ABSTRACT
INTRODUCTION: The overcrowding of intensive care units during the corona virus pandemic increased the number of patients managed in the emergency department (ED). The detection timely of the predictive factors of mortality and bad outcomes improve the triage of those patients. AIM: To define the predictive factors of mortality at 30 days among patients admitted on ED for covid-19 pneumonia. METHODS: This was a prospective, monocentric, observational study for 6 months. Patients over the age of 16 years admitted on the ED for hypoxemic pneumonia due to confirmed SARS-COV 2 infection by real-time reverse-transcription polymerase chain reaction (rRT-PCR) were included. Multivariate logistic regression was performed to investigate the predictive factors of mortality at 30 days. RESULTS: 463 patients were included. Mean age was 65±14 years, Sex-ratio=1.1. Main comorbidities were hypertension (49%) and diabetes (38%). Mortality rate was 33%. Patients who died were older (70±13 vs. 61±14;p<0.001), and had more comorbidities: hypertension (57% vs. 43%, p=0.018), chronic heart failure (8% vs. 3%, p=0.017), and coronary artery disease (12% vs. 6%, p=0.030). By multivariable analysis, factors independently associated with 30-day mortality were age ≥65 years aOR: 6.9, 95%CI 1.09-44.01;p=0.04) SpO2<80% (aOR: 26.6, 95%CI 3.5-197.53;p=0.001) and percentage of lung changes on CT scan>70% (aOR: 5.6% 95%CI .01-31.29;p=0.04). CONCLUSION: Mortality rate was high among patients admitted in the ED for covid-19 pneumonia. The identification of predictive factors of mortality would allow better patient management.
Subject(s)
COVID-19 , Hypertension , Aged , Humans , Middle Aged , Emergency Service, Hospital , Prospective Studies , Retrospective Studies , RNA, Viral , SARS-CoV-2 , Male , Female , Adult , Aged, 80 and overABSTRACT
INTRODUCTION: Severe trauma is a frequent condition encountered in Emergency department (ED) in which vital prognosis can easily be engaged. This condition could be responsible for unusual injuries occurrence. Emergency physician must be aware of these situations where adequate management is urgently required. We report a case of e 45-year-old patient who was admitted to the ED after a high velocity road traffic accident resulting in multiple injuries and fracture dislocation and migrating humeral head into intra thoracic position. OBSERVATION: We report the clinical case of a patient aged 45 years without medical history admitted to the ED after being involved in a high-velocity road traffic accident. On clinical presentation, the patient was dyspneic and desaturated on ambient air room, he presented moreover clinical signs of blunt right shoulder trauma and deformation of the 2 thighs. Final screening of injuries by radiological and a tomographic exams retained a polytrauma status with fracture dislocation and migration of humeral head, homolateral hemothorax and double femur fracture. Patient was managed by multidisciplinary surgical approaches. Discusssion et conclusion: We illustrated by this case a very rare post trauma condition represented by a fracture dislocation of the humeral head resulting in an intrathoracic migration and a homolateral hemothorax. This diagnosis was reported only a few times by the literature within last decades and management suffers from lack of treatment guidelines, which remain team-dependent. At the very early stage of management and before surgical step, emergency physician must be aware of the possibility of this clinical condition with evolution into some threatening clinical presentations with specific management.
Subject(s)
Fracture Dislocation , Humeral Head , Male , Humans , Middle Aged , Humeral Head/diagnostic imaging , Hemothorax , Radiography , PrognosisABSTRACT
BACKGROUND: Fibrinolysis during ST elevation myocardial infarction (STEMI) is feasible in the emergency departments (ED), and this reduces the delay from first medical contact to coronary reperfusion. The aim of the study is to: 1) Evaluate fibrinolysis with streptokinase (SK) in STEMI admitted to the ED. 2) identify clinical criteria predictive of fibrinolysis success. METHODS: prospective study (July 2008-March 2012). Inclusion of STEMI thrombolysed by SK. Fibrinolysis success was defined according to clinical and Electrocardiogram criteria. Multivariate study is used to identify the factors associated with thrombolysis success. RESULTS: Out of the 329 STEMI enrolled during the study period, 224 (68%) were thrombolysed. Mean age = 57 ± 11 years (20-86 years) sex ratio = 6. The average time chest pain - emergency admission was 195 ± 177 min (15 min to 12 hours). The 2/3 of patients had consulted during the first 3 hours. The average success rate of thrombolysis was 59% and reached 83% the first hour, 66% the second hour and 58.7% the third hour. In multivariate analysis, the three independent predictors factors of a fibrinolysis success were: active smoking, current treatment with beta blockers and the delay from onset chest pain to the ED visit less than 180 min. Conversely, diabetes was associated with fibrinolysis failure. Fibrinolysis got complicated by two intracerebral hemorrhages. Three patients had died in the ED. CONCLUSION: Two thirds of patients with STEMI have consulted 3 h after onset of chest pain. Fibrinolysis with streptokinase was effective in 59% of cases.
