Written by EJ Wright, MD
This post first appeared on REBEL Cast
Welcome to the EMRA Basics of Emergency Medicine Podcast. I am your host EJ Wright, and the following series is an all encompassing approach to the most common chief complaints in the ED based on the well known EMRA Basics of Emergency Medicine, A Chief Complaint-Based Guide. Each cast will highlight myself and a guest attending physician as we take new learners through the differentials, red flags, physical exam findings, and a sample presentation that you need to know to treat patients in the ED.
Written by Jessica DiPeri, MD
This post first appeared on REBEL EM
Background: COVID-19 infection increases the risk of thrombosis due to multiple factors. (Rico-Mesa, 2020). Over the last 2 years, researchers have published 12 RCTs investigating various anticoagulation strategies among patients diagnosed with COVID-19 in multiple clinical settings. To date, only a multiplatform trial in noncritically ill patients, the HEP-COVID trial, and the MICHELLE trial have shown a benefit.
Severely ill patients with COVID-19 in the intensive care setting have an increased risk of thromboembolism, with an incidence reported as high as 31% (Klok, 2020). It remains unclear what the optimal prophylactic anticoagulation strategy is in critically ill patients.
Does intermediate-dose anticoagulation improve clinical outcomes compared to standard prophylactic anticoagulation in patients with COVID-19 treated in the intensive care unit?
Background:Patients diagnosed with COVID-19 have an increased risk of thromboembolic events, including pulmonary embolism and deep vein thrombosis (DVT). In addition, COVID-19 patients with increased coagulation parameters such as D-dimer, fibrin degradation products, prothrombin time, and activated partial thromboplastin time are at higher risk of morbidity and mortality.
Several RCTs have investigated the benefit of anticoagulation in patients with COVID-19 in various clinical settings. The INSPIRATION Trial investigated outcomes with an intermediate vs. standard prophylactic dose of anticoagulation in ICU patients. A multiplatform trial and HEP-COVID Trial investigated therapeutic anticoagulation in critically ill and non-critically ill hospitalized patients. The ACTIV-4B Trial investigated anticoagulation in symptomatic COVID-19 patients who did not require hospitalization. Currently, there is some evidence in support of therapeutic anticoagulation in non-critically ill hospitalized patients. However, there is no evidence to support the use of full dose anticoagulation in either the ICU or outpatient setting.
A 15-year-old female, with no past medical history, presented to the pediatric emergency department with cough and fever after being discharge with a diagnosis pneumonia two days prior. A chest x-ray on her first visit showed a single left lower lobe infiltrate and she was subsequently prescribed amoxicillin for suspected community acquired pneumonia (Figure 1). Upon return to emergency department, the patient complained of worsening symptoms, including dysphagia, secondary to sores in her mouth that developed after being discharge.
Varicella-zoster virus Varicella (chickenpox) is a highly contagious disease caused by primary infection with varicella-zoster virus (VZV)2 and may cause maternal mortality or serious morbidity > Reactivation of latent infection, usually many years after the primary infection, may result in herpes zoster (shingles), a painful vesicular eruption in the distribution of sensory nerve roots2 > …
Read more “Varicella in Pregnancy”
CC: Left leg pain HPI: 52 year old male with PMH of IDDM presents to the Emergency Dept. (ED) with left leg pain for the past 9 days which has become progressively worse. He is a taxi driver and reports that a part of the seat, which supports his legs, has been rubbing against his …
Read more “Case of the Week COW #12”
CC: Can’t see for 2 months HPI: 10 year old male with no significant past medical history presents to the Emergency Dept. complaining of painless vision loss in the right eye for 2-3 months. Patient states he has been having difficulty seeing out of his right eye for 2 months despite changing positions in class, …
Read more “Case of the week COW #11”
CC: Nausea and vomiting and “ I think my sugar is low” HPI: 36-year-old Female with PMH of Diabetes presents to the Emergency Department complaining of multiple episodes of non-bloody, non-bilious vomiting for the past 5 days. Associated symptoms include chills and a mild sore throat. Denies fever, HA, neck pain, chest pain, SOB, abdominal …
Read more “Case of the week COW #10”
CC: “Post Surgical Pain” ; Abdominal pain HPI: 8 year old Male with PMH of Sickle Cell Disease (HbSC), Post-opt Day 10 for laparoscopic splenectomy for recurrent sequestration crises presents to the Emergency Department (ED) complaining of abdominal pain x 2 days. The pain is described as diffuse and worse in the RUQ. Denies exacerbating …
Read more “Case of the Week COW #9”
CC: Altered Mental Status HPI: 50 -year-old Male with PMH of HIV, CVA and Meningitis presents to the Emergency Department (ED) for altered mental status. As per the patient’s girlfriend at bedside, the patient woke up confused and was not making any sense when he spoke. He even urinated on the floor but does not …
Read more “Case of the Week COW #8”
Check out Take Home PEARLS from this week’s Wednesday EM Conference! Topics include Asthma/COPD, Sepsis, and mgmt of hemoptysis.
CC: Generalized Weakness HPI: 55 y/o male presents complaining of 4 days of gradually worsening weakness in bilateral arms and legs. The patient also reports lower extremity pain one week ago, which resolved. Patient also complains of intermittent left sided back pain for the past couple of months that is exacerbated by walking. ROS: …
Read more “Case of the Week (COW) #4”
Here’s a quick hit summary of the evidence regarding the use of systemic corticosteroids in the treatment of SJS/TEN
Patients that stink can really hinder an ED. It creates a difficult work environment for ED staff and makes nearby patients, families and visitors uncomfortable. Here are a few ways I came across to neutralize the stank
Not much gets more exciting than bronchiolitis! Check out this quick review of the quick hitting points