A Unique Case of COVID-19-related Acute Coronary Thrombosis Complicated by Severe Hypokalemia.

We report the case of a 52-year-old white male who was recently diagnosed with symptomatic coronavirus disease-2019 (COVID-19) and presented to the hospital with ventricular tachycardia/ventricular fibrillation cardiac arrest, ST elevation myocardial infarction, and profound hypokalemia. The patient was successfully treated with primary percutaneous coronary intervention and concurrent aggressive potassium repletion. To the authors' knowledge, this is the first case of COVID-19 presenting not only with an acute coronary thrombosis but also severe hypokalemia, both of which contributed to his cardiac arrest. The association of COVID-19 with acute coronary thrombosis, including the challenges surrounding the diagnosis and management in this patient population, is discussed. Additionally, the effect of COVID-19 on the renin-angiotensin-aldosterone system is reviewed with a focus on hypokalemic presentations.

Retrospective Review of a Novel Virtual Medical Soldier Readiness Processing Process in Response to the COVID-19 Pandemic.

INTRODUCTION: Medical solider readiness processing (SRP) needed to continue during the COVID-19 pandemic. We developed a rapid practice improvement project to allow for a hybrid virtual medical SRP/in-person medical SRP to decrease exposure risk. A retrospective review comparing this virtual SRP to a historical in-person SRP cohort to the same combatant command was then performed. PROCEDURES: A virtual medical SRP was completed for 204 soldiers in preparation for deployment within 24 hours of receiving the deployment roster. Each soldier had their MEDPROS data sheet printed and reviewed for deficiencies. Soldiers were then divided into two groups. Group 1 required hybrid SRP with need for in-person labs or vaccinations. Group 2 had no deficiencies noted on MEDPROS review, and the entire medical SRP was done virtually. Pre-deployment health assessment (pre-DHA) was completed over the phone for both groups. The provider then determined whether the soldier was a GO or NO GO, and this information was passed to the unit's medical staff. Comparative data analysis was performed using t-tests assuming unequal variances and chi-square tests. INFORMATION FOUND: A total of 204 soldiers were expected to complete the virtual SRP process. Of those 204, 191 MEDPROS records were reviewed (93%). Seventy-seven of the 191 soldiers (40%) required level one labs and immunizations, had not completed their pre-DHA, or had a combination of these factors. One hundred and fourteen soldiers (60%) had these items completed and were given virtual appointments in GENESIS. One hundred and six of the 114 (95%) soldiers were able to complete their medical SRP virtually. Eighty-six soldiers (80%) of this cohort were a GO for deployment at the end of their virtual SRP visit.The novel virtual SRP process was comparable to the historic in-person SRP as evidenced by no statistically significant difference in terms of the number of providers required and the number of soldiers that was seen by any one provider. The groups did show statistically significant differences based on age, gender, and GOs/NO GOs. CONCLUSION: This is the first proof of concept of a virtual medical SRP on literature review. A virtual SRP process that combines a pre-visit record review with a virtual pre-DHA is a viable process for SRP. The ability to utilize providers outside of a confined location or post may allow for optimized utilization of this scarce resource and result in cost savings to the Army. The recreation of this virtual medical SRP within other Army installations may allow for the improvement and standardization of the medical SRP process as a whole.