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Spinal cord infarction (SCI) is an uncommon vascular syndrome that leads to neurologic abnormalities with multiple implicated causes. Percutaneous coronary intervention (PCI) is a non-surgical invasive procedure used to relieve an arterial occlusion or narrowing that causes ischemia to the heart. This is usually performed by different methods and different arterial access sites. Here, we present a case of a patient who developed bilateral lower limb weakness eight days after a femoral artery PCI and was diagnosed with SCI. This case report aims to document a rare complication and highlight the most important demographic, investigation, management, risk factors, and prognosis data available in the literature.
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BACKGROUND: A high-flow nasal cannula (HFNC) is a device for non-invasive ventilation (NIV). It was utilized during the COVID-19 pandemic in patients with moderate to severe respiratory distress due to its benefit profile in delaying intubation, ease of use, and comfort of patients in comparison to NIV. OBJECTIVES: Our main objective is to calculate the intubation rate of patients with suspected or lab-confirmed COVID-19 in moderate to severe respiratory distress who failed graded oxygen therapy (GOT). Before incorporating HFNC as a treatment option, the intubation rate was 100% after GOT failure. We calculated the rate of intubation at two, six, and 12 hours of starting HFNC, where each patient is in their own control with an assumed intubation rate of 100%. Other objectives include measuring the rate of improvement of the ROX index, respiratory rate (RR), and oxygen saturation (SPO2) levels at two, six, and 12 hours. METHODS: We retrospectively screened patients with suspected or lab-confirmed COVID-19 infection in moderate to severe respiratory distress at Rashid Hospital Trauma Center, Emergency Department in Dubai, United Arab Emirates, from April 10, 2020, until December 31, 2020. The list of patients was pooled from the SALAMA electronic system. RESULTS: A total of 121 patients were included in the analysis. Assuming an intubation rate of 100% at 0 hours (end of GOT), after starting HFNC, the intubation rate (primary outcome) at two hours was 7.43% (9/121), at six hours was 7.14% (8/112), and at 12 hours was 5.77% (6/104). The total intubation rate at 12 hours was 19% (23/121). The use of HFNC was also shown to improve the ROX index, RR, and SPO2 at two, six, and 12 hours. CONCLUSION: In patients with suspected or lab-confirmed COVID-19 in moderate to severe respiratory distress who failed GOT and were started on HFNC, it was noted that the intubation rate decreased from an assumed rate of 100% to 19% at 12 hours from starting the treatment. There was also a statistically significant improvement in the ROX index, SPO2, and RR at two, six, and 12 hours from the initiation at 0 hours.
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BACKGROUND: Workplace violence and abuse in the emergency department (ED) has increasingly become a serious and alarming phenomenon worldwide where health care professionals are more prone to violence compared with other specialties. AIMS: We aimed to estimate prevalence, and types of work place violence made against health care workers (HCW) in emergency departments of Arabian Gulf area. METHODS: We performed a descriptive cross-sectional study at several emergency departments in Saudi Arabia and United Arab Emirates wherein a previously validated questionnaire was distributed among health care workers. The survey consisted of 22 questions that assessed respondent's workplace violence and/or abuse encounters, protective measures, available work place policies, and actions implemented to detect and deal with violence and abuse against healthcare providers. Descriptive statistics was used and P value < 0.05 was considered significant for all statistical tests performed. RESULTS: Seven hundred HCW in eleven emergency departments agreed to participate in the survey. Four hundred ninety-two completed the questionnaire with a response rate of 70%. More than 90% of the respondents were in the 20-39 years old bracket with an approximately equal gender distribution. Then, 20.9% of the respondents stated that they were physically attacked and 32.3% were attacked with a weapon. Most of the respondents (75.6%) reported that they were verbally abused or bullied by patients or relatives of patients. Staff responses to emotional abuse varied among respondents with the most frequent response of "told the person to stop" (22%), followed by "took no action" (19%). Further, 83.3% of respondents stated that there was an existing policy and procedure guidelines for reporting work place violence while 30.1% reported that they had not used any of these measures. CONCLUSION: Workplace violence among HCW in the emergency departments are common in the Gulf area and can be serious in as far as use of weapons. Staff awareness focus on this under reported issue, and staff training to recognize and report potential aggression can predict a significant reduction of incidents.
