Three waves of COVID-19 in a Norwegian local hospital. / Tre bølger med covid-19 på et norsk lokalsykehus.

BACKGROUND: The objective of this article is to summarise the course of illness and treatment for patients with COVID-19 admitted to Bærum Hospital since the start of the pandemic. MATERIAL AND METHOD: We present data from a prospective observational study with the aim of systematising knowledge about patients admitted because of COVID-19. All patients admitted to Bærum Hospital up to and including 28 June 2021 were included. The results are presented for three waves of admissions: 9 March-23 June 2020, 21 September 2020-28 February 2021 and 1 March-28 June 2021. RESULTS: A total of 300 patients, divided into 77, 101 and 122 in the three waves respectively, were admitted because of COVID-19. The number of hospital deaths during the three waves was 14 (18 %), 11 (11 %) and 5 (4 %) respectively. The average age of the patients was 67.6 years in the first wave and 53.3 years in the third wave. Altogether 204 patients (68 %) received medical oxygen or ventilation support, and 31 of these (10 % of all the patients) received invasive ventilation support. Non-invasive ventilation support was used as the highest level of treatment in 4 (8 %), 9 (13 %) and 17 (20 %) patients with respiratory failure in the three waves respectively. In the second and third wave, 125 out of 152 patients with respiratory failure (82 %) were treated with dexamethasone. INTERPRETATION: Differences in patient characteristics and changes to treatment methods, such as the use of dexamethasone and non-invasive ventilation support, may have contributed to the apparent fall in mortality from the first to the third wave. Conditions that are not registered in the study, such as vaccination status, may also have impacted on mortality.

Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis: a prospective cohort study.

PURPOSE: We aimed to study the use of The 4 'A's test (4AT), a rapid delirium screening tool, performed upon Emergency Department (ED) admission, and to characterize older patients admitted to the ED with and without sepsis in terms of delirium features. METHODS: In this prospective cohort study, we included patients aged ≥ 65 years, admitted to the ED with suspected sepsis. ED nurses and doctors performed delirium screening with 4AT within two hours after ED admission, and registered the time spent on the screening in each case. Sepsis and delirium during the hospital stay were diagnosed retrospectively, according to recommended diagnosis criteria. RESULTS: Out of the 196 patients included (mean age 81 years, 60% men), 100 patients fulfilled the sepsis diagnosis criteria. The mean 4AT screening time was 2.5 Minutes. In total, 114 patients (58%) had a 4AT score ≥ 1, indicating cognitive impairment, upon ED admission. Sepsis patients more often had a 4AT score ≥ 4, indicating delirium, than patients without sepsis (40% vs. 26%, p < 0.05). Out of the 100 patients with sepsis, 68 (68%) had delirium during the hospital stay, as compared to 34 out of 96 patients (35%) without sepsis (p < 0.05). CONCLUSION: Delirium screening upon ED admission, using 4AT, was feasible among patients aged ≥ 65 years admitted with suspected sepsis. Two out of three patients had at least one feature of delirium upon admission. The prevalence of delirium during the hospital stay was high, particularly in patients with sepsis. Delirium screening with 4AT in the Emergency Department.

[A man in his eighties with recurrent syncope]. / En mann i 80-årene med gjentatte synkoper.

BACKGROUND: Syncope is usually a benign event that affects up to 50% of people over a lifetime, needing no extensive examination. The challenge is to diagnose the few with underlying life-threatening disease in need of immediate medical attention. Guidelines are clear, but unfortunately, clinical practice does not always follow recommendations, as illustrated by this case report. CASE PRESENTATION: A diabetic, hypertensive male in his eighties had a myocardial infarction in his medical history. He presented to his GP with recurrent syncopal episodes that had occurred while erect and in motion. Physical examination was found to be normal for his age, and he was referred to a cardiologist and seen three months later. An ECG showed sinus rhythm and a previous inferior wall myocardial infarction. A 24-hour ECG recorder was fitted, and a consultation was scheduled for the next day. At home the patient died. The ECG recording revealed sinus rhythm with increasing depression of the ST segment, followed by rapidly conducted atrial fibrillation, and then rapid ventricular tachycardia followed by terminal ventricular fibrillation. INTERPRETATION: A patient with a history where there is suspicion of cardiac syncope should be immediately and intensively examined when presenting to the healthcare services.