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2.
Am J Emerg Med ; 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1062207
3.
Am J Emerg Med ; 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1023411

RESUMEN

INTRODUCTION: The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality. The impact of thrombotic complications has been increasingly recognized as an important component of this disease. OBJECTIVE: This narrative review summarizes the thrombotic complications associated with COVID-19 with an emphasis on information for Emergency Medicine clinicians. DISCUSSION: Thrombotic complications from COVID-19 are believed to be due to a hyperinflammatory response caused by the virus. Several complications have been described in the literature. These include acute limb ischemia, abdominal and thoracic aortic thrombosis, mesenteric ischemia, myocardial infarction, venous thromboembolism, acute cerebrovascular accident, and disseminated intravascular coagulation. CONCLUSION: It is important for Emergency Medicine clinicians to be aware of the thrombotic complications of COVID-19. Knowledge of these components are essential to rapidly recognize and treat to reduce morbidity and mortality in these patients.

4.
Am J Emerg Med ; 41: 96-103, 2020 Dec 29.
Artículo en Inglés | MEDLINE | ID: covidwho-986919

RESUMEN

INTRODUCTION: Coronavirus disease of 2019 (COVID-19) is a lower respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This disease can impact the cardiovascular system and lead to abnormal electrocardiographic (ECG) findings. Emergency clinicians must be aware of the ECG manifestations of COVID-19. OBJECTIVE: This narrative review outlines the pathophysiology and electrocardiographic findings associated with COVID-19. DISCUSSION: COVID-19 is a potentially critical illness associated with a variety of ECG abnormalities, with up to 90% of critically ill patients demonstrating at least one abnormality. The ECG abnormalities in COVID-19 may be due to cytokine storm, hypoxic injury, electrolyte abnormalities, plaque rupture, coronary spasm, microthrombi, or direct endothelial or myocardial injury. While sinus tachycardia is the most common abnormality, others include supraventricular tachycardias such as atrial fibrillation or flutter, ventricular arrhythmias such as ventricular tachycardia or fibrillation, various bradycardias, interval and axis changes, and ST segment and T wave changes. Several ECG presentations are associated with poor outcome, including atrial fibrillation, QT interval prolongation, ST segment and T wave changes, and ventricular tachycardia/fibrillation. CONCLUSIONS: This review summarizes the relevant ECG findings associated with COVID-19. Knowledge of these findings in COVID-19-related electrocardiographic presentations may assist emergency clinicians in the evaluation and management of potentially infected and infected patients.

5.
AEM Education and Training ; n/a(n/a), 2020.
Artículo | WHO COVID | ID: covidwho-956688

RESUMEN

Abstract Introduction In December 2019, a novel coronavirus (COVID-19) caused widespread clinical disease, triggering limited in-person gatherings and social-distancing guidelines to minimize transmission These regulations led most Emergency Medicine (EM) residency training programs to rapidly transition to virtual didactics We sought to evaluate EM resident perceptions of the effects of COVID-19 on their didactic and clinical education Methods We performed a cross-sectional survey study at seven EM residency programs using a mixed-methods approach designed to understand resident perceptions regarding the impact of COVID-19 on their educational experience Quantitative data were presented as percentages with comparison of subgroups, while open-ended responses were analyzed using qualitative methodology Results We achieved a 59% response rate (187/313) The majority of respondents (119/182, 65 4%) reported that the COVID-19 pandemic had a negative impact on their residency education with junior residents disproportionately affected 81/182 (44 5%) participants reported that one or more of their clinical rotations were partially or completely cancelled due to the pandemic Additionally, we identified four themes and 34 subthemes highlighting the contextual effects of the pandemic, which were then divided into positive and negative influences on the residency experience The four themes include: systems experience, clinical experience, didactic experience, and wellness Conclusion Our study examined the impact of COVID-19 on residents? educational experiences We found overall mixed responses with a slightly negative impact on residency education, wellness, and clinical rotations, while satisfaction with EM as a career choice was increased Factors influencing this included systems, clinical, and didactic experiences, as well as overall wellness

6.
7.
CJEM ; 22(5): 587-590, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-834795

RESUMEN

A 37-year-old female presents with cough, fever, dyspnea, and myalgias for five days after recent contact with a family member with confirmed 2019 coronavirus disease (COVID-19). Her vital signs include T 38.3° C, HR 108, BP 118/70 mm Hg, RR 26 breaths per minute, and oxygen saturation 67% on room air. She is not in respiratory distress currently and is protecting her airway. Her chest X-ray reveals bilateral airspace opacities. You plan to immediately intervene and address her hypoxia.


Asunto(s)
Infecciones por Coronavirus/terapia , Ventilación no Invasiva/métodos , Terapia por Inhalación de Oxígeno/métodos , Oxígeno/sangre , Neumonía Viral/terapia , Síndrome Respiratorio Agudo Grave/terapia , Adulto , Manejo de la Vía Aérea/métodos , Canadá , Infecciones por Coronavirus/diagnóstico , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Consumo de Oxígeno/fisiología , Pandemias , Neumonía Viral/diagnóstico , Medición de Riesgo , Rol , Síndrome Respiratorio Agudo Grave/diagnóstico , Resultado del Tratamiento , Signos Vitales
8.
Am J Emerg Med ; 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: covidwho-809179

RESUMEN

INTRODUCTION: The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality. The impact of thrombotic complications has been increasingly recognized as an important component of this disease. OBJECTIVE: This narrative review summarizes the thrombotic complications associated with COVID-19 with an emphasis on information for Emergency Medicine clinicians. DISCUSSION: Thrombotic complications from COVID-19 are believed to be due to a hyperinflammatory response caused by the virus. Several complications have been described in the literature. These include acute limb ischemia, abdominal and thoracic aortic thrombosis, mesenteric ischemia, myocardial infarction, venous thromboembolism, acute cerebrovascular accident, and disseminated intravascular coagulation. CONCLUSION: It is important for Emergency Medicine clinicians to be aware of the thrombotic complications of COVID-19. Knowledge of these components are essential to rapidly recognize and treat to reduce morbidity and mortality in these patients.

10.
Am J Emerg Med ; 2020 Aug 17.
Artículo en Inglés | MEDLINE | ID: covidwho-716507

RESUMEN

INTRODUCTION: A great deal of literature has recently discussed the evaluation and management of the coronavirus disease of 2019 (COVID-19) patient in the emergency department (ED) setting, but there remains a dearth of literature providing guidance on cardiac arrest management in this population. OBJECTIVE: This narrative review outlines the underlying pathophysiology of patients with COVID-19 and discusses approaches to cardiac arrest management in the ED based on the current literature as well as extrapolations from experience with other pathogens. DISCUSSION: Patients with COVID-19 may experience cardiovascular manifestations that place them at risk for acute myocardial injury, arrhythmias, and cardiac arrest. The mortality for these critically ill patients is high and increases with age and comorbidities. While providing resuscitative interventions and performing procedures on these patients, healthcare providers must adhere to strict infection control measures and prioritize their own safety through the appropriate use of personal protective equipment. A novel approach must be implemented in combination with national guidelines. The changes in these guidelines emphasize early placement of an advanced airway to limit nosocomial viral transmission and encourage healthcare providers to determine the effectiveness of their efforts prior to placing staff at risk for exposure. CONCLUSIONS: While treatment priorities and goals are identical to pre-pandemic approaches, the management of COVID-19 patients in cardiac arrest has distinct differences from cardiac arrest patients without COVID-19. We provide a review of the current literature on the changes in cardiac arrest management as well as details outlining team composition.

11.
Am J Emerg Med ; 38(7): 1504-1507, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-699678

RESUMEN

BACKGROUND: The coronavirus disease of 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While systemic inflammation and pulmonary complications can result in significant morbidity and mortality, cardiovascular complications may also occur. OBJECTIVE: This brief report evaluates cardiovascular complications in the setting of COVID-19 infection. DISCUSSION: The current COVID-19 pandemic has resulted in over one million infected worldwide and thousands of death. The virus binds and enters through angiotensin-converting enzyme 2 (ACE2). COVID-19 can result in systemic inflammation, multiorgan dysfunction, and critical illness. The cardiovascular system is also affected, with complications including myocardial injury, myocarditis, acute myocardial infarction, heart failure, dysrhythmias, and venous thromboembolic events. Current therapies for COVID-19 may interact with cardiovascular medications. CONCLUSIONS: Emergency clinicians should be aware of these cardiovascular complications when evaluating and managing the patient with COVID-19.


Asunto(s)
Enfermedades Cardiovasculares/patología , Arritmias Cardíacas/patología , Arritmias Cardíacas/virología , Betacoronavirus , Enfermedades Cardiovasculares/virología , Infecciones por Coronavirus/inmunología , Insuficiencia Cardíaca/patología , Insuficiencia Cardíaca/virología , Humanos , Miocarditis/patología , Miocarditis/virología , Pandemias , Neumonía Viral/inmunología
12.
Acad Emerg Med ; 27(10): 963-973, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-697161

RESUMEN

BACKGROUND: SARS-CoV-2 is a global pandemic associated with significant morbidity and mortality. However, information from United States cohorts is limited. Understanding predictors of admission and critical illness in these patients is essential to guide prevention and risk stratification strategies. METHODS: This was a retrospective, registry-based cohort study including all patients presenting to Rush University Medical Center in Chicago, Illinois, with COVID-19 from March 4, 2020 to June 21, 2020. Demographic, clinical, laboratory, and treatment data were obtained from the registry and compared between hospitalized and nonhospitalized patients as well as those with critical illness. We used logistic regression modeling to explore risk factors associated with hospitalization and critical illness. RESULTS: A total of 8,673 COVID-19 patients were included in the study, of whom 1,483 (17.1%) were admitted to the hospital and 528 (6.1%) were admitted to the intensive care unit. Risk factors for hospital admission included advanced age, male sex (odds ratio [OR] = 1.69, 95% confidence interval [CI] = 1.44 to 1.98), Hispanic/Latino ethnicity (OR = 1.52, 95% CI = 1.18 to 1.92), hypertension (OR = 1.77, 95% CI = 1.46 to 2.16), diabetes mellitus (OR = 1.84, 95% CI = 1.53 to 2.22), prior CVA (OR = 3.20, 95% CI = 1.99 to 5.14), coronary artery disease (OR = 1.45, 95% CI = 1.03 to 2.06), heart failure (OR = 1.79, 95% CI = 1.23 to 2.61), chronic kidney disease (OR = 2.60, 95% CI = 1.77 to 3.83), end-stage renal disease (OR = 2.22, 95% CI = 1.12 to 4.41), cirrhosis (OR = 2.03, 95% CI = 1.42 to 2.91), fever (OR = 1.43, 95% CI = 1.19 to 1.71), and dyspnea (OR = 4.53, 95% CI = 3.75 to 5.47). Factors associated with critical illness included male sex (OR = 1.45, 95% CI = 1.12 to 1.88), congestive heart failure (OR = 1.45, 95% CI = 1.00 to 2.12), obstructive sleep apnea (OR = 1.58, 95% CI = 1.07 to 2.33), blood-borne cancer (OR = 3.53, 95% CI = 1.26 to 9.86), leukocytosis (OR = 1.53, 95% CI = 1.15 to 2.17), elevated neutrophil-to-lymphocyte ratio (OR = 1.61, 95% CI = 1.20 to 2.17), hypoalbuminemia (OR = 1.80, 95% CI = 1.39 to 2.32), elevated AST (OR = 1.66, 95% CI = 1.20 to 2.29), elevated lactate (OR = 1.95, 95% CI = 1.40 to 2.73), elevated D-Dimer (OR = 1.44, 95% CI = 1.05 to 1.97), and elevated troponin (OR = 3.65, 95% CI = 2.03 to 6.57). CONCLUSION: There are a number of factors associated with hospitalization and critical illness. Clinicians should consider these factors when evaluating patients with COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Enfermedad Crítica/epidemiología , Hospitalización/tendencias , Unidades de Cuidados Intensivos , Pandemias , Neumonía Viral/epidemiología , Medición de Riesgo/métodos , Chicago/epidemiología , Estudios de Cohortes , Comorbilidad , Enfermedad Crítica/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
13.
Am J Emerg Med ; 38(10): 2160-2168, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-696301

RESUMEN

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 respiratory support. 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.

14.
J Contin Educ Health Prof ; 40(3): 187-191, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-643961

RESUMEN

The COVID-19 pandemic has required a substantial change to the approach used for traditional, in-person continuing professional development (CPD) conferences. Running a virtual CPD conference will necessitate consideration of digital platforms and conversion of large group and small group sessions, abstract presentations, and networking events to a digital medium. This paper will discuss these challenges and present strategies to address them for CPD conference planning in the era of COVID-19.


Asunto(s)
Congresos como Asunto/organización & administración , Infecciones por Coronavirus/epidemiología , Educación Continua/métodos , Personal de Salud/educación , Pandemias , Neumonía Viral/epidemiología , Humanos
16.
Am J Emerg Med ; 38(10): 2194-2202, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-634245

RESUMEN

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging viral pathogen that causes the novel coronavirus disease of 2019 (COVID-19) and may result in hypoxemic respiratory failure necessitating invasive mechanical ventilation in the most severe cases. OBJECTIVE: This narrative review provides evidence-based recommendations for the treatment of COVID-19 related respiratory failure requiring invasive mechanical ventilation. DISCUSSION: In severe cases, COVID-19 leads to hypoxemic respiratory failure that may meet criteria for acute respiratory distress syndrome (ARDS). The mainstay of treatment for ARDS includes a lung protective ventilation strategy with low tidal volumes (4-8 mL/kg predicted body weight), adequate positive end-expiratory pressure (PEEP), and maintaining a plateau pressure of < 30 cm H2O. While further COVID-19 specific studies are needed, current management should focus on supportive care, preventing further lung injury from mechanical ventilation, and treating the underlying cause. CONCLUSIONS: This review provides evidence-based recommendations for the treatment of COVID-19 related respiratory failure requiring invasive mechanical ventilation.

17.
Am J Emerg Med ; 38(9): 1715-1721, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-549274

RESUMEN

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality. While much of the focus has been on the cardiac and pulmonary complications, there are several important dermatologic components that clinicians must be aware of. OBJECTIVE: This brief report summarizes the dermatologic manifestations and complications associated with COVID-19 with an emphasis on Emergency Medicine clinicians. DISCUSSION: Dermatologic manifestations of COVID-19 are increasingly recognized within the literature. The primary etiologies include vasculitis versus direct viral involvement. There are several types of skin findings described in association with COVID-19. These include maculopapular rashes, urticaria, vesicles, petechiae, purpura, chilblains, livedo racemosa, and distal limb ischemia. While most of these dermatologic findings are self-resolving, they can help increase one's suspicion for COVID-19. CONCLUSION: It is important to be aware of the dermatologic manifestations and complications of COVID-19. Knowledge of the components is important to help identify potential COVID-19 patients and properly treat complications.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pandemias , Neumonía Viral/complicaciones , Enfermedades de la Piel/etiología , Piel/patología , Infecciones por Coronavirus/epidemiología , Salud Global , Humanos , Incidencia , Neumonía Viral/epidemiología , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/epidemiología
18.
Ann Glob Health ; 86(1): 51, 2020 05 18.
Artículo en Inglés | MEDLINE | ID: covidwho-460242

RESUMEN

The developed countries of the world were ill-prepared for the pandemic that they have suffered. When we compare developed to developing countries, the sophisticated parameters we use do not necessarily address the weaknesses in the healthcare systems of developed countries that make them susceptible to crises like the present pandemic. We strongly suggest that better preparation for such events is necessary for a country to be considered developed.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud , Países Desarrollados/clasificación , Reglamento Sanitario Internacional , Pandemias , Neumonía Viral/epidemiología , Salud Pública , Betacoronavirus/aislamiento & purificación , Defensa Civil/organización & administración , Defensa Civil/normas , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Humanos , Reglamento Sanitario Internacional/organización & administración , Reglamento Sanitario Internacional/normas , Salud Pública/normas
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