radiological


# bib

id: cord-027892-5ik9f6nx
author: So, Mitsuhito
date: 2020-06-25
txt: ./txt/cord-027892-5ik9f6nx.txt
cache: ./cache/cord-027892-5ik9f6nx.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316042/
doi: 10.1016/j.ajem.2020.06.048
abstract: nan
summary:
  First, we could not describe the details of symptoms or the differential diagnosis in the text because of the word limit; therefore, we sincerely appreciate the authors/editors providing us the opportunity to describe the details of neuroleptic malignant syndrome (NMS) in patients with COVID-19 infection. The authors proposed a possible diagnosis of serotonin syndrome (SS) in our reported two cases of NMS following COVID-19 infection because both cases fulfilled the Sternbach''s criteria of SS [1] . In case 1, hyperreactivity symptoms such as tremor and myoclonus were not observed. This patient had loose stools and watery stools since the time of admission, but no apparent improvement was observed even after the discontinuation of the causative drugs. In case 2, hyperreactivity and rigidity findings such as tremor and myoclonus were not recognized. Neuroleptic malignant syndrome in patients with COVID-19 Neuroleptic malignant syndrome in patients with COVID-19

title:
  The authors'' response: A diagnostic confusion between serotonin syndrome and neuroleptic malignant syndrome


id: cord-253657-fminkpas
author: Maslanka, Maciej
date: 2020-09-04
txt: ./txt/cord-253657-fminkpas.txt
cache: ./cache/cord-253657-fminkpas.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720307798?v=s5
doi: 10.1016/j.ajem.2020.08.085
abstract: nan
summary:
  title: Vie scope® laryngoscope versus Macintosh laryngoscope with personal protective equipment during intubation of COVID-19 resuscitation patient The aim of this study was to evaluate intubation performance by paramedics wearing PPE-AGP using Macintosh laryngoscope and Vie Scope® laryngoscope under simulated resuscitation of COVID-19 patient. The study participants then attended a 20-minute practical training course during which they performed endotracheal intubation using Vie Scope® under normal airway conditions. During the target study, paramedics dressed in full PPE-AGP were to perform endotracheal intubation with continuous chest compression. Endotracheal intubation was performed using Macintosh laryngoscope (MAC; blade no.3) as well as with Vie Scope® laryngoscope (VSC). In conclusion, under the conditions of intubation performed by paramedics wearing PPE-AGP with continuous chest compression, the results of the study indicate higher efficiency of intubation with Vie Scope® compared to Macintosh laryngoscope in terms of both the efficiency of the first intubation attempt and the time of the procedure.

title:
  Vie scope® laryngoscope versus Macintosh laryngoscope with personal protective equipment during intubation of COVID-19 resuscitation patient


id: cord-254919-fi3inp67
title: Nitrous oxide inhalant abuse and massive pulmonary embolism in COVID-19
author: Molina, Melanie F.
date: 2020-05-16
txt: ./txt/cord-254919-fi3inp67.txt
cache: ./cache/cord-254919-fi3inp67.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.05.023
doi: 10.1016/j.ajem.2020.05.023
summary:
  title: Nitrous oxide inhalant abuse and massive pulmonary embolism in COVID-19 A patient presented to the emergency department with altered mental status and lower extremity weakness in the setting of nitrous oxide inhalant abuse and Coronavirus Disease-2019 (COVID-19) infection. Given the high concern for pulmonary embolism with the above findings, computed tomography (CT) was performed and analysis of 183 confirmed COVID-19 patients demonstrating an 11.5% death rate. This patient''s coagulopathy may have been secondary to a combination of COVID-19 infection and N2O inhalant abuse leading to hyperhomocysteinemia. There are case reports illustrating a higher risk of VTE associated with chronic N2O inhalant abuse [6, 7] . Nitrous oxide leads to decreased Vitamin B12 levels with chronic abuse, which leads to increased homocysteinemia by inhibition of methionine synthase [7] . Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy Pulmonary embolism and deep vein thrombosis caused by nitrous oxide abuse: A case report

abstract:
  A patient presented to the emergency department with altered mental status and lower extremity weakness in the setting of nitrous oxide inhalant abuse and Coronavirus Disease-2019 (COVID-19) infection. He subsequently developed hypotension and severe hypoxia, found to have a saddle pulmonary embolus (PE) with right heart strain requiring alteplase (tPA).


id: cord-255267-o8k5ep9y
title: Personal ventilation hood for protecting healthcare workers from aerosol-transmissible diseases
author: Gan, Connie Cai Ru
date: 2020-07-22
txt: ./txt/cord-255267-o8k5ep9y.txt
cache: ./cache/cord-255267-o8k5ep9y.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32771295/
doi: 10.1016/j.ajem.2020.07.036
abstract: nan
summary:
  title: Personal ventilation hood for protecting healthcare workers from aerosol-transmissible diseases In terms of healthcare workers'' safety, the hood ensures lower close contact with the patients, primarily perform medical and surgical procedures that can potentially generate aerosolized particles include intubation and bronchoscopy. The hood protects patients that would be required to undergo several tests differently, radiology, physical therapy, pulmonary, and laboratory. Even in situations where a patient needs to be moved to another facility, the hood could limit the exposure to other patients and hospital personnel. We urged that with the protection provided to both patient and hospital personnel, visitors of the health facility are protected from possible exposure. Are Powered Air Purifying Respirators a Solution for Protecting Healthcare Workers from Emerging Aerosol-Transmissible Diseases? Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient


id: cord-256688-yy7abob9
title: Coronavirus Disease (COVID-19): A primer for emergency physicians
author: Chavez, Summer
date: 2020-03-24
txt: ./txt/cord-256688-yy7abob9.txt
cache: ./cache/cord-256688-yy7abob9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32265065/
doi: 10.1016/j.ajem.2020.03.036
summary:
  DISCUSSION: Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for causing COVID-19, is primarily transmitted from person-to-person through close contact (approximately 6 ft) by respiratory droplets. Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), previously referred to as 2019-nCoV, is the virus responsible for causing Coronavirus Disease 2019 (COVID-19) [3] [4] [5] [6] [7] . An emergency medicine approach to COVID-19 should focus on identifying and isolating patients at risk for infection, informing hospital infection prevention and local public health authorities, and engaging infectious disease and other specialists early in care. Emergency physicians should obtain a detailed travel history from all patients and suspect COVID-19 in patients presenting with symptoms of an acute upper respiratory illness and fever. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts

abstract:
  INTRODUCTION: Rapid worldwide spread of Coronavirus Disease 2019 (COVID-19) has resulted in a global pandemic. OBJECTIVE: This review article provides emergency physicians with an overview of the most current understanding of COVID-19 and recommendations on the evaluation and management of patients with suspected COVID-19. DISCUSSION: Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for causing COVID-19, is primarily transmitted from person-to-person through close contact (approximately 6 ft) by respiratory droplets. Symptoms of COVID-19 are similar to other viral upper respiratory illnesses. Three major trajectories include mild disease with upper respiratory symptoms, non-severe pneumonia, and severe pneumonia complicated by acute respiratory distress syndrome (ARDS). Emergency physicians should focus on identifying patients at risk, isolating suspected patients, and informing hospital infection prevention and public health authorities. Patients with suspected COVID-19 should be asked to wear a facemask. Respiratory etiquette, hand washing, and personal protective equipment are recommended for all healthcare personnel caring for suspected cases. Disposition depends on patient symptoms, hemodynamic status, and patient ability to self-quarantine. CONCLUSION: This narrative review provides clinicians with an updated approach to the evaluation and management of patients presenting to the emergency department with suspected COVID-19.


id: cord-257535-v8dwkngi
title: A state overview of COVID19 spread, interventions and preparedness
author: Sen-Crowe, Brendon
date: 2020-04-11
txt: ./txt/cord-257535-v8dwkngi.txt
cache: ./cache/cord-257535-v8dwkngi.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720302485?v=s5
doi: 10.1016/j.ajem.2020.04.020
abstract: nan
summary:
  In mid-March Washington state took measures to limit the spread of infection, by closing educational facilities, closing non-essential services, and a stay at home order (SAHO) 7 . After March 25 th the fatality rate increased slightly, and then showed a decreasing trend and lower percent increase in new cases ( Figure 2 ). However, their percent increase in cases over the past two weeks has decreased comparably to states in which a SAHO was in effect earlier ( Figure 2 ). To address the first issue, an executive order was issued, allowing the state to increase J o u r n a l P r e -p r o o f hospital capacity 14 . The new rules allow for patient transfers to ambulatory surgery centers, freeing hospital beds for the critically ill 19 There is an association between implementing social distancing and a lowering of the percent increase of cases. During Coronavirus Briefing, Governor Cuomo Issues Executive Order Allowing State to Increase Hospital Capacity.


id: cord-258662-6y45gb0t
title: Cardiovascular complications in COVID-19
author: Butt, Nausharwan
date: 2020-07-19
txt: ./txt/cord-258662-6y45gb0t.txt
cache: ./cache/cord-258662-6y45gb0t.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720306240?v=s5
doi: 10.1016/j.ajem.2020.07.032
abstract: nan
summary:
  key: cord-258662-6y45gb0t authors: Butt, Nausharwan; Arshid, Awais; Ahmad, Sarah Aftab; Khalid, Nauman; Kayani, Waleed Tallat title: Cardiovascular complications in COVID-19 date: 2020-07-19 journal: Am J Emerg Med DOI: 10.1016/j.ajem.2020.07.032 sha: doc_id: 258662 cord_uid: 6y45gb0t nan In summary, COVID-19 is associated with significant cardiovascular complications which may also include pericarditis, pericardial effusion and Takotsubo (stress) cardiomyopathy. Further larger studies are required to evaluate this association. Cardiovascular complications in COVID-19 SARS-CoV-2 detection in the pericardial fluid of a patient with cardiac tamponade COVID-19 (SARS-Cov-2) and the heart -An ominous association All authors have no sources of funding to disclose The authors have no conflict of interest to declare.


id: cord-258676-6kgxpcwc
title: Areas of academic research with the impact of COVID-19
author: Haleem, Abid
date: 2020-04-15
txt: ./txt/cord-258676-6kgxpcwc.txt
cache: ./cache/cord-258676-6kgxpcwc.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.04.022
doi: 10.1016/j.ajem.2020.04.022
summary:
  SARS-CoV-2 is the name of the virus responsible for causing COVID-19 disease, which is highly infectious and lethal.With exponentially increasing infections, proportionate fatalities are being reported both from developed and under developed countries. Hence, there is an urgent requirement for conducting academic research on several aspects of this highly contagious disease, to find effective means of containment and treatment of the disease, for now, and in future. We have identified some opportunities for academic research related to COVID-19 and have also provided suggestions to contain, prevent and treat this viral infection. There is an urgent need to identify and study the areas of academic research which will be impacted by COVID-19 [3] . COVID-19 pandemic is a public health emergency of international concern.It has posed new challenges to the global research community. With the help of academic research, there is a need for a better understanding of the COVID-19 and its socio-economic ramifications on society.

abstract:
  Coronavirus (COVID-19) endemic is growing exponentially in the whole world. Researchers, technologists, doctors and other healthcare workers are working day and night on the development of vaccine and medicinesto control and treat this virus. SARS-CoV-2 is the name of the virus responsible for causing COVID-19 disease, which is highly infectious and lethal.With exponentially increasing infections, proportionate fatalities are being reported both from developed and under developed countries. As of today, more than one million people across the world have been reported infected with this virus, and more than 65,000 people have died of this disease. Hence, there is an urgent requirement for conducting academic research on several aspects of this highly contagious disease, to find effective means of containment and treatment of the disease, for now, and in future. We have identified some opportunities for academic research related to COVID-19 and have also provided suggestions to contain, prevent and treat this viral infection.


id: cord-263753-p3evgngz
title: Dexmedetomidine in COVID-19: probing promises with prudence!
author: Magoon, Rohan
date: 2020-10-27
txt: ./txt/cord-263753-p3evgngz.txt
cache: ./cache/cord-263753-p3evgngz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33168381/
doi: 10.1016/j.ajem.2020.10.034
abstract: nan
summary:
  While the peak DEX-doses >0.8 µg/kg/hr and daily cumulative DEX-doses >12.9 µg/kg/day have been described to be associated with an elevated withdrawal incidence [7] , lack of presentation of the contextual DEXdose administered in the COVID-19 patient featured in the Stockton and Kyle-Sidell case-report, captivates attention [1] . (iii) In addition, once on invasive mechanical ventilation, a precision approach to sedation in COVID-19 patients, as epitomized by Payen et al, appears to be prudent centralising the focus on inter-individual variability and synchronizing the level of ventilator support to the subsequent target of sedation, thereby directing the subsequent choice of sedative agents, including DEX [8, 9] . Dexmedetomidine and worsening hypoxemia in the setting of COVID-19: A case report Dexmedetomidine-Associated Hyperpyrexia in Three Critically Ill Patients With Coronavirus Disease Incidence of dexmedetomidine withdrawal in adult critically Ill patients: a pilot study Sedation for critically ill patients with COVID-19: Which specificities?


id: cord-264257-iu67n7qw
title: The impact of H1N1 influenza A virus pandemic on the emergency medical service in Kobe
author: Tsubokura, Masaharu
date: 2010-02-12
txt: ./txt/cord-264257-iu67n7qw.txt
cache: ./cache/cord-264257-iu67n7qw.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675709005373
doi: 10.1016/j.ajem.2009.10.013
abstract: nan
summary:
  title: The impact of H1N1 influenza A virus pandemic on the emergency medical service in Kobe To investigate the impacts of the H1N1 influenza pandemic on EMS, we studied the situation of EMS during the epidemic provided by the emergency paramedics. The number of hospitals with which the paramedics negotiated for patients'' transfer was comparable between the 2 periods ( Fig. 3 and Table 1 ), whereas the sojourn time at the site was prolonged in the postepidemic period (mean, 17.0 minutes; range, 4.0-70 minutes) compared with the preepidemic period (mean, 14.0 minutes; range, 1.0Fig. 1 The number of febrile patients who called an ambulance remained unchanged during the study period. Considering that the number of hospitals with which the paramedics negotiated for patients'' transfer was comparable between the 2 periods, this extra time was required to provide the hospitalists with precise information on febrile patients, including symptoms and records of oversea travel.


id: cord-265098-u5qssib9
author: Fu, Xin-yan
date: 2020-09-17
txt: ./txt/cord-265098-u5qssib9.txt
cache: ./cache/cord-265098-u5qssib9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33039221/
doi: 10.1016/j.ajem.2020.09.038
summary:
  title: Effect of COVID-19 outbreak on the treatment time of patients with acute ST-segment elevation myocardial infarction OBJECTIVE: To explore the effect of COVID-19 outbreak on the treatment time of patients with ST-segment elevation myocardial infarction (STEMI) in Hangzhou, China. METHODS: We retrospectively reviewed the data of STEMI patients admitted to the Hangzhou Chest Pain Center (CPC) during a COVID-19 epidemic period in 2020 (24 cases) and the same period in 2019 (29 cases). Cumulative mortality was showed in Kaplan-Meier survival curves after the surgery in the 2020 group was significantly different higher than the 2019 group during the 28 days.The diagnosis and treatment process of STEMI patients during an epidemic should be optimized to improve their prognosis. Suggestions on management strategies for ST-segment elevation acute myocardial infarction (STEMI) combined with novel coronavirus infection Impact of symptom onset to first medical contact time on the prognosis of patients with acute ST-segment elevation myocardial infarction

title:
  Effect of COVID-19 outbreak on the treatment time of patients with acute ST-segment elevation myocardial infarction

abstract:
  OBJECTIVE: To explore the effect of COVID-19 outbreak on the treatment time of patients with ST-segment elevation myocardial infarction (STEMI) in Hangzhou, China. METHODS: We retrospectively reviewed the data of STEMI patients admitted to the Hangzhou Chest Pain Center (CPC) during a COVID-19 epidemic period in 2020 (24 cases) and the same period in 2019 (29 cases). General characteristics of the patients were recorded, analyzed, and compared. Moreover, we compared the groups for the time from symptom onset to the first medical contact (SO-to-FMC), time from first medical contact to balloon expansion (FMC-to-B), time from hospital door entry to first balloon expansion (D-to-B), and catheter room activation time. The groups were also compared for postoperative cardiac color Doppler ultrasonographic left ventricular ejection fraction (LVEF),the incidence of major adverse cardiovascular and cerebrovascular events (MACCE),Kaplan-Meier survival curves during the 28 days after the operation. RESULTS: The times of SO-to-FMC, D-to-B, and catheter room activation in the 2020 group were significantly longer than those in the 2019 group (P < 0.05). The cumulative mortality after the surgery in the 2020 group was significantly higher than the 2019 group (P < 0.05). CONCLUSION: The pre-hospital and in-hospital treatment times of STEMI patients during the COVID-19 epidemic were longer than those before the epidemic. Cumulative mortality was showed in Kaplan-Meier survival curves after the surgery in the 2020 group was significantly different higher than the 2019 group during the 28 days.The diagnosis and treatment process of STEMI patients during an epidemic should be optimized to improve their prognosis.


id: cord-268049-7xqln70d
title: COVID-19 respiratory support in the emergency department setting
author: Montrief, Tim
date: 2020-08-08
txt: ./txt/cord-268049-7xqln70d.txt
cache: ./cache/cord-268049-7xqln70d.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.08.001
doi: 10.1016/j.ajem.2020.08.001
summary:
  DISCUSSION: Patients presenting with SARS-CoV-2 infection are at high risk for acute respiratory failure requiring airway management. [29] [30] [31] [32] Based on currently available evidence, the WHO states that "HFNC and NIV systems with good interface fitting do not create widespread dispersion of exhaled air and therefore should be associated with [a] low risk of airborne transmission." 15 The risk of respiratory pathogen transmission when using HFNC is subject to a variety of factors, including the duration of support, maximal flow rate, patient sneezing or coughing, cannula fit, and patient cooperation. 35 Many guidelines, including those by Australian and New Zealand Intensive Care Society (ANZICS), the WHO, and the Surviving Sepsis Campaign recommend the use of HFNC in COVID-19 patients presenting with acute hypoxemic respiratory failure unresponsive to conventional oxygen therapy. 20 Notably, the SCCM guidelines on the management of critically ill patients with COVID-19 recommend "a trial of NIV with close monitoring and shortinterval assessment for worsening of respiratory failure" if HFNC is not available and there is no urgent indication for intubation.

abstract:
  INTRODUCTION: Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19), may result in severe complications, multiorgan dysfunction, acute respiratory failure, and death. SARS-CoV-2 is highly contagious and places healthcare workers at significant risk, especially during aerosol-generating procedures, including airway management. OBJECTIVE: This narrative review outlines the underlying respiratory pathophysiology of patients with COVID-19 and discusses approaches to airway management in the emergency department (ED) based on current literature. DISCUSSION: Patients presenting with SARS-CoV-2 infection are at high risk for acute respiratory failure requiring airway management. Among hospitalized patients, 10–20% require intensive care unit admission, and 3–10% require intubation and mechanical ventilation. While providing respiratory support for these patients, proper infection control measures, including adherence to personal protective equipment policies, are necessary to prevent nosocomial transmission to healthcare workers. A structured approach to respiratory failure in these patients includes the use of exogenous oxygen via nasal cannula or non-rebreather, as well as titrated high-flow nasal cannula and non-invasive ventilation. This review offers several guiding principles and resources designed to be adapted in conjunction with local workplace policies for patients requiring endotracheal intubation. CONCLUSIONS: While the fundamental principles of acute respiratory failure management are similar between COVID-19 and non-COVID-19 patients, there are some notable differences, including a focus on provider safety. This review provides an approach to airway management and respiratory support in the patient with COVID-19.


id: cord-268526-gh9sy7sl
author: Hwang, Sung Yeon
date: 2019-03-27
txt: ./txt/cord-268526-gh9sy7sl.txt
cache: ./cache/cord-268526-gh9sy7sl.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675719301913
doi: 10.1016/j.ajem.2019.03.041
summary:
  Then, the participants performed three sessions of continuous chest compressions, each with a duration of 2 min, while undergoing real-time fit testing. CONCLUSIONS: Even if the participants passed the QNFT, the N95 respirator did not provide adequate protection against respiratory infections during chest compression. Thus, we compared the respirator failure (FF < 100) rates during chest compression between a partially passed group (the overall fit factor was adequate, but at least one specific exercise was failed; the PPG) and an all passed group (group that passed all exercises: the APG). Therefore, our findings are clinically significant in terms of the safety of HCWs who are at high risk for airborne disease transmission during chest compression even when wearing adequately fit-tested N95 respirators. This study indicated that N95 respirators may not provide consistent protection against respiratory infection for HCWs. The QNFT failure rates during chest compression after the user-seal-check did not differ between the two groups.

title:
  N95 filtering facepiece respirators do not reliably afford respiratory protection during chest compression: A simulation study

abstract:
  BACKGROUND: N95 filtering facepiece respirators (N95 respirators) may not provide adequate protection against respiratory infections during chest compression due to inappropriate fitting. METHODS: This was a single-center simulation study performed from December 1, 2016, to December 31, 2016. Each participant underwent quantitative fit test (QNFT) of N95 respirators according to the Occupational Safety and Health Administration protocol. Adequacy of respirator fit was represented by the fit factor (FF), which is calculated as the number of ambient particles divided by the number inside the respirator. We divided all participants into the group that passed the overall fit test but failed at least one individual exercise (partially passed group [PPG]) and the group that passed all exercises (all passed group [APG]). Then, the participants performed three sessions of continuous chest compressions, each with a duration of 2 min, while undergoing real-time fit testing. The primary outcome was any failure (FF < 100) of the fit test during the three bouts of chest compression. RESULTS: Forty-four participants passed the QNFT. Overall, 73% (n = 32) of the participants failed at least one of the three sessions of chest compression; the number of participants who failed was significantly higher in the PPG than in the APG (94% vs. 61%; p = 0.02). Approximately 18% (n = 8) of the participants experienced mask fit failures, such as strap slipping. CONCLUSIONS: Even if the participants passed the QNFT, the N95 respirator did not provide adequate protection against respiratory infections during chest compression.


id: cord-268840-m3fp9q3p
title: Lung sonographic findings in COVID-19 patients
author: Sahu, Ankit Kumar
date: 2020-09-04
txt: ./txt/cord-268840-m3fp9q3p.txt
cache: ./cache/cord-268840-m3fp9q3p.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720307749
doi: 10.1016/j.ajem.2020.08.080
summary:
  Sonographic characteristics like bilateral lung involvement, B – profile, spared areas and confluent B – lines or waterfall sign were significantly associated (p < 0.01) with clinical severity (more frequent with increasing disease severity). [2] The clinical spectrum of COVID-19 patients range from asymptomatic to critical illness, which can include severe acute respiratory distress (ARDS) requiring ventilatory support [3] [4] [5] [6] . [12] Confirmed COVID-19 patients were categorised by the treating physician (also performed the ultrasound) according to their severity of illness according to Chinese CDC definitions (mild disease: patients with respiratory tract infection, not fulfilling criteria for severe and critical disease, severe disease: any of the following signs or symptoms like shortness of breath, respiratory rate > 30/min or oxygen saturation < 93%, and critical disease: patients requiring intensive care for organ failure or invasive ventilation) [11] .

abstract:
  OBJECTIVE: The objective of this study was to describe the lung sonographic findings of COVID-19 patients prospectively and investigate its association with disease severity. METHODS: This study was conducted in an emergency department and included consecutively enrolled laboratory confirmed COVID-19 patients. Lung sonography findings were described in all the included patients and analysed with respect to the clinical severity of the patients. RESULTS: 106 patients were included in the study. Common sonographic findings in COVID-19 patients were pleural line irregularity or shredding (70% of patients), followed by B – profile (59%), pleural line thickening (33%), occasional B – lines (26%), sub-pleural consolidations (35%), deep consolidations (6%), spared areas (13%), confluent B – lines or waterfall sign (14%) and pleural effusion (9%). These findings tended to be present more bilaterally and in lower lung zones. Sonographic characteristics like bilateral lung involvement, B – profile, spared areas and confluent B – lines or waterfall sign were significantly associated (p < 0.01) with clinical severity (more frequent with increasing disease severity). CONCLUSION: The lung sonographic findings of COVID-19 were found more bilaterally and in lower lung zones, and specific findings like B – profile, pleural thickening, spared areas and confluent B – lines or waterfall sign were associated with severe COVID-19.


id: cord-278413-vad80mg5
title: Psychiatric emergency department volume during Covid-19 pandemic
author: Goldenberg, Matthew N.
date: 2020-06-01
txt: ./txt/cord-278413-vad80mg5.txt
cache: ./cache/cord-278413-vad80mg5.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720304502?v=s5
doi: 10.1016/j.ajem.2020.05.088
abstract: nan
summary:
  title: Psychiatric emergency department volume during Covid-19 pandemic One commonly reported phenomenon in the first months of the Covid-19 era in the United States has been the reduction in emergency department (ED) visits and hospitalizations of patients with heart attacks, strokes and other acute, non-Covid illnesses. The psychiatric emergency service (PES) is staffed 24 hours per day and treats patients 16 years and older. At YNHH, PES and overall ED volumes for January, February and early March 2020 were similar to prior years (see Table 1 ). PES volume decreased less than overall ED volume, suggesting that patients may be less willing or able to defer their need for acute psychiatric care as opposed to other acute medical care. That the rate of hospitalization of psychiatric patients was just slightly higher than prior years may indicate that the overall acuity in PES was similar to previous years.


id: cord-286348-3p7gz8wi
author: Choudhary, Rahul
date: 2020-10-16
txt: ./txt/cord-286348-3p7gz8wi.txt
cache: ./cache/cord-286348-3p7gz8wi.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720309116?v=s5
doi: 10.1016/j.ajem.2020.10.025
summary:
  We analysed demographic, clinical, echocardiographic and outcome parameters in patients admitted for AHF during the study period of 16 weeks (March 25 to July 14, 2020; starting from the day when lockdown was imposed by Government of India) and compared this data with a control period of 16 weeks (Dec 05, 2019 to March 24, 2020; when there was no lockdown and number of COVID-19 attributed death ≤10). We analysed demographic, clinical, echocardiographic and outcome parameters in patients admitted for AHF during the study period of 16 weeks (March 25 to July 14, 2020; starting from the day when lockdown was imposed by Government of India) and compared this data with a control period of 16 weeks (Dec 05, 2019 to March 24, 2020; when there was no lockdown and number of COVID-19 attributed death ≤10).

title:
  Impact of Covid-19 outbreak on clinical presentation of patients admitted for acute heart failure in India

abstract:
  Acute Heart Failure (AHF) is a life-threatening, rapid onset or worsening of sign and/or symptoms of heart failure (HF) which often requires urgent hospitalization for rapid evaluation and treatment. It may present as de novo or, more frequently, as a result of acute decompensation of chronic heart failure (ADHF). Apart from the economic burden on patient and health care system, each AHF related hospitalization is associated with significant increases in 12-month rehospitalization and mortality rate (44% and 17% in ESC-HF pilot study; 30.2 and 30.8% in Trivandrum Heart Failure Registry) Maggioni et al. (2013), Harikrishnan et al. (2017) [1,2]. As of July 15th, India has about 936,181 cases and nearly 24,309 death attributed to novel coronavirus disease 2019 (Covid-19) infection (Solomon et al., n.d. [3]). Unprecedented apprehension due to the rapid spread of COVID-19 pandemic has resulted in hospital avoiding behavior among patients suffering other diseases, including HF. Also, spread of COVID-19 pandemic attracted the major allocation of healthcare infrastructure and human resources, including emergency services, for the care of COVID-19 infected patients, and little is known about the effect of this stressed-out healthcare system on short and long term outcome in patients suffering from HF. Although, the implementation of lockdown by the Government (from March 25, 2020) initially slowed the community spread of COVID-19, but inadvertently, suspension of public transport further affected the delivery of medical care for HF patients, as most of the patients in India still use public transport for their emergency department (ED) visits. In this study, we performed a retrospective analysis of all consecutive patients who were admitted for AHF (de novo and ADHF; left ventricular ejection fraction <40%) in two Medical college hospitals providing healthcare services in Jodhpur, western India. Both are regional tertiary care centres of local hub and spike networks for the management of various cardiovascular emergencies. Our EDs have a separate registration desks for patients coming with non-Covid-19 emergencies and COVID-19 symptoms, with clear signs at the entrance directing patients to the designated registration desk. Also, ED was expanded to avoid overcrowding and separate waiting area was created for those who have COVID-19 signs and symptoms. We analysed demographic, clinical, echocardiographic and outcome parameters in patients admitted for AHF during the study period of 16 weeks (March 25 to July 14, 2020; starting from the day when lockdown was imposed by Government of India) and compared this data with a control period of 16 weeks (Dec 05, 2019 to March 24, 2020; when there was no lockdown and number of COVID-19 attributed death ≤10). In addition, hospitalization rates during the study period were also compared with data from the same period in 2018–19. Patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were not included in study. Our analysis of patients admitted during the study (lockdown) period revealed 69% reduction in AHF hospitalizations as compared to the control period (241 vs 782) and 60% reduction compared to same calendar period from the previous year (144 vs 602; Figure 1). It was contrary to an expected increase due to the availability issue of guideline-directed medical therapy in follow-up patients and an anticipated surge in AHF due to late presentation of patients with acute myocardial infarction associated mechanical complications. Among the patients from the lockdown period, 96.7% presented with NYHA IV symptoms, this was significantly higher than the rate during the control period (out of 782; 76.6% presented with NYHA IV symptoms during the control period; p value <0.001; Table 1). The mean age (±SD) of patients in study and control period was 63.5(±11.2) and 61.1(±11.9) respectively, with no significant difference. Compared with control group, study group patients were more commonly male (82.6 vs 71.6%; p value <0.02), more likely to have atrial fibrillation (23.7 vs 18.2%; p value <0.02), lower eGFR (64.6 vs 77.7%; p value <0.05), lower mean ejection fraction (24.2 ± 5.6 vs 30.4 ± 4.9%; p value <0.001) and higher NT pro BNP levels (mean value 7349.2 vs 5680.4 pg/ml; p value <0.001). Median length of stay during study and control period was 5 and 4 days respectively. We also observed significantly increased in-hospital mortality during the lockdown period as compared to the control period (8.3% vs 5.4%; p value <0.001). The number of patients presenting to ED with AHF in western India has reduced significantly, and yet, late presentations with advanced symptoms and low EF seem to have increased. Similar pattern of decreased admission for cardiovascular emergency was reported from California, where weekly rates of hospitalization for acute myocardial infarction decreased by up to 48% during the Covid-19 period (Solomon et al., n.d. [3]). The current case fatality rate for COVID-19 in India is approximately 2.6% [4], which is far less than that of AHF and we presume that many untreated AHF patients must have died at home during COVID-19 pandemic. There have been reports of the inexplicable increase in out of hospital cardiac arrests, revealing that patients were staying too long at home to seek care for a more severe medical condition (Wong et al., 2020 [5]). Complete suspension of public transit system along with lack of emergency medical services in India, risk of acquiring COVID-19 at ED and misleading information in media and social platforms about flooding of hospital beds due to COVID-19, even when there were reserved wards for other emergencies, led to hospital avoiding behavior among patients suffering from even the most serious medical conditions. Hospitals are now erroneously perceived as reservoirs of SARS-CoV-2. Community educational campaigns are imperative to convey that hospitals are secured, resourceful, and fully prepared for life-threatening emergencies; which if untreated, has higher morbidity and mortality rate as compared to COVID-19.


id: cord-286977-330p60oh
author: Barcala-Furelos, Roberto
date: 2020-09-16
txt: ./txt/cord-286977-330p60oh.txt
cache: ./cache/cord-286977-330p60oh.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720307695
doi: 10.1016/j.ajem.2020.08.101
summary:
  title: Plastic blanket drowning kit: A protection barrier to immediate resuscitation at the beach in the Covid-19 era. OBJECTIVE: Introducing a new, simple and inexpensive portable equipment for lifeguards, consisting of a pre-assembled full-size plastic blanket with a mask and HEPA filter, which could offer significant time-saving advantages to reduce COVID-19 risk transmission in the first few minutes of CPR after water rescue, avoiding the negative impact of delayed ventilation. METHOD: A pilot study was carried out to determine the feasibility of the pre-assembled kit of face-mask and HEPA filter adapted on a pre-set plastic-blanket. The PPE kit consists of a pre-assembled full-size transparent plastic blanket with an adaptation to a ventilation face mask with a High Efficiency Particulate Air (HEPA) filter. Plastic blanket drowning kit: a protection barrier to immediate resuscitation at the beach in the Covid-19 era.

title:
  Plastic blanket drowning kit: A protection barrier to immediate resuscitation at the beach in the Covid-19 era. A pilot study.

abstract:
  OBJECTIVE: Introducing a new, simple and inexpensive portable equipment for lifeguards, consisting of a pre-assembled full-size plastic blanket with a mask and HEPA filter, which could offer significant time-saving advantages to reduce COVID-19 risk transmission in the first few minutes of CPR after water rescue, avoiding the negative impact of delayed ventilation. METHOD: A pilot study was carried out to determine the feasibility of the pre-assembled kit of face-mask and HEPA filter adapted on a pre-set plastic-blanket. The first step consisted of washing hands, putting on safety glasses and gloves as the first personal protection equipment (PPE) and then covering the victim with an assembled plastic blanket. The second step consisted of 10 min of cardiopulmonary resuscitation (CPR) with PPE and plastic blanket, following the technical recommendations for ventilation during COVID-19. RESULTS: Ten rescuers took part in the pilot study. The average time to wear PPE and place the pre-assembly kit on the victim was 82 s [IC 58–105]. After 10 min the quality of the resuscitation (QCPR) was 91% [87–94]. Quality chest compressions (CC) were 22% better than ventilations (V). Most of the rescuers (60%) thought that placing the plastic blanket on the victim on the beach was somewhat simple or very simple. CONCLUSIONS: Resuscitation techniques in COVID-19 era at the beach have added complexities for the correct use of PPE. Plastic blanket plus basic ventilations equipment resource could be a new alternative to be considered for lifeguards to keep ventilation on use while reducing risk transmission.


id: cord-289684-rvbofsmb
title: COVID-19 associated parotitis: A case report
author: Fisher, Jennifer
date: 2020-06-27
txt: ./txt/cord-289684-rvbofsmb.txt
cache: ./cache/cord-289684-rvbofsmb.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32631770/
doi: 10.1016/j.ajem.2020.06.059
summary:
  We present a case report of a woman infected with COVID-19 and diagnosed with parotitis. The patient was prescribed a course of amoxicillin/clavulanate to J o u r n a l P r e -p r o o f treat a possible concomitant bacterial parotitis and advised to apply warm compresses, massage the gland, use sialagogues to increase salivary flow and stay hydrated. Typically, viral parotitis is characterized by a prodrome of flu-like symptoms followed 2-4 days later by gradual swelling of the bilateral parotid glands, though unilateral involvement is seen in up to 25% of cases [6, 7] . Physical exam findings in suppurative parotitis include induration and tenderness of the parotid gland and purulent discharge from the duct orifice with massaging the gland [6, 7] . While we believe this was a viral-induced parotitis, given the unilateral presentation we treated her for possible bacterial co-infection. At the time we evaluated this patient there were no reports of COVID-19 associated parotitis.

abstract:
  As the 2019 coronavirus pandemic has unfolded, an increasing number of atypical presentations of COVID-19 have been reported. As patients with COVID-19 often present to emergency departments for initial care, it is important that emergency clinicians are familiar with these atypical presentations in order to prevent disease transmission. We present a case of a 21-year-old woman diagnosed in our ED with COVID-19 associated parotitis and review the epidemiology and management of parotitis. We discuss the importance of considering COVID-19 in the differential of parotitis and other viral-associated syndromes and emphasize the importance of donning personal protective equipment during the initial evaluation.


id: cord-290684-3f6prlqy
author: Duan, Jun
date: 2020-07-29
txt: ./txt/cord-290684-3f6prlqy.txt
cache: ./cache/cord-290684-3f6prlqy.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720306665?v=s5
doi: 10.1016/j.ajem.2020.07.071
summary:
  title: Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study BACKGROUND: The use of high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) in patients with COVID-19 is debated. CONCLUSIONS: In critically ill patients with COVID-19 who used HFNC and NIV as first-line therapy, the duration of HFNC + NIV, intubation rate and mortality did not differ between two groups. The Asian Critical Care Clinical Trials Group has suggested that the HFNC and NIV only can be used in COVID-19 patients with mild acute respiratory distress syndrome (ARDS) [21] .

title:
  Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study

abstract:
  BACKGROUND: The use of high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) in patients with COVID-19 is debated. METHODS: This study was performed in four hospitals of China from January to March 2020. We retrospectively enrolled 23 and 13 COVID-19 patients who used HFNC and NIV as first-line therapy, respectively. RESULTS: Among the 23 patients who used HFNC as first-line therapy, 10 experienced HFNC failure and used NIV as rescue therapy. Among the 13 patients who used NIV as first-line therapy, one (8%) used HFNC as rescue therapy due to NIV intolerance. The duration of HFNC + NIV (median 7.1, IQR: 3.5–12.2 vs. 7.3, IQR: 5.3–10.0 days), intubation rate (17% vs. 15%) and mortality (4% vs. 8%) did not differ between patients who used HFNC and NIV as first-line therapy. In total cohorts, 6 (17%) patients received intubation. Time from initiation of HFNC or NIV to intubation was 8.4 days (IQR: 4.4–18.5). And the time from initiation of HFNC or NIV to termination in patients without intubation was 7.1 days (IQR: 3.9–10.3). Among all the patients, C-reactive protein was independently associated with intubation (OR = 1.04, 95% CI: 1.01–1.07). In addition, no medical staff got nosocomial infection who participated in HFNC and NIV management. CONCLUSIONS: In critically ill patients with COVID-19 who used HFNC and NIV as first-line therapy, the duration of HFNC + NIV, intubation rate and mortality did not differ between two groups. And no medical staff got nosocomial infection during this study.


id: cord-293535-9bj5ev1a
title: The influence of corticosteroid on patients with COVID-19 infection: A meta-analysis
author: Wang, Yushu
date: 2020-06-23
txt: ./txt/cord-293535-9bj5ev1a.txt
cache: ./cache/cord-293535-9bj5ev1a.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720305283?v=s5
doi: 10.1016/j.ajem.2020.06.040
abstract: nan
summary:
  title: The influence of corticosteroid on patients with COVID-19 infection: A meta-analysis Therefore, we aim to perform this meta-analysis to identify the roles of corticosteroids in patients with or without severe COVID-19. An electronic search was performed in Pubmed, Embase, Cochrane library, and China National Knowledge Infrastructure (CNKI), using the keywords "steroid" or "corticosteroid" or "cortisol" or "prednisolone" or "prednisone" or "glucocorticoid" or "hydrocortisone" or "dexamethasone" or "methylprednisolone" AND "novel coronavirus" or "2019-nCoV" or "COVID-19" or "SARS-CoV-2" between 2019 and present time (i.e., up to May 7th, 2020) and without language restrictions. A total of 466 studies were originally identified based on our search criteria, 411 of which were excluded after title, abstract or full text reading since they were review articles, editorial materials or letters, and did not report the use of corticosteroid in patients with or without severe COVID-19. Correction to: Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from


id: cord-294736-ji4jz3h6
title: Acute myocarditis associated with COVID-19 infection()
author: Beşler, Muhammed Said
date: 2020-06-02
txt: ./txt/cord-294736-ji4jz3h6.txt
cache: ./cache/cord-294736-ji4jz3h6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.05.100
doi: 10.1016/j.ajem.2020.05.100
summary:
  title: Acute myocarditis associated with COVID-19 infection() We present the case of a 20-year-old male patient without previous history of cardiovascular disease who was admitted to our hospital with a new onset febrile sensation and chest pain. Cardiac MRI showed myocardial edema and late gadolinium enhancement compatible with myocarditis associated with COVID-19 infection. This case showed that acute myocarditis can be the initial presentation of patients with COVID-19 infection. Acute or fulminant myocarditis as well as heart failure have been reported with Middle East respiratory syndrome coronavirus and could be expected to occur with SARS-CoV-2, given the similar pathogenicity [2] . Previous severe acute respiratory syndrome (SARS) beta-coronavirus infections could be associated with tachyarrhythmias and signs and symptoms of heart failure [3] . Association of Coronavirus Disease 2019 (COVID-19) With Myocardial Injury and Mortality Cardiovascular complications of severe acute respiratory syndrome Cardiac Involvement in a Patient With Coronavirus Disease

abstract:
  We present the case of a 20-year-old male patient without previous history of cardiovascular disease who was admitted to our hospital with a new onset febrile sensation and chest pain. Chest computed tomography revealed a subpleural consolidation with a halo of ground-glass opacification. Blood tests revealed elevated levels of markers of myocyte necrosis (troponin I and creatine kinase–MB). Nasopharyngeal swab was positive for COVID-19. Cardiac MRI showed myocardial edema and late gadolinium enhancement compatible with myocarditis associated with COVID-19 infection. This case showed that acute myocarditis can be the initial presentation of patients with COVID-19 infection.


id: cord-297671-3d3gcn6k
title: A case series of pediatric croup with COVID-19
author: Venn, April M.R.
date: 2020-09-15
txt: ./txt/cord-297671-3d3gcn6k.txt
cache: ./cache/cord-297671-3d3gcn6k.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720308299
doi: 10.1016/j.ajem.2020.09.034
summary:
  We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children''s hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11 months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. The novel 2019 coronavirus SARS-CoV-2, responsible for COVID-19 disease, commonly presents in children with fever, cough or shortness of breath. [7] After an electronic health record database review, we describe this ca 1 se series of our ED''s only three cases, between March 1, 2020 and July 31, 2020, of children who received nebulized racemic epinephrine (NRE) and had a positive SARS-CoV-2 infection. [15] Pediatric croup patients who received ≥3 NRE in one children''s hospital were more likely to need intensive care management.

abstract:
  We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11 months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. All were diagnosed with SARS-CoV-2 by polymerase chain reaction testing from nasopharyngeal samples that were negative for all other pathogens including the most common etiologies for croup. Each received multiple (≥3) doses of nebulized racemic epinephrine with minimal to no improvement shortly after medication. All had a prolonged period of time from ED presentation until the resolution of their stridor at rest (13, 19, and 21 h). All received dexamethasone early in their ED treatment and all were admitted. All three received at least one additional dose of dexamethasone, an atypical treatment occurrence in our hospital, due to each patient's prolonged duration of symptoms. One child required heliox therapy and admission to intensive care. All patients were eventually discharged. Pathogen testing is usually not indicated in croup, but with “COVID-19 croup,” SARS-CoV-2 testing should be considered given the prognostic significance and prolonged quarantine implications. Our limited experience with this newly described COVID-19 croup condition suggests that cases can present with significant pathology and might not improve as rapidly as those with typical croup.


id: cord-298640-zwg8ueyb
title: The use of personal protective equipment in the COVID-19 pandemic era
author: Smereka, Jacek
date: 2020-04-15
txt: ./txt/cord-298640-zwg8ueyb.txt
cache: ./cache/cord-298640-zwg8ueyb.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32305157/
doi: 10.1016/j.ajem.2020.04.028
abstract: nan
summary:
  The use of personal protective equipment in the COVID-19 pandemic era American Journal of Emergency Medicine xxx (xxxx) xxx YAJEM-158899; No of Pages 2 At present, it is recommended to apply various types of equipment, including, in particular, partial protection of the environment through the use of surgical masks or ordinary face masks by persons with confirmed or potential SARS-CoV-2 infection; this may reduce the risk of infecting people in the environment, including medical personnel [3, 7] . At present, performing a number of procedures in emergency medicine is associated with additional problems and risks for medical personnel. Emergency physicians, anesthesiologists and intensive care specialists, as well as the relevant scientific societies issue recommendations concerning endotracheal intubation or other procedures dangerous for the medical personnel [1, 2] . COVID 19 a challenge for emergency medicine and every health care professional


id: cord-300132-lbbibqv3
author: Clifford, Christopher T.
date: 2020-11-07
txt: ./txt/cord-300132-lbbibqv3.txt
cache: ./cache/cord-300132-lbbibqv3.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720309864?v=s5
doi: 10.1016/j.ajem.2020.11.006
summary:
  title: Association between COVID-19 diagnosis and presenting chief complaint from New York City triage data Conclusion: A novel high risk COVID-19 patient population was identified from chief complaint data, which is different from current suggested CDC guidelines, and may help triage systems to better isolate COVID-19 patients. Conclusion: A novel high risk COVID-19 patient population was identified from chief complaint data, which is different from current suggested CDC guidelines, and may help triage systems to better isolate COVID-19 patients. This study aimed to investigate the association between different triage chief complaints and COVID-19 status by retroactively looking at a large set of COVID-19 RT-PCR testing done in the ED. It is important for physicians in the ED to test elderly patients for COVID-19 if they present with atypical chief complaints as described above in order to reduce spread of the disease amongst a vulnerable population and increase quality of care.

title:
  Association between COVID-19 diagnosis and presenting chief complaint from New York City triage data

abstract:
  BACKGROUND AND AIM: New York City (NYC) is an epicenter of the COVID-19 pandemic in the United States. Proper triage of patients with possible COVID-19 via chief complaint is critical but not fully optimized. This study aimed to investigate the association between presentation by chief complaints and COVID-19 status. METHODS: We retrospectively analyzed adult emergency department (ED) patient visits from five different NYC hospital campuses (hospital blinded) from March 1, 2020 to May 13, 2020 of patients who underwent nasopharyngeal COVID-19 RT-PCR testing. The positive and negative COVID-19 cohorts were then assessed for different chief complaints obtained from structured triage data. Sub-analysis was performed for patients older than 65 and within chief complaints with high mortality. RESULTS: Of 11,992 ED patient visits who received COVID-19 testing, 6524/11992 (54.4%) were COVID-19 positive. 73.5% of fever, 67.7% of shortness of breath, and 65% of cough had COVID-19, but others included 57.5% of weakness/fall/altered mental status, 55.5% of glycemic control, and 51.4% of gastrointestinal symptoms. In patients over 65, 76.7% of diarrhea, 73.7% of fatigue, and 69.3% of weakness had COVID-19. 45.5% of dehydration, 40.5% of altered mental status, 27% of fall, and 24.6% of hyperglycemia patients experienced mortality. CONCLUSION: A novel high risk COVID-19 patient population was identified from chief complaint data, which is different from current suggested CDC guidelines, and may help triage systems to better isolate COVID-19 patients. Older patients with COVID-19 infection presented with more atypical complaints warranting special consideration. COVID-19 was associated with higher mortality in a unique group of complaints also warranting special consideration.


id: cord-301623-uza6gu4r
title: Cardiopulmonary resuscitation in prone position: A scoping review
author: Moscarelli, Alessandra
date: 2020-09-10
txt: ./txt/cord-301623-uza6gu4r.txt
cache: ./cache/cord-301623-uza6gu4r.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720307919?v=s5
doi: 10.1016/j.ajem.2020.08.097
summary:
  This scoping review aimed to summarize the available evidence on cardiopulmonary resuscitation in prone position (''reverse CPR'') and knowledge or research gaps to be further evaluated. RESULTS: We included 1 study on manikins, 31 case reports (29 during surgery requiring prone position) and 2 nonrandomized studies describing reverse CPR. This scoping review aimed to summarize the available evidence on the cardiopulmonary resuscitation in prone position ("reverse CPR") and to highlight possible knowledge or research gaps to be further evaluated. We collected data regarding the type of study (e.g. design and country), population characteristics at baseline (e.g. age, main disease), setting (e.g. operatory room, ICU), occurred events (e.g. rhythm and cause of the cardiac arrest), intervention (e.g. prone or standard CPR) and outcomes (e.g. mortality, return of spontaneous circulation -ROSC).

abstract:
  INTRODUCTION: The ongoing pandemic of COVID-19 brought to the fore prone positioning as treatment for patients with acute respiratory failure. With the increasing number of patients in prone position, both spontaneously breathing and mechanically ventilated, cardiac arrest in this position is more likely to occur. This scoping review aimed to summarize the available evidence on cardiopulmonary resuscitation in prone position (‘reverse CPR’) and knowledge or research gaps to be further evaluated. The protocol of this scoping review was prospectively registered on 10th May 2020 in Open Science Framework (https://osf.io/nfuh9). METHODS: We searched PubMed, EMBASE, MEDLINE and pre-print repositories (bioRxiv and medRxiv) for simulation, pre-clinical and clinical studies on reverse CPR until 31st May 2020. RESULTS: We included 1 study on manikins, 31 case reports (29 during surgery requiring prone position) and 2 nonrandomized studies describing reverse CPR. No studies were found regarding reverse CPR in patients with COVID-19. CONCLUSIONS: Even if the algorithms provided by the guidelines on basic and advanced life support remain valid in cardiac arrest in prone position, differences exist in the methods of performing CPR. There is no clear evidence of superiority in terms of effectiveness of reverse compared to supine CPR in patients with cardiac arrest occurring in prone position. The quality of evidence is low and knowledge gaps (e.g. protocols, training of healthcare personnel, devices for skill acquisition) should be fulfilled by further research. Meanwhile, a case-by-case evaluation of patient and setting characteristics should guide the decision on how to start CPR in such cases.


id: cord-308807-9yggo5yk
title: National analysis of COVID-19 and older emergency physicians
author: Zheng, DavidX.
date: 2020-11-04
txt: ./txt/cord-308807-9yggo5yk.txt
cache: ./cache/cord-308807-9yggo5yk.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720309748
doi: 10.1016/j.ajem.2020.10.074
abstract: nan
summary:
  On October 23, 2020, the U.S. reached a new pandemic record of 83,010 daily cases, 1 and all signs point toward an impending "second wave" or "third surge." Given the association between advanced age and COVID-19 severity, 2 our objective was to compare the geographic distribution of U.S. EPs age  60 years to the cumulative distribution of confirmed COVID-19 cases, to highlight the potential risks faced by this vulnerable population of clinicians. Emergency departments could also amend operations to prioritize reduction of nosocomial transmission risk among advanced age EPs (e.g., allocating critically limited PPE to higher-risk physicians, geographically cohorting patients with suspected or confirmed COVID-19 infection within an emergency department). States were grouped into color-coordinated quintiles based on relative proportion of older EPs, and cumulative COVID-19 case volumes were adjusted with a logarithmic scale to create proportionally-sized data points.


id: cord-310207-lfub6y5m
author: Nanda, Satyan
date: 2020-09-16
txt: ./txt/cord-310207-lfub6y5m.txt
cache: ./cache/cord-310207-lfub6y5m.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720308238?v=s5
doi: 10.1016/j.ajem.2020.09.029
summary:
  title: Covid-19 associated Guillain-Barre Syndrome: Contrasting tale of four patients from a tertiary care centre in India OBJECTIVE: In this brief communication we report four cases of Covid-19 who presented to our hospital with features suggestive of Guillain-Barre Syndrome (GBS). DISCUSSION: The mechanisms by which SARS-CoV-2 causes neurologic damage are multifaceted, including direct damage to specific receptors, cytokine-related injury, secondary hypoxia, and retrograde travel along nerve fibres. One patient who presented with respiratory complaints and X-ray changes along with neurological deficits continued to deteriorate even after starting treatment for both GBS and Covid-19, and eventually succumbed to the disease. All our patients developed features of GBS, 5-10 days after the onset of Covid-19 symptoms, which is similar to the interval seen with Guillain-Barré syndrome that occurs secondary to other infections [9] . Atypical clinical presentation of COVID-19: a case of Guillain-Barrè Syndrome related to SARS-Cov-2 infection

title:
  Covid-19 associated Guillain-Barre Syndrome: Contrasting tale of four patients from a tertiary care centre in India

abstract:
  BACKGROUND: Globally, more than 12 million people have been infected with COVID −19 infection till date with more than 500,000 fatalities. Although, Covid-19 commonly presents with marked respiratory symptoms in the form of cough and dyspnoea, a neurotropic presentation has been described of late as well. OBJECTIVE: In this brief communication we report four cases of Covid-19 who presented to our hospital with features suggestive of Guillain-Barre Syndrome (GBS). DISCUSSION: The mechanisms by which SARS-CoV-2 causes neurologic damage are multifaceted, including direct damage to specific receptors, cytokine-related injury, secondary hypoxia, and retrograde travel along nerve fibres. The pathogenesis of GBS secondary to Covid-19 is not well understood. It is hypothesised that viral illnesses related GBS could be due to autoantibodies or direct neurotoxic effects of viruses. CONCLUSION: Nervous system involvement in Covid-19 may have been grossly underestimated. In this era of pandemic, it is very important for the physicians to be aware of association of GBS with Covid-19, as early diagnosis and treatment of this complication could have gratifying results. To the best of our knowledge, this is the first such case series of Guillain-Barre Syndrome associated with Covid-19 to be reported from India.


id: cord-311353-ozqfsuh8
title: The role of Chinese medicine in COVID-19 pneumonia: A systematic review and meta-analysis
author: Sun, Chun-Yang
date: 2020-07-08
txt: ./txt/cord-311353-ozqfsuh8.txt
cache: ./cache/cord-311353-ozqfsuh8.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720305593
doi: 10.1016/j.ajem.2020.06.069
summary:
  title: The role of Chinese medicine in COVID-19 pneumonia: A systematic review and meta-analysis INTRODUCTION: Chinese medicine (CM) has been used to treat Novel Coronavirus 2019 (COVID-19) pneumonia in China. This meta-analysis was conducted to evaluate the clinical efficacy and safety of CM in the treatment of COVID-19 pneumonia. CONCLUSION: According to the allocated data, CM has demonstrated clinical efficacy and safety on COVID-19 pneumonia, which need to be confirmed by high quality, multiple-center, large sample randomized controlled trials. Therefore, the meta-analysis method will be used to systematically review the clinical efficacy and safety of CM for COVID-19 pneumonia. Studies meeting the following criteria were included: (1) randomized controlled trials (RCTs) using CM (including Chinese herbal medicine, Chinese patent medicine and Chinese medicine injections) to treat COVID-19 pneumonia regardless of J o u r n a l P r e -p r o o f meta-analysis.

abstract:
  INTRODUCTION: Chinese medicine (CM) has been used to treat Novel Coronavirus 2019 (COVID-19) pneumonia in China. This meta-analysis was conducted to evaluate the clinical efficacy and safety of CM in the treatment of COVID-19 pneumonia. METHODS: Randomized controlled trials (RCTs) involving CM in the treatment of COVID-19 pneumonia were identified from Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, Wanfang Database and VIP Information Database. The methodological quality of trials was evaluated with Cochrane Hanadbook criteria, and the Cochrane Collaboration's Review Manager 5.3 software was used for meta-analysis. RESULTS: A total of 7 valid studies involving 681 patients were included. The meta-analysis exhibited in comparison to conventional treatment, CM combined with conventional treatment significantly improved clinical efficacy (RR = 1.21, 95% CI [1.08,1.36]), and significantly increased viral nucleic acid negative conversion rate (RR = 1.49, 95% CI [1.13,1.97]). CM also prominently reduced pulmonary inflammation (RR = 1.27, 95% CI [1.12,1.44]), and improved host immune function (WBC, MD = 0.92, 95% CI [0.07,1.76]; LYM, MD = 0.33, 95% CI [0.08,0.57]; LYM%, MD = 2.90, 95% CI [2.09,3.71]; CRP, MD = −12.66, 95% CI [−24.40, −0.92]). Meanwhile, CM did not increase the incidence of adverse reactions (RR = 1.17, 95% CI [0.39,3.52]). CONCLUSION: According to the allocated data, CM has demonstrated clinical efficacy and safety on COVID-19 pneumonia, which need to be confirmed by high quality, multiple-center, large sample randomized controlled trials.


id: cord-312623-ktswh3fu
title: Mucormycosis with orbital compartment syndrome in a patient with COVID-19
author: Werthman-Ehrenreich, Amanda
date: 2020-09-16
txt: ./txt/cord-312623-ktswh3fu.txt
cache: ./cache/cord-312623-ktswh3fu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32972795/
doi: 10.1016/j.ajem.2020.09.032
summary:
  title: Mucormycosis with orbital compartment syndrome in a patient with COVID-19 I describe a novel case of COVID-19 in a previously healthy 33-year-old female who presented for altered mental status and proptosis. I describe a novel case of COVID-19 in a previously healthy 33-year-old female who presented for altered mental status and proptosis. She was ultimately diagnosed with mucormycosis and orbital compartment syndrome, in addition to COVID-19. Herein I present a case of rhino-orbital-cerebral mucormycosis in a patient who presented to the Emergency Department with altered mental status, proptosis, and COVID-19 infection. The most common clinical presentation of mucormycosis is rhino-orbital-cerebral infection, believed to be secondary to inhalation of spores into the paranasal sinuses of a susceptible host [1] . Seventy percent of rhino-orbital-cerebral mucormycosis cases have been found to be in patients with diabetes mellitus, most of whom had also developed ketoacidosis at the time of presentation.

abstract:
  Abstract During the current pandemic of COVID-19, a myriad of manifestations and complications has emerged and are being reported on. We are discovering patients with COVID-19 are at increased risk of acute cardiac injury, arrythmias, thromboembolic complications (pulmonary embolism and acute stroke), and secondary infection to name a few. I describe a novel case of COVID-19 in a previously healthy 33-year-old female who presented for altered mental status and proptosis. She was ultimately diagnosed with mucormycosis and orbital compartment syndrome, in addition to COVID-19. Early identification of these high morbidity conditions is key to allow for optimal treatment and improved outcomes.


id: cord-316513-dbzj101e
author: Sen-Crowe, Brendon
date: 2020-07-04
txt: ./txt/cord-316513-dbzj101e.txt
cache: ./cache/cord-316513-dbzj101e.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720305969
doi: 10.1016/j.ajem.2020.07.003
abstract: nan
summary:
  title: Utilizing technology as a method of contact tracing and surveillance to minimize the risk of contracting COVID-19 infection A call for new methods of testing and surveillance on a large scale will be important if we hope to control the spread of SARS-CoV-2 infections. On example is the Oura ring (Ooura Health Ltd.''s, Oulu, Finland) which can detect physiologic changes and alert the possibility of infection. For example, one study at West Virginia Univeristy, Rockefeller Neuroscience Institute predicted symptoms 24 hours prior to onset based on physiologic changes detected by the Oura ring, and aim to achieve a 3-day forecast in the future. In addition, early detection and contact tracing has the potential to conserve hospital resources that have become scarce throughout the pandemic. CDC Diagnostic Test for COVID-19 WVU Rockefeller Neuroscience Institute and Oura Health unveil study to predict the outbreak of COVID-19 in healthcare professionals

title:
  Utilizing technology as a method of contact tracing and surveillance to minimize the risk of contracting COVID-19 infection


id: cord-317784-fl9zbgad
title: Propofol in COVID 19 — From basic science to clinical impact
author: Senthilkumaran, Subramanian
date: 2020-07-09
txt: ./txt/cord-317784-fl9zbgad.txt
cache: ./cache/cord-317784-fl9zbgad.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720306033?v=s5
doi: 10.1016/j.ajem.2020.07.011
abstract: nan
summary:
  However, recently [3] it was demonstrated that propofol infusion increases ACE2 mediated conversion of angiotensin II to angiotensin, which results in a fall in angiotensin II levels and an elevation of angiotensin 1 to7; and these exhibit protective effects of lungs by way of recovery of endothelial cell function via an up-regulation of ACE2-Ang -Mas axis, subsequent to phosphorylation of endothelial nitric oxide (NO) synthase to generate NO, and regulation of apoptosis-related protein such as bcl-2, caspase9. Propofol prevents human umbilical vein endothelial cell injury from ang II-induced apoptosis by activating the ACE2-(1-7)-Mas axis and eNOS phosphorylation Propofol stimulates nitric oxide release from cultured porcine aortic endothelial cells Effects of propofol on endothelial cells subjected to a peroxynitrite donor Effects of propofol on hemodynamic and inflammatory responses to endotoxemia in rats


id: cord-318188-baat9464
author: Park, Soo Hyun
date: 2020-03-31
txt: ./txt/cord-318188-baat9464.txt
cache: ./cache/cord-318188-baat9464.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720301960
doi: 10.1016/j.ajem.2020.03.054
summary:
  We investigated the protective effect and usefulness of loose-fitting powered air-purifying respirators (PAPRs) during chest compression. We measured the concentrations of ambient aerosol and particles inside the loose-fitting PAPR during chest compression, and this ratio was set as the simulated workplace protecting factor (SWPF). The purpose of this study was to investigate the protective effect of loose-fitting PAPRs during chest compressions. We measured the concentrations of ambient aerosol and particles inside the loose-fitting PAPR''s hood during chest compression, and this ratio was set as the simulated workplace protecting factor (SWPF). A previous simulation study showed that the N95 respirator failed to provide sufficient protection, with the fit factor falling below 100 in 73% of participants during chest compressions [7] . In this study, most participants (81%) did not think that the loose-fitting PAPR interfered with the ability to perform chest compression. In conclusion, the loose-fitting PAPRs provided sufficient respiratory protection and comfort during chest compression.

title:
  Are loose-fitting powered air-purifying respirators safe during chest compression? A simulation study

abstract:
  BACKGROUND: The application of appropriate personal protective equipment for respiratory protection to health care workers is a cornerstone for providing safe healthcare in emergency departments. We investigated the protective effect and usefulness of loose-fitting powered air-purifying respirators (PAPRs) during chest compression. METHODS: This was a single-center simulation study performed from May 2019 to July 2019 in a tertiary hospital. We measured the concentrations of ambient aerosol and particles inside the loose-fitting PAPR during chest compression, and this ratio was set as the simulated workplace protecting factor (SWPF). According to the National Institute for Occupational Safety and Health regulations, the assigned protection factor (APF) of loose-fitting PAPRs is 25. Thus, the loose-fitting PAPRs were assumed to have a protective effect when the SWPF were ≥ 250 (APF × 10). We measured the SWPF of PAPR in real time during chest compression and also investigated the problems encountered during its use. RESULTS: Ninety-one participants (median age 29 [interquartile range (IQR): 26–32] years; 74% female) completed the simulation. None of the participants failed with SWPF below 250 during three sessions of chest compression. The median (IQR) values of SWPF at three cycles were 17,063 (10,145-26,373), 15,683 (9477-32,394), and 16,960 (7695-27,279). There was no disconnection of equipment or mechanical failures during chest compression. In addition, most participants (83%) replied that they rarely or never experienced difficulty in verbal communication and felt that the loose-fitting PAPR was comfortable. CONCLUSIONS: The loose-fitting PAPRs provided sufficient respiratory protection without disturbances during chest compression.


id: cord-322297-euqmv6rw
author: Kim, Sung Hyun
date: 2018-11-24
txt: ./txt/cord-322297-euqmv6rw.txt
cache: ./cache/cord-322297-euqmv6rw.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675718309471
doi: 10.1016/j.ajem.2018.11.034
summary:
  The outcome was the daily number of people who visited the emergency departments in Seoul from 2015 to 2016 with a diagnostic code for psychiatric diseases (International Classification of Disease-1oth version, Mental and Behavioral Disease, F00-F99, including F00-F09 (Organic, including symptomatic, mental disorders), F10-F19 (Mental and behavioral disorders due to psychoactive substance use), F20-F29 (Schizophrenia, schizotypal and delusional disorders), F30-F39 (Mood [affective] disorders), F40-F48 (Neurotic, stress-related and somatoform disorders), F50-F59 (Behavioral syndromes associated with physiological disturbances and physical factors), F60-F69 (Disorders of adult personality and behavior), F70-F79 (Mental retardation), F80-F89 (Disorders of psychological development), F90-F98 (Behavioral and emotional disorders with onset usually occurring in childhood and adolescence), and F99-F99 (Unspecified mental disorder)). We found a significant association between the PM 2.5 concentration and emergency department visits for psychiatric diseases on lag 1 day in the adjusted models.

title:
  Association between ambient PM(2.5) and emergency department visits for psychiatric emergency diseases()

abstract:
  BACKGROUND: Whether or not short-term exposure to particulate matter <2.5 μm in diameter (PM(2.5)) increases the risk of psychiatric emergency diseases is unclear. METHODS: The study was performed in a metropolis from January 2015 to December 2016. The exposure was PM(2.5), and the confounders were weather (temperature and humidity) and other pollutants (PM(10), SO(2), CO, O(3), and NO(2)). The outcomes were emergency department (ED) visits with psychiatric disease codes (F00-F99 in ICD10 codes). General additive models were used for the statistical analysis to calculate the adjusted relative risks (ARRs) and 95% confidence intervals (95% CIs) for the daily number of ED visits with a lag of 1 to 3 days following a 10 μg/m(3) increase in PM(2.5). RESULTS: During the study period, a total of 67,561 ED visits for psychiatric diseases were identified and tested for association with PM(2.5). Daily ED visits for all psychiatric diseases were not associated with PM(2.5) in the model that was not adjusted for other pollutants. The ARR (95% CI) in the model adjusted for SO(2) was 1.011 (1.002–1.021) by 10 μg/m(3) of PM(2.5) on Lag 1 for all psychiatric diseases (F00-F99). The ARR (95% CI) in the model adjusted for O(3) was 1.015 (1.003–1.029) by 10 μg/m(3) of PM(2.5) on Lag 1 for F40-F49 (Neurotic, stress-related and somatoform disorders). CONCLUSION: An increase in PM(2.5) showed a significant association with an increase in ED visits for all psychiatric diseases (F00-F99) and for neurotic, stress-related and somatoform disorders (F40-F49) on lag day 1.


id: cord-322778-a411t2wg
author: Skalidis, Ioannis
date: 2020-07-28
txt: ./txt/cord-322778-a411t2wg.txt
cache: ./cache/cord-322778-a411t2wg.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.07.058
doi: 10.1016/j.ajem.2020.07.058
summary:
  We therefore conducted this retrospective study to evaluate the diagnostic performance of CT in patients presenting to ED with COVID-19 suspicion compared with both RT-PCR, which is currently used as a gold standard, and a clinical adjudication committee decision. After the completion of the study, the adjudication committee, blinded to the RT-PCR results, retrospectively reviewed the ED admission charts of all patients and graded the probability of COVID-19 by integrating data from several parts of the chart: the history section, the results of the clinical examination and the laboratory tests. After integrating the results of RT-PCR (integrating serial analyses if available) and the clinical follow-up in the referral hospital, their final consensus decision was considered as the reference diagnosis for COVID-19 infection. The study primary endpoints were the test diagnostic characteristics; specifically, sensitivity, specificity, positive and negative predictive values of CT first in comparison to RT-PCR as gold standard and, second, to the final adjudication committee decision.

title:
  Unenhanced computed tomography (CT) utility for triage at the emergency department during COVID-19 pandemic

abstract:
  BACKGROUND: Unenhanced chest computed tomography (CT) can assist in the diagnosis and classification of coronavirus disease 2019 (COVID-19), complementing to the reverse-transcription polymerase chain reaction (RT-PCR) tests; the performance of which has yet to be validated in emergency department (ED) setting. The study sought to evaluate the diagnostic performance of chest CT in the diagnosis and management of COVID-19 in ED. METHODS: This retrospective single-center study included 155 patients in ED who underwent both RT-PCR and chest CT for suspected COVID-19 from March 1st to April 1st, 2020. The clinical information, CT images and laboratory reports were reviewed and the performance of CT was assessed, using the RT-PCR as standard reference. Moreover, an adjudication committee retrospectively rated the probability of COVID-19 before and after the CT calculating the net reclassification improvement (NRI). Their final diagnosis was considered as reference. The proportion of patients with negative RT-PCR test that was directed to the referent hospital based on positive CT findings was also assessed. RESULTS: Among 155 patients, 42% had positive RT-PCR results, and 46% had positive CT findings. Chest CT showed a sensitivity of 84.6%, a specificity of 80.0% and a diagnostic accuracy of 81.9% in suggesting COVID-19 with RT-PCR as reference. Concurrently, corresponding values of 89.4%, 84.3% and 86.5% were retrieved with the adjudication committee diagnosis as reference. For the subgroup of patients with age > 65, specificity and sensitivity were 50% and 80.8%, respectively. In patients with negative RT-PCR results, 20% (18/90) had positive chest CT finding and 22% (4/18) of those were eventually considered as COVID-19 positive according to the adjudication committee. After CT, the estimated probability of COVID-19 changed in 10/104 (11%) patients with available data: 4 (4%) were downgraded, 6 (6%) upgraded. The NRI was 1.92% (NRI event −2.08% + NRI non-event 5.36%). No patient with negative RT-PCR but positive CT was eventually directed to hospital. CONCLUSION: Chest CT showed promising sensitivity for diagnosing COVID-19 across all patients' subgroups. However, CT did not modify the estimated probability of COVID-19 infection in a substantial proportion of patients and its utility as an emergency department triage tool warrants further analyses.


id: cord-322887-md446f9p
title: Cardiac injury and ARDS meta-analysis validity – Correspondence in response to Santoso et al.
author: Carver, Catherine
date: 2020-06-27
txt: ./txt/cord-322887-md446f9p.txt
cache: ./cache/cord-322887-md446f9p.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.06.028
doi: 10.1016/j.ajem.2020.06.028
abstract: nan
summary:
  This paper was of note to us because it included a meta-analysis on acute respiratory distress syndrome (ARDS) and cardiac injury, based on two papers -one by Shi (2) and another by Wu (3). On reading the paper by Wu, we have significant concerns about the inclusion of this study in Santoso''s meta-analysis as we believe it currently underpins an inaccurate conclusion that cardiac injury is not significantly associated with increased risk of ARDS in COVID-19 by Santoso. However, from what we currently have access to, it seems most likely that Santoso''s meta-analysis for ARDS has been based on composite endpoint data. Moreover, the conclusion of Santoso runs counter to Shi''s JAMA Cardiology paper, which was the other paper included in Santoso''s meta-analysis, which did report on purely ARDS cases and cardiac injury and did find a statistically significant association. Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: A meta-analysis


id: cord-330704-4piesfxu
title: Noninvasive ventilation for acute hypoxemic respiratory failure in patients with COVID-19
author: Avdeev, Sergey N.
date: 2020-10-01
txt: ./txt/cord-330704-4piesfxu.txt
cache: ./cache/cord-330704-4piesfxu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33067061/
doi: 10.1016/j.ajem.2020.09.075
summary:
  MATERIALS & METHODS: In this retrospective cohort study, patients with confirmed diagnosis of COVID-19 and AHRF receiving NIV in general wards were recruited from two university-affiliated hospitals. However, there were major concerns that HFNC or NIV may create risks for health care workers (HCWs) because of SARS-CoV-2 transmission via aerosols [6] while the data on the efficacy of noninvasive modalities in COVID-19-associated AHRF are still limited [6] [7] [8] . This study suggests that the use of NIV is feasible in acute hypoxemic respiratory failure in patients with COVID-19 outside intensive care unit and can be considered as an effective means to improve oxygenation in patients not responding to conventional oxygen therapy. In summary, we have shown that NIV is feasible in patients with COVID-19 with acute hypoxemic respiratory failure outside the intensive care unit, and it can be considered as a valuable option for the management of AHRF in these patients.

abstract:
  AIM: Noninvasive ventilation (NIV) is known to reduce intubation in patients with acute hypoxemic respiratory failure (AHRF) [1]. We aimed to assess the outcomes of NIV application in COVID-19 patients with AHRF. MATERIALS & METHODS: In this retrospective cohort study, patients with confirmed diagnosis of COVID-19 and AHRF receiving NIV in general wards were recruited from two university-affiliated hospitals. Demographic, clinical, and laboratory data were recorded at admission. The failure of NIV was defined as intubation or death during the hospital stay. RESULTS: Between April 8 and June 10, 2020, 61 patients were enrolled into the final cohort. NIV was successful in 44 out of 61 patients (72.1%), 17 patients who failed NIV therapy were intubated, and among them 15 died. Overall mortality rate was 24.6%. Patients who failed NIV were older, and had higher respiratory rate, PaCO(2), D-dimer levels before NIV and higher minute ventilation and ventilatory ratio on the 1-st day of NIV. No healthcare workers were infected with SARS-CoV-2 during the study period. CONCLUSIONS: NIV is feasible in patients with COVID-19 and AHRF outside the intensive care unit, and it can be considered as a valuable option for the management of AHRF in these patients.


id: cord-333176-6v7ficfk
author: Snell, Jonathan
date: 2020-09-30
txt: ./txt/cord-333176-6v7ficfk.txt
cache: ./cache/cord-333176-6v7ficfk.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33036853/
doi: 10.1016/j.ajem.2020.09.072
summary:
  SARS-CoV-2 infection is well-documented to cause severe pneumonia, however, thrombosis and thrombotic complications, such as ischemic stroke, have also been documented in a variety of patient demographics. 5,6 This is likely due to the presence of asymptomatic or mildly symptomatic transmission of SARS-CoV-2, and its current prevalence in the human population supports the infective potential of this novel coronavirus. 37 Imbalance of the interactions between ACE2 and the RAS axis may also contribute to the thromboembolic events seen in SARS-CoV-2 infection. 44, 45 Ischemic stroke due to occlusion of large arteries has been a documented complication of SARS-CoV infection in patients with minimal to no risk factors. 46 SARS-CoV-2 infection seems to also increase risk of developing ischemic stroke, among other neurological consequences. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Ischemic Stroke

title:
  SARS-CoV-2 infection and its association with thrombosis and ischemic stroke: A review COVID-19, thrombosis, and ischemic stroke

abstract:
  This review of current literature provides background to the COVID-19 pandemic, as well as an examination of potential pathophysiologic mechanisms behind development of thrombosis and ischemic stroke related to COVID-19. SARS-CoV-2 infection is well-documented to cause severe pneumonia, however, thrombosis and thrombotic complications, such as ischemic stroke, have also been documented in a variety of patient demographics. SARS-CoV-2 infection is known to cause a significant inflammatory response, as well as invasion of vascular endothelial cells, resulting in endothelial dysfunction. These factors, coupled with imbalance of ACE2 and RAS axis interactions, have been shown to create a prothrombotic environment, favoring thromboembolic events. Ischemic stroke is a severe complication of COVID-19 and may be a presenting symptom in some patients.


id: cord-333797-six8wzxz
title: Newly diagnosed diabetes and diabetic ketoacidosis precipitated by COVID-19 infection
author: Heaney, Ashley I.
date: 2020-06-06
txt: ./txt/cord-333797-six8wzxz.txt
cache: ./cache/cord-333797-six8wzxz.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720304885?v=s5
doi: 10.1016/j.ajem.2020.05.114
abstract: nan
summary:
  J o u r n a l P r e -p r o o f COVID-19 infections and diabetes have been linked since early reports identified patients with diabetes mellitus having worse clinical outcomes. 2 However, there has only been one case reported on COVID-19 infection precipitating a new diagnosis of diabetes mellitus type II. Testing in the ED revealed hyperglycemia, anion gap metabolic acidosis and ketonuria which confirmed the patient to be in diabetic ketoacidosis (DKA). We report a case of DKA precipitated by Covid-19 in a patient with newly diagnosed diabetes mellitus. There has been one prior case report of DKA and new onset diabetes mellitus in the setting of COVID-19 infection. Patients with elevated blood sugar and no history of diabetes should be evaluated for the possibility of new onset diabetes mellitus and DKA, especially in the setting of concomitant COVID-19 infection. Diabetic ketoacidosis precipitated by Covid-19 in a patient with newly diagnosed diabetes mellitus


id: cord-333827-zpdnzwle
author: Zhao, Jinqiu
date: 2020-08-17
txt: ./txt/cord-333827-zpdnzwle.txt
cache: ./cache/cord-333827-zpdnzwle.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33131974/
doi: 10.1016/j.ajem.2020.08.039
summary:
  title: Potential risk factors for case fatality rate of novel coronavirus (COVID-19) in China: A pooled analysis of individual patient data This study aims to perform the meta-analysis of risk factors for the case fatality rate (CFR) of the 2019 novel coronavirus (COVID-19). After comparing the patients between fatal cases and non-fatal cases, several important factors are found to significantly increase the CFR in patients with COVID-19, and include the age ranging 60–70 (OR = 1.85; 95% CI = 1.62 to 2.11; P < .00001) and especially≥70 (OR = 8.45; 95% CI = 7.47 to 9.55; P < .00001), sex of male (OR = 1.88; 95% CI = 1.30 to 2.73; P = .0008), occupation of retirees (OR = 4.27; 95% CI = 2.50 to 7.28; P < .00001), and severe cases (OR = 691.76; 95% CI = 4.82 to 99,265.63; P = .01).

title:
  Potential risk factors for case fatality rate of novel coronavirus (COVID-19) in China: A pooled analysis of individual patient data

abstract:
  BACKGROUND AND OBJECTIVE: Since the first case of the pneumonia caused by 2019 novel coronavirus (COVID-19) is found in Wuhan, there have been more than 70,000 cases reported in China. This study aims to perform the meta-analysis of risk factors for the case fatality rate (CFR) of the 2019 novel coronavirus (COVID-19). DESIGN AND METHODS: We have searched PubMed, Google scholar and medRxiv for the cohort studies involving risk factors for the CFR of COVID-19. This meta-analysis compares the risk factors of CFR between fatal patients and non-fatal patients. RESULTS: Two cohort studies are included in this study. After comparing the patients between fatal cases and non-fatal cases, several important factors are found to significantly increase the CFR in patients with COVID-19, and include the age ranging 60–70 (OR = 1.85; 95% CI = 1.62 to 2.11; P < .00001) and especially≥70 (OR = 8.45; 95% CI = 7.47 to 9.55; P < .00001), sex of male (OR = 1.88; 95% CI = 1.30 to 2.73; P = .0008), occupation of retirees (OR = 4.27; 95% CI = 2.50 to 7.28; P < .00001), and severe cases (OR = 691.76; 95% CI = 4.82 to 99,265.63; P = .01). As the advancement of early diagnosis and treatment, the CFR after January 21 (or 22), 2020 is substantially decreased in COVID-19 than before (OR = 0.21; 95% CI = 0.19 to 0.24; P < .00001). CONCLUSIONS: Several factors are confirmed to significantly improve the CFR in patients with COVID-19, which is very important for the treatment and good prognosis of these patients.


id: cord-333872-shhugvx0
title: The conundrum of rising Covid19 infection among health care workers: An emerging paradigm
author: Kumar, Jitendra
date: 2020-07-04
txt: ./txt/cord-333872-shhugvx0.txt
cache: ./cache/cord-333872-shhugvx0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.07.001
doi: 10.1016/j.ajem.2020.07.001
abstract: nan
summary:
  title: The conundrum of rising Covid19 infection among health care workers: An emerging paradigm Such asymptomatic infected HCWs can transmit infection unknowingly to the patients and other HCWs. At one of the London hospital, sample for RT-PCR testing for covid19 taken from asymptomatic and healthy HCWs at multiple point of time. In a total number of 1,479 health care worker''s sample, 1.1% to 7.1% (at different point of time) were found positive for Covid19 [9] . COVID-19 and the Risk to Health Care Workers: A Case Report Death from Covid-19 of 23 Health Care Workers in China COVID-2019) Infection Among Health Care Workers and Implications for Prevention Measures in a Tertiary Hospital in Wuhan, China Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19 COVID-19: PCR screening of asymptomatic health-care workers at London hospital COVID-19: the case for health-care worker screening to prevent hospital transmission


id: cord-334416-4tslee57
title: Social distancing during the COVID-19 pandemic: Staying home save lives
author: Sen-Crowe, Brendon
date: 2020-04-02
txt: ./txt/cord-334416-4tslee57.txt
cache: ./cache/cord-334416-4tslee57.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.03.063
doi: 10.1016/j.ajem.2020.03.063
abstract: nan
summary:
  title: Social distancing during the COVID-19 pandemic: Staying home save lives With the incidence of COVID-19 increasing, it may only be time before the healthcare system becomes overwhelmed and forces physicians to triage treatment among critically ill patients. Social distancing is the practice of increasing the space between people in order to decrease the chance of spreading illness. Nationwide measures taken to minimize contact with potentially infected individuals include cancelling travel from China and Europe [10] . Social distancing has the potential to slow the rate of infection and reduce the peak of incidence, and then fewer critically ill patients would need care on any one day. Delaying the peak incidence to the summer holds potential for healthcare facilities to dedicate more resources to those ill with COVID-19. Social distancing is a realistic solution that all individuals can take part in to reduce the risk of infection while increasing available resources to critically ill patients, during this pandemic.


id: cord-334705-vclkuink
title: Is social distancing keeping patients from the ED?()
author: Sokas, Claire M.
date: 2020-07-16
txt: ./txt/cord-334705-vclkuink.txt
cache: ./cache/cord-334705-vclkuink.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32712237/
doi: 10.1016/j.ajem.2020.07.025
abstract: nan
summary:
  We sought to characterize perceptions of public health recommendations and explore the decision to seek medical care for common symptoms. To understand the impact on individual medical decision making, we asked participants to describe their approach to care for common symptoms before and during the pandemic, classifying behaviors according to escalation of care: 1) stay home and see if it gets better ("wait and see"); 2) call my doctor; 3) present to an emergency department (ED), urgent care (UC), or call 911. Most participants worry about their own and their family''s health, their ability to obtain medical care, and prolonged, severe illness if they contracted COVID-19. In the weeks following the initiation of public health recommendations, public perceptions were overall favorable and participants reported adherence to mandates in the setting of worry about personal health and reluctance to seek emergency care for COVID-19-related symptoms.


id: cord-336005-nm34bfsl
title: Abdominal pain in a patient with COVID-19 infection: A case of multiple thromboemboli
author: Mahan, Keenan
date: 2020-05-26
txt: ./txt/cord-336005-nm34bfsl.txt
cache: ./cache/cord-336005-nm34bfsl.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.05.054
doi: 10.1016/j.ajem.2020.05.054
summary:
  Although there appears to be an increased incidence of thromboembolic disease in patients with COVID-19 infection, recommendations regarding anticoagulation are lacking. We present the case of a 61-year-old woman with clinically significant venous and arterial thromboemboli in the setting of COVID-19 infection requiring tissue plasminogen activator (tPA). In addition, there is no clear guidance as to whether anticoagulation should be initiated for emergency department (ED) patients with presumed COVID-19 and elevated D-dimer. The patient''s CXR demonstrated bilateral peripheral opacities consistent with COVID-19 infection ( Figure 1 ) and her D-dimer returned elevated at 8,264ng/mL. Based on the patient''s hypoxemia, persistent tachycardia, and marked D-dimer elevation, we ordered a CT pulmonary angiogram which revealed multiple filling defects in the thoracic and abdominal aorta representing thromboemboli as well as diffuse bilateral ground glass opacities in the lungs (Figure 2) . Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

abstract:
  The novel coronavirus SARS-CoV-2 (COVID-19) pandemic has created diagnostic uncertainty with regards to distinguishing this infection from pulmonary embolism (PE). Although there appears to be an increased incidence of thromboembolic disease in patients with COVID-19 infection, recommendations regarding anticoagulation are lacking. We present the case of a 61-year-old woman with clinically significant venous and arterial thromboemboli in the setting of COVID-19 infection requiring tissue plasminogen activator (tPA).


id: cord-338814-r9ym1h3m
title: Using social media for telemedicine during the COVID-19 epidemic
author: Li, Yan
date: 2020-08-17
txt: ./txt/cord-338814-r9ym1h3m.txt
cache: ./cache/cord-338814-r9ym1h3m.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720306902?v=s5
doi: 10.1016/j.ajem.2020.08.007
abstract: nan
summary:
  title: Using social media for telemedicine during the COVID-19 epidemic As the first country to discover COVID-19, China has taken strict precautionary measures. The Chinese government strives to raise public awareness of prevention and protection by providing daily monitoring and updates on websites and social media [4] . Social media played an essential role during the COVID-19 epidemic. The government should support and encourage medical personnel to participate in science education on social media. Because the strict quarantine measures make it difficult for patients to see a doctor, it is urgent to establish an appropriate telemedicine and appointment system. The emergence of the virus pandemic will make the public health system and community health service institutions face special and lasting epidemic prevention situation. An investigation of transmission control measur es during the first 50 days of the COVID-19 epidemic in China Access to lifesaving medical resources for African countries: COVID-19 testing and response, ethics, and politics


id: cord-338855-1hfj8qj9
title: Traditional chinese medicine and COVID-19: should emergency practitioners use it?
author: Dr Adylle Varon, L.
date: 2020-07-03
txt: ./txt/cord-338855-1hfj8qj9.txt
cache: ./cache/cord-338855-1hfj8qj9.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720305660
doi: 10.1016/j.ajem.2020.06.076
abstract: nan
summary:
  title: Traditional chinese medicine and COVID-19: should emergency practitioners use it? Classical herbal formulas, such as Yu Ping Feng San, Sang Ju Yin and Yin Qiao San, were highly sought out for prevention and treatment of In this issue of The American Journal of Emergency Medicine, Sun and coworkers present an adept metanalysis supporting the clinical efficacy and safety of using TCM herbal prescriptions for the treatment of COVID-19. For example, we are concerned that the depicted results reflect a steady state of illness, whereas in TCM, measures can vary depending on which herbal formulations are administered, and the stage or rate of infection in each patient. Clinical features of patients infected with 2019 novel coronavirus in Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Traditional Chinese Medicine treatment of COVID-19 The role of Chinese Medicine in COVID-19 pneumonia: A systematic review and meta-analysis


id: cord-338863-0jlp9lb4
title: COVID-19: Optimizing healthcare provider wellness and posttraumatic growth
author: Huecker, Martin
date: 2020-08-27
txt: ./txt/cord-338863-0jlp9lb4.txt
cache: ./cache/cord-338863-0jlp9lb4.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720307592
doi: 10.1016/j.ajem.2020.08.066
abstract: nan
summary:
  A systematic review found that 53% of individuals who endure trauma experienced PTG (4), enjoying greater life satisfaction, happiness, psychological, emotional, and even physical wellbeing (5) . While COVID-19 has already resulted in negative outcomes for HCWs, individuals can still strive for greater appreciation of life, improved self-esteem, and positive approaches to daily responsibilities (16) . Mindfulness interventions facilitate self-awareness and presence, with studies repeatedly demonstrating positive effects of meditation on sleep and other mental and physical health outcomes (30) . Effect of Positive Psychological Intervention on Posttraumatic Growth among Primary Healthcare Workers in China: A Preliminary Prospective Study Psychological impact of the coronavirus disease 2019 (COVID-19) outbreak on healthcare workers in China. Preserving mental health and resilience in frontline healthcare workers during COVID-19. Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic


id: cord-338922-wew3hety
title: Impact of COVID-19 on professional and personal responsibilities of Massachusetts physicians
author: Miller, Kelsey A.
date: 2020-08-27
txt: ./txt/cord-338922-wew3hety.txt
cache: ./cache/cord-338922-wew3hety.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33041148/
doi: 10.1016/j.ajem.2020.08.051
summary:
  title: Impact of COVID-19 on professional and personal responsibilities of Massachusetts physicians 4 This study examines changes in the professional status and personal responsibilities of physicians related to the COVID-19 pandemic and the stay-at-home advisories. They were selected to characterize effects of a single state''s stay-at-home advisory among physicians with different clinical impacts from COVID-19. More men (28.9%) reported increased hours spent on professional responsibilities compared to women (15.9%, p=0.02). We report an early perspective of the personal and professional impacts of the COVID-19 pandemic on EM and pediatric physicians. Our study supports concerns for increased professional gender disparities during the pandemic stayat-home advisory, 2 including fewer scientific publication submissions by women compared to men. 7 In our study, female physicians invested more time in child and household care and less time on selfcare and professional responsibilities, compared to men.

abstract:
  • The professional impact is more uniform but the personal impact varies by specialty & demographics. • Physicians report minimal change in employment status but half report a decrease in income. • Emergency Medicine physicians have experienced quarantining from family at a higher frequency. • Female physicians report spending more hours on child and household care and less time on selfcare.


id: cord-339864-rv5zw972
title: Non-evidenced based treatment: An unintended cause of morbidity and mortality related to COVID-19
author: Reihani, Hamidreza
date: 2020-05-06
txt: ./txt/cord-339864-rv5zw972.txt
cache: ./cache/cord-339864-rv5zw972.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S073567572030317X
doi: 10.1016/j.ajem.2020.05.001
abstract: nan
summary:
  In Iran, social media accounts circulated false stories of curing COVID-19 by drinking high-proof alcohol, poisoning over 2,000 people due to the inadvertent consumption of methanol with bleach to hide its color [5] . In Madagascar, President Andry Rojoelina launched an herbal coronavirus "cure" produced from the artemisia plant, yet the WHO stated that the tonic is not evidence-based and is potentially toxic [9] . These herbal formulas contain a combination of many herbs and the exact proprietary mixture is not available, posing a major health risk to patients due to their potential toxicity, contamination, or adulteration [10] . The implications of medicating with herbal-based formulas is serious and dangerous because there is no scientific evidence suggesting that these alternative remedies can prevent or cure COVID-19. The spread of nonevidence-based COVID-19 treatments or cures will undoubtedly worsen the magnitude of the pandemic.


id: cord-341060-otvoo99j
title: Thrombolysis in severe COVID-19 pneumonia with massive pulmonary embolism
author: Alharthy, Abdulrahman
date: 2020-07-30
txt: ./txt/cord-341060-otvoo99j.txt
cache: ./cache/cord-341060-otvoo99j.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S073567572030663X
doi: 10.1016/j.ajem.2020.07.068
summary:
  Keywords: COVID-19, massive pulmonary embolism, thrombolysis, acute respiratory distress syndrome, point-of-care ultrasound. Recently, a preliminary analysis of a large US cohort of critically ill patients with severe novel SARS-CoV-2 disease (COVID-19) has suggested the benefit of systemic anticoagulation on their J o u r n a l P r e -p r o o f anticoagulation in patients with severe COVID-19, and Padua prediction score ≥4 or D-dimer>3.0 μg/mL has been previously suggested due to the increased occurrence of pulmonary embolism (PE) [3, 4] . Point-of-care-cardiac ultrasound modified four-chamber view (day-2) revealing a large thrombus in a dysfunctional right heart "en-route" to the pulmonary circulation in our critically ill COVID-19 patient. Point-of-care-cardiac ultrasound modified four-chamber view (day-5) depicting no thrombi in the right heart, and normalization of right ventricular function in our critically ill COVID-19 patient. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

abstract:
  OBJECTIVE: No guidelines exist for the management of massive pulmonary embolism (PE) in COVID-19. We present a COVID-19 patient with refractory acute respiratory syndrome (ARDS), and life-threatening PE who underwent successful thrombolysis. CASE PRESENTATION: A previously healthy 47 year old male was admitted to our hospital due to severe COVID-19 pneumonia [confirmed by Real-Time-Polymerase-Chain-Reaction (RT-PCR)]. He had rapidly evolving ARDS [partial arterial pressure of oxygen to fractional inspired concentration of oxygen ratio: 175], and sepsis. Laboratory results showed lymphocytopenia, and increased D-dimer levels (7.7 μg/ml; normal: 0–0.5 μg/ml). The patient was treated in the intensive care unit. On day-1, ARDS-net/prone positioning ventilation, and empiric anti-COVID treatment integrating prophylactic anticoagulation was administered. On hospital day-2, the patient developed shock with worsening oxygenation. Point-of-care-ultrasound depicted a large thrombus migrating from the right atrium to the pulmonary circulation. Intravenous alteplase (100 mg over 2 h) was administered as rescue therapy. The patient made an uneventful recovery, and was discharged to home isolation (day-20) on oral rivaroxaban. CONCLUSION: Thrombolysis may have a critical therapeutic role for massive PE in COVID-19; however the risk of potential bleeding should not be underestimated. Point-of-care ultrasound has a pivotal role in the management of refractory ARDS in COVID-19.


id: cord-341527-03rh966o
title: Dexmedetomidine and worsening hypoxemia in the setting of COVID-19: A case report
author: Stockton, John
date: 2020-05-27
txt: ./txt/cord-341527-03rh966o.txt
cache: ./cache/cord-341527-03rh966o.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32475761/
doi: 10.1016/j.ajem.2020.05.066
summary:
  Here, we report a case of dexmedetomidine use in the setting of worsening hypoxemia, whereby oxygenation improved and intubation was avoided. Well known pharmacologic properties of the drug, namely the lack of respiratory depression and its anti-delirium effects, as well as other possible physiologic effects, suggest potential benefit for patients being managed with a delayed intubation approach. If dexmedetomidine can improve compliance with non-invasive oxygen support (the current recommended first-line therapy) while promoting better oxygenation, it may also decrease the need for mechanical ventilation and thus improve mortality. While early intubation was the initial recommended strategy for COVID-19 hypoxemia, a large case series in the US as well as data coming out of Britain, China, and Italy suggests a high mortality for patients requiring invasive ventilation [2] . In this case, we believe dexmedetomidine helped one patient avoid mechanical ventilation by improving compliance with non-invasive ventilation and promoting better oxygenation.

abstract:
  Emergency department management of hypoxemia in the setting of COVID-19 is riddled with uncertainty. The lack of high-quality research has translated to an absence of clarity at the bedside. With disease spread outpacing treatment consensus, provider discretion has taken on a heightened role. Here, we report a case of dexmedetomidine use in the setting of worsening hypoxemia, whereby oxygenation improved and intubation was avoided. Well known pharmacologic properties of the drug, namely the lack of respiratory depression and its anti-delirium effects, as well as other possible physiologic effects, suggest potential benefit for patients being managed with a delayed intubation approach. If dexmedetomidine can improve compliance with non-invasive oxygen support (the current recommended first-line therapy) while promoting better oxygenation, it may also decrease the need for mechanical ventilation and thus improve mortality.


id: cord-344120-7t5ce2hb
title: SARS-CoV-2 pharmacologic therapies and their safety/effectiveness according to level of evidence
author: Baroutjian, Amanda
date: 2020-09-01
txt: ./txt/cord-344120-7t5ce2hb.txt
cache: ./cache/cord-344120-7t5ce2hb.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720307853
doi: 10.1016/j.ajem.2020.08.091
summary:
  CONCLUSION: According to level 1 evidence reviewed here, the most effective SARS-Co-V-2 pharmacologic treatments include remdesivir for mild to severe disease, and a triple regimen therapy consisting of lopinavir-ritonavir, ribavirin and interferon beta-1b for mild to moderate disease. 20 Another randomized controlled open-label trial in 199 hospitalized patients with confirmed SARS-CoV-2 with severe COVID-19 was done to compare the clinical effectiveness of lopinavir-ritonavir to standard care alone. According to the level 1 evidence reviewed here, the most effective treatments against SARS-CoV-2, measured by time to negative RT-PCR and time to clinical improvement, are remdesivir therapy and a triple medication regimen (lopinavir-ritonavir, ribavirin, and interferon beta-1b). First, in patients with severe COVID-19, treatment with lopinavir-ritonavir showed no significant difference in time to clinical improvement, mortality at day 28, or detectable viral load compared to standard care alone.

abstract:
  INTRODUCTION: There is a pressing need for COVID-19 transmission control and effective treatments. We aim to evaluate the safety and effectiveness of SARS-CoV-2 pharmacologic therapies as of August 2, 2020 according to study level of evidence. METHODS: PubMed, ScienceDirect, Cochrane Library, JAMA Network and PNAS were searched. The following keywords were used: ((COVID-19) OR (SARS-CoV-2)) AND ((((((therapeutics) OR (treatment)) OR (vaccine)) OR (hydroxychloroquine)) OR (antiviral)) OR (prognosis)). Results included peer-reviewed studies published in English. RESULTS: 15 peer-reviewed articles met study inclusion criteria, of which 14 were RCTs and one was a systematic review with meta-analysis. The following pharmacologic therapies were evaluated: chloroquine (CQ), hydroxychloroquine (HCQ), antivirals therapies, plasma therapy, anti-inflammatories, and a vaccine. CONCLUSION: According to level 1 evidence reviewed here, the most effective SARS-Co-V-2 pharmacologic treatments include remdesivir for mild to severe disease, and a triple regimen therapy consisting of lopinavir-ritonavir, ribavirin and interferon beta-1b for mild to moderate disease. Also, dexamethasone significantly reduced mortality in those requiring respiratory support. However, there is still a great need for detailed level 1 evidence on pharmacologic therapies.


id: cord-344136-k5gh0s6y
author: Ouyang, Lichen
date: 2020-09-02
txt: ./txt/cord-344136-k5gh0s6y.txt
cache: ./cache/cord-344136-k5gh0s6y.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33046323/
doi: 10.1016/j.ajem.2020.08.089
summary:
  RESULTS: In 41 studies with 10,335 COVID-19 patients, the serum creatinine (sCr) in severe cases was much higher than that in non-severe cases (SMD = 0.34, 95% CI: 0.29–0.39), with a similar trend for blood urea nitrogen (BUN) (SMD = 0.66, 95%CI: 0.51–0.81), hematuria (OR = 1.59, 95% CI: 1.15–2.19), and proteinuria (OR = 2.92, 95% CI: 1.58–5.38). Pooled analysis of four studies among 792 COVID-19 patients revealed that the incidence of AKI was statistically higher in non-survival group (30.72%) compared with survival group Our meta-analysis including 14094 subjects from 52 studies explored the potential relationship between renal impairment as well as AKI and the clinical outcome J o u r n a l P r e -p r o o f Journal Pre-proof (severity and mortality) of COVID-19 patients. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study Clinical characteristics of patients with 2019 coronavirus disease in a non-Wuhan area of Hubei Province, China: a retrospective study

title:
  Association of acute kidney injury with the severity and mortality of SARS-CoV-2 infection: A meta-analysis

abstract:
  BACKGROUND: we aimed to explore the relationship of acute kidney injury (AKI) with the severity and mortality of coronavirus disease 2019 (COVID-19). METHODS: A systematic literature search was conducted in PubMed, EMBASE, Scopus, Web of Science, MedRxiv Database. We compared the laboratory indicators of renal impairment and incidences of AKI in the severe versus non-severe cases, and survival versus non-survival cases, respectively. RESULTS: In 41 studies with 10,335 COVID-19 patients, the serum creatinine (sCr) in severe cases was much higher than that in non-severe cases (SMD = 0.34, 95% CI: 0.29–0.39), with a similar trend for blood urea nitrogen (BUN) (SMD = 0.66, 95%CI: 0.51–0.81), hematuria (OR = 1.59, 95% CI: 1.15–2.19), and proteinuria (OR = 2.92, 95% CI: 1.58–5.38). The estimated glomerular filtration rate decreased significantly in severe cases compared with non-severe cases (SMD = -0.45, 95% CI: −0.67–0.23). Moreover, the pooled OR of continuous renal replacement therapy (CRRT) and AKI prevalence for severe vs. non-severe cases was 12.99 (95%CI: 4.03–41.89) and 13.16 (95%CI: 10.16–17.05), respectively. Additionally, 11 studies with 3759 COVID-19 patients were included for analysis of disease mortality. The results showed the levels of sCr and BUN in non-survival cases remarkably elevated compared with survival patients, respectively (SMD = 0.97, SMD = 1.49). The pooled OR of CRRT and AKI prevalence for non-survival vs. survival cases was 31.51 (95%CI: 6.55–151.59) and 77.48 (95%CI: 24.52–244.85), respectively. CONCLUSIONS: AKI is closely related with severity and mortality of COVID-19, which gives awareness for doctors to pay more attention for risk screening, early identification and timely treatment of AKI.


id: cord-344154-j5jjl0ok
title: MAGraine: Magnesium compared to conventional therapy for treatment of migraines
author: Kandil, Manar
date: 2020-09-14
txt: ./txt/cord-344154-j5jjl0ok.txt
cache: ./cache/cord-344154-j5jjl0ok.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33041146/
doi: 10.1016/j.ajem.2020.09.033
summary:
  This study was a single-center, prospective, double-blinded, randomized-controlled, three-armed trial comparing magnesium, metoclopramide, and prochlorperazine for the treatment of migraine. 15 Secondary endpoints included change in pain score from baseline to 60 minutes and 120 minutes after initiation of infusion (as defined on a 11-point NRS), ED length of stay, and J o u r n a l P r e -p r o o f Journal Pre-proof necessity for rescue analgesia at any time following the study drug administration. No statistically significant differences in change in pain scores were found between all three treatment arms; however, a post hoc noninferiority analysis revealed that when compared to prochlorperazine and metoclopramide, IV magnesium was non-inferior ( figure 3) . The results of the MAGraine study demonstrated that IV magnesium sulfate, metoclopramide, and prochlorperazine were effective in decreasing pain scores for migraines at 30, 60, and 120 minutes, however one agent was not superior to the rest.

abstract:
  Due to the healthcare burden associated with migraines, prompt and effective treatment is vital to improve patient outcomes and ED workflow. This was a prospective, randomized, double-blind trial. Adults who presented to the ED with a diagnosis of migraine from August of 2019 to March of 2020 were included. Pregnant patients, or with renal impairment were excluded. Patients were randomized to receive intravenous magnesium, prochlorperazine, or metoclopramide. The primary outcome was change in pain from baseline on a numeric rating scale (NRS) evaluated at 30 min after initiation of infusion of study drug. Secondary outcomes included NRS at 60 and 120 min, ED length of stay, necessity for rescue analgesia, and adverse effects. A total of 157 patients were analyzed in this study. Sixty-one patients received magnesium, 52 received prochlorperazine, and 44 received metoclopramide. Most patients were white females, and the median age was 36 years. Hypertension and migraines were the most common comorbidities, with a third of the patients reporting an aura. There was a median decrease in NRS at 30 min of three points across all three treatment arms. The median decrease in NRS (IQR) at 60 min was −4 (2–6) in the magnesium group, −3 (2–5) in the metoclopramide group, and − 4.5 (2–7) in the prochlorperazine group (p = 0.27). There were no statistically significant differences in ED length of stay, rescue analgesia, or adverse effects. Reported adverse effects were dizziness, anxiety, and akathisia. No significant difference was observed in NRS at 30 min between magnesium, metoclopramide and prochlorperazine.


id: cord-345510-togrmvlk
author: Kinney, Brad
date: 2020-05-27
txt: ./txt/cord-345510-togrmvlk.txt
cache: ./cache/cord-345510-togrmvlk.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S073567572030437X
doi: 10.1016/j.ajem.2020.05.080
summary:
  title: Rapid outdoor non-compression intubation (RONCI) of cardiac arrests to mitigate COVID-19 exposure to emergency department staff The COVID-19 pandemic has introduced numerous challenges for Health Care Professionals including exposing Emergency Department (ED) staff to the SARS-CoV-2 virus during Cardiopulmonary Resuscitation (CPR). We propose a novel technique for rapid outdoor non-compression intubation (RONCI) of cardiac arrest patients while en route from the ambulance bay to the resuscitation bay to further decrease the risk of viral aerosolization. 5 We present a case of an outdoor non-compression intubation of a patient in cardiac arrest to minimize COVID-19 exposure to staff while still providing standard Advanced Cardiac Life Support (ACLS). Non-compression intubation is suggested by ED resuscitation experts and the American Heart Association (AHA) to minimize COVID-19 exposure to staff. 5 The AHA recommends that the "provider…with the best chance of first-pass success" should perform the intubations in suspected COVID-19 infected patients in cardiac arrest.

title:
  Rapid outdoor non-compression intubation (RONCI) of cardiac arrests to mitigate COVID-19 exposure to emergency department staff

abstract:
  The COVID-19 pandemic has introduced numerous challenges for Health Care Professionals including exposing Emergency Department (ED) staff to the SARS-CoV-2 virus during Cardiopulmonary Resuscitation (CPR). Recent guidelines from the American Heart Association (AHA) prioritize early intubation with viral filter placement to minimize hospital staff exposure. We propose a novel technique for rapid outdoor non-compression intubation (RONCI) of cardiac arrest patients while en route from the ambulance bay to the resuscitation bay to further decrease the risk of viral aerosolization.


id: cord-349355-k48s9sum
title: Spontaneous pneumomediastinum in a male adult with COVID-19 pneumonia
author: Janssen, Joris
date: 2020-07-30
txt: ./txt/cord-349355-k48s9sum.txt
cache: ./cache/cord-349355-k48s9sum.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720306616?v=s5
doi: 10.1016/j.ajem.2020.07.066
summary:
  Here we report a case of a 52 year old male who presented with a spontaneous pneumomediastinum in COVID-19 pneumonia, followed by a severe course of disease. Here we present a case of spontaneous pneumomediastinum in COVID-19 pneumonia, and discuss the possible mechanism underlying this association as well as clinical implications. Furthermore, a recent case series described three cases of COVID-19 pneumonia that were complicated by spontaneous pneumomediastinum and pneumothorax, all of which were followed by a severe course of disease with fatal outcome [13] . J o u r n a l P r e -p r o o f Therefore, further research is warranted to assess whether spontaneous pneumomediastinum is an indicator of disease severity in COVID-19 pneumonia. Spontaneous pneumomediastinum is a rare complication of COVID-19 pneumonia and was associated with a severe course of disease in our patient. Future studies are warranted to assess whether spontaneous pneumomediastinum is an indicator of disease severity in COVID-19 pneumonia.

abstract:
  Spontaneous pneumomediastinum is a rare complication of viral pneumonia. Here we report a case of a 52 year old male who presented with a spontaneous pneumomediastinum in COVID-19 pneumonia, followed by a severe course of disease. We discuss the pathophysiological mechanisms underlying this association as well as its possible clinical implications as a marker of disease severity in COVID-19.


id: cord-349561-4mkiwg9k
title: Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians
author: Porta, Alessandra Della
date: 2020-07-19
txt: ./txt/cord-349561-4mkiwg9k.txt
cache: ./cache/cord-349561-4mkiwg9k.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720306252?v=s5
doi: 10.1016/j.ajem.2020.07.030
summary:
  BACKGROUND: Acute chloroquine and hydroxychloroquine toxicity is characterized by a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias and is associated with significant morbidity and mortality. Following the United States Food and Drug Administration emergency use authorization for chloroquine and hydroxychloroquine in the treatment of SARS-CoV-2, many additional clinical trials with randomization, blinding, and larger sample sizes were initiated to determine the benefit and risks. 59 While unlikely to occur in acute overdose, cardiomyopathy is described in case reports of patients presenting with chronic chloroquine and/or hydroxychloroquine toxicity. 59 While unlikely to occur in acute overdose, cardiomyopathy is described in case reports of patients presenting with chronic chloroquine and/or hydroxychloroquine toxicity. Although case report literature describes the finding in chloroquine and hydroxychloroquine use, the largest chart review to date examining these drugs in patients with G6PD noted no occurrence of hemolysis.

abstract:
  BACKGROUND: Acute chloroquine and hydroxychloroquine toxicity is characterized by a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias and is associated with significant morbidity and mortality. OBJECTIVE: This review describes acute chloroquine and hydroxychloroquine toxicity, outlines the complex pathophysiologic derangements, and addresses the emergency department (ED) management of this patient population. DISCUSSION: Chloroquine and hydroxychloroquine are aminoquinoline derivatives widely used in the treatment of rheumatologic diseases including systemic lupus erythematosus and rheumatoid arthritis as well as for malaria prophylaxis. In early 2020, anecdotal reports and preliminary data suggested utility of hydroxychloroquine in attenuating viral loads and symptoms in patients with SARS-CoV-2 infection. Aminoquinoline drugs pose unique and significant toxicological risks, both during their intended use as well as in unsupervised settings by laypersons. The therapeutic range for chloroquine is narrow. Acute severe toxicity is associated with 10–30% mortality owing to a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias. Treatment in the ED is focused on decontamination, stabilization of cardiac dysrhythmias, hemodynamic support, electrolyte correction, and seizure prevention. CONCLUSIONS: An understanding of the pathophysiology of acute chloroquine and hydroxychloroquine toxicity and available emergency treatments can assist emergency clinicians in reducing the immediate morbidity and mortality associated with this disease.


id: cord-349909-hmyv1nep
author: Misa, Nana-Yaa
date: 2020-09-24
txt: ./txt/cord-349909-hmyv1nep.txt
cache: ./cache/cord-349909-hmyv1nep.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33039228/
doi: 10.1016/j.ajem.2020.09.053
summary:
  BACKGROUND: We sought to examine racial and ethnic disparities in test positivity rate and mortality among emergency department (ED) patients tested for COVID-19 within an integrated public health system in Northern California. Results from ED-based testing can identify racial and ethnic disparities in COVID-19 testing, test positivity rates, and mortality associated with COVID-19 infection and can be used by health departments to inform policy. We pre-specified the regression model to contain COVID-19 positivity as the dependent variable, with the following predictor variables: race and ethnicity; age; medical co-morbidities (that may influence disease severity); documented epidemiologic concern (defined as healthcare worker or living with elderly family members); skilled nursing facility residence; whether or not a patient had a PCP (to control for access to medical care); and which AHS ED conducted the test to control for geographic and hospital site clustering.

title:
  Racial/ethnic disparities in COVID-19 disease burden & mortality among emergency department patients in a safety net health system

abstract:
  BACKGROUND: We sought to examine racial and ethnic disparities in test positivity rate and mortality among emergency department (ED) patients tested for COVID-19 within an integrated public health system in Northern California. METHODS: In this retrospective study we analyzed data from patients seen at three EDs and tested for COVID-19 between April 6 through May 4, 2020. The primary outcome was the test positivity rate by race and ethnicity, and the secondary outcome was 30 day in-hospital mortality. We used multivariable logistic regression to examine associations with COVID-19 test positivity. RESULTS: There were 526 patients tested for COVID-19, of whom 95 (18.1%) tested positive. The mean age of patients tested was 54.2 years, 54.7% were male, and 76.1% had at least one medical comorbidity. Black patients accounted for 40.7% of those tested but 16.8% of the positive tests, and Latinx patients accounted for 26.4% of those tested but 58.9% of the positive tests. The test positivity rate among Latinx patients was 40.3% (56/139) compared with 10.1% (39/387) among non-Latinx patients (p < 0.001). Latinx ethnicity was associated with COVID-19 test positivity (adjusted odds ratio 9.6, 95% confidence interval: 3.5–26.0). Mortality among Black patients was higher than non-Black patients (18.7% vs 1.3%, p < 0.001). CONCLUSION: We report a significant disparity in COVID-19 adjusted test positivity rate and crude mortality rate among Latinx and Black patients, respectively. Results from ED-based testing can identify racial and ethnic disparities in COVID-19 testing, test positivity rates, and mortality associated with COVID-19 infection and can be used by health departments to inform policy.


id: cord-350045-85jug39x
title: Risk of coronavirus infections among medical personnel
author: Pruc, Michal
date: 2020-05-08
txt: ./txt/cord-350045-85jug39x.txt
cache: ./cache/cord-350045-85jug39x.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32414525/
doi: 10.1016/j.ajem.2020.05.017
abstract: nan
summary:
  Due to the current situation of the COVID-19 pandemic, we can predict how the morbidity of health care workers will develop based on data on other viruses from the coronavirus group. In global research on SARS-CoV-1, MERS-CoV and SARS-CoV-2, it can be seen that a very large percentage of the number of infected people are health professionals struggling with them in various medical facilities. In the Netherlands a survey was conducted from 6-8 March 2020 on 1097 health care workers, among whom the percentage of infected was 4.1%. 4 Currently, the total number of infected healthcare workers on SARS-CoV-2 is unknown due to the steadily increasing number of infections and the lack of global data on the problem. The data on SARS-CoV-1 and MERS-CoV can predict how much health care workers may be infected despite the lack of up-to-date data on SARS-CoV-2. Risks to healthcare workers with emerging diseases: lessons from MERS-CoV, Ebola, SARS, and avian flu


id: cord-350473-f47i7y5h
author: Sen-Crowe, Brendon
date: 2020-05-27
txt: ./txt/cord-350473-f47i7y5h.txt
cache: ./cache/cord-350473-f47i7y5h.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.05.071
doi: 10.1016/j.ajem.2020.05.071
abstract: nan
summary:
  The sensitivity of PCR tests have been estimated at 71%, resulting in ~30% of infected patients having a negative finding. The second type of test is serologic, which detects immunoglobulins (IgG and IgM) specific for SARS-CoV-2 and provides an estimation of population virus exposure 4 . Many FDA-approved serologic tests have high sensitivity and specificity. To address the development of a reliable test, the Department of Health & Human Services (HHS) provided funding for the development of Simplexa COVID-19 Direct Assay and to QIAGEN to accelerate development of their RPS2 test 15 . Additionally, HHS is purchasing the ID NOW COVID-19 rapid point-of-care test (Abbott Diagnostics Scarborough Inc.) for public health labs (Table 1) 16 . Saliva is more sensitive for SARS-CoV-2 detection in COVID-19 patients than nasopharyngeal swabs

title:
  COVID-19 laboratory testing issues and capacities as we transition to surveillance testing and contact tracing


id: cord-352656-hpuhjbki
title: Emergency department operations in a large health system during COVID-19
author: Cohen, Brett A.
date: 2020-06-02
txt: ./txt/cord-352656-hpuhjbki.txt
cache: ./cache/cord-352656-hpuhjbki.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32505468/
doi: 10.1016/j.ajem.2020.05.097
summary:
  The following operational metrics were collected: median daily visits, COVID-19 specific J o u r n a l P r e -p r o o f visits, patients LWBS, door to diagnostic evaluation by a qualified medical professional ("doorto-doc" time), hospitalization rate, decision to admit to ED departure (boarding time), and median ED LOS. The evaluation of operational metrics revealed the very high-volume urban academic ED experienced the greatest improvements, with LWBS, ED LOS, boarding time, and door-to-doc time decreasing by 89.5%, 36.1%, 49.4% and 83.8% respectively (all p<0.001) ( Table 3) . The above data demonstrate a trend of decreased ED patient visits across a single health system during the initial stages of the COVID-19 pandemic, in conjunction with greater improvements in ED operational metrics observed at a large urban academic center compared to smaller community hospitals within the same health system.

abstract:
  • The initial COVID-19 pandemic led to decreased ED volumes across a health system. • Decreased ED volumes during the COVID-19 pandemic led to improved operations metrics. • Hospital decompression led to decreased boarding times during the COVID-19 pandemic.


id: cord-353698-gj8sx3zy
title: Adapted Diving Mask (ADM) device as respiratory support with oxygen output during COVID-19 pandemic
author: Bibiano-Guillen, C.
date: 2020-10-28
txt: ./txt/cord-353698-gj8sx3zy.txt
cache: ./cache/cord-353698-gj8sx3zy.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720309396?v=s5
doi: 10.1016/j.ajem.2020.10.043
abstract: nan
summary:
  title: Adapted Diving Mask (ADM) device as respiratory support with oxygen output during COVID-19 pandemic The most extended therapeutic approach for COVID-19 is based on two main strategies [10] [11] [12] [13] : pharmacological treatment directed toward several physiological targets (viremia, immunological reactions, prothrombotic reactions) and hemodynamic and respiratory support with positive end-expiratory pressure (PEEP) in addition to mechanical ventilation. A descriptive case series study of twenty-five patients with acute respiratory syndrome secondary to SARS-CoV2 infection was performed at a Spanish center, Hospital Universitario Infanta Leonor of Madrid, between March 30 and April 18, 2020. Table 4 shows the different variables used to analyze the improvement in the intervention and the mean value of all oxygen saturation measurements for all days that ADM therapy was used in those patients who prolonged its time of use.


id: cord-354468-bew35s8q
author: Margus, Colton
date: 2020-08-18
txt: ./txt/cord-354468-bew35s8q.txt
cache: ./cache/cord-354468-bew35s8q.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S073567572030721X?v=s5
doi: 10.1016/j.ajem.2020.08.034
summary:
  title: Discharge in pandemic: Suspected Covid-19 patients returning to the Emergency Department within 72 hours for admission In this paper, we focus on ED disposition decision-making in New York City during the Covid-19 pandemic, by identifying patients suspected of Covid-19 who are discharged yet ultimately require hospital return and admission within 72 hours. Case subjects were identified as those patients suspected of Covid-19 and discharged from the ED but who returned to an ED within the system in 72 hours and required admission. This analysis of suspected Covid-19 patients aimed to describe key features of the initial ED visit that may ultimately influence the likelihood of ED return for admission within 72 hours of discharge. Prior to the emergence of Covid-19, several studies assessing return admission indicated associations with increasing age, disease severity, ambulance transport, gastrointestinal or infectious disease symptoms, and prolonged time in the ED.

title:
  Discharge in pandemic: Suspected Covid-19 patients returning to the Emergency Department within 72 hours for admission

abstract:
  INTRODUCTION: Coronavirus disease 2019 (Covid-19) has led to unprecedented healthcare demand. This study seeks to characterize Emergency Department (ED) discharges suspected of Covid-19 that are admitted within 72 h. METHODS: We abstracted all adult discharges with suspected Covid-19 from five New York City EDs between March 2nd and April 15th. Those admitted within 72 h were then compared against those who were not using descriptive and regression analysis of background and clinical characteristics. RESULTS: Discharged ED patients returning within 72 h were more often admitted if suspected of Covid-19 (32.9% vs 12.1%, p < .0001). Of 7433 suspected Covid-19 discharges, the 139 (1.9%) admitted within 72 h were older (55.4 vs. 45.6 years, OR 1.03) and more often male (1.32) or with a history of obstructive lung disease (2.77) or diabetes (1.58) than those who were not admitted (p < .05). Additional associations included non-English preference, cancer, heart failure, hypertension, renal disease, ambulance arrival, higher triage acuity, longer ED stay or time from symptom onset, fever, tachycardia, dyspnea, gastrointestinal symptoms, x-ray abnormalities, and decreased platelets and lymphocytes (p < .05 for all). On 72-h return, 91 (65.5%) subjects required oxygen, and 7 (5.0%) required mechanical ventilation in the ED. Twenty-two (15.8%) of the study group have since died. CONCLUSION: Several factors emerge as associated with 72-h ED return admission in subjects suspected of Covid-19. These should be considered when assessing discharge risk in clinical practice.


