Comparison of High-Dose, Short-Term Steroid and Low-Dose Long Term Steroid Use in ARDS Caused by COVID-19
Suna KOC, MD and Ilke KUPELI, MD
Article Type: Original Article | First Published: March 19, 2022
We aimed to compare the 15-day continuous hemodynamic, laboratory and clinical course of patients with ARDS due to COVID-19 who received short-term highdose and long-term low-dose systemic methylprednisolone. Two hundred and two patients were recorded to be diagnosed with ARDS due to COVID 19 in the intensive care unit between June 1, 2020 and February 1, 2021. Patients were received systemic methylprednisolone for the short or long term and high or low doses were applied. Age, gender, APACHE II...
Chest X-Ray Findings in Asthma Exacerbation and the Association with Acute Asthma Management among Children
Gul Sher, Fernanda E Kupferman and Mohamed Gaffoor
Article Type: Original Article | First Published: March 19, 2022
The National Heart and Lung Institute’s guidelines advise against routine use of chest X-ray (CXR) for acute asthma exacerbation. Despite this recommendation, unnecessary CXR are still being performed. The objective of this study is to assess the association between abnormal CXR findings and the severity of asthma exacerbation and its impact on acute asthma management. A retrospective chart review was performed of all pediatric patients 2-17 years of age who presented to the emergency departme...
Cardiovascular Collapse, Progressive Lactic Acidosis, Pulmonary Hypertension and Polyuria: Think Thiamine Deficiency!
Gul Sher, MBBS, Mona Nourani, DO, Kristen Beebe, PA-C, Peggy Fullenkamp Oomens, MS, RDN, CNSC, Megan Land, MD and Alexander Ngwube, MD
Article Type: Original Article | First Published: March 13, 2022
Shock is a pathological condition characterized by imbalance between oxygen demand and supply. Irrespective of the cause, shock leads to a state of energy failure due to a decrease in adenosine triphosphate (ATP) production, creation of lactic acidosis, and as a consequence, multiple organ dysfunction. Lactic acidosis is an ominous finding in critically ill patients. The severity and increased duration of lactic acidosis are associated with increased mortality. Lactic acidosis can result from hy...
Transient Asystole Linked to Dexmedetomidine Infusion
Noelle Provenzano, DO, Olivia Johnson, PharmD, BCCCP, Aaron Brophy, DO and Jaber Monla-Hassan, MD
Article Type: Case Report | First Published: February 17, 2022
Five adult medical, critically ill patients developed bradycardia leading to asystole while receiving dexmedetomidine infusion. This is a case series of five adult patients obtained from the medical intensive care unit in a community teaching hospital between May 2019 through August 2020. These patients were each receiving dexmedetomidine infusion while on invasive mechanical ventilation leading to periods of asystole that resolved after stopping dexmedetomidine infusion in all five patients. Th...
Hyperglycemic Crisis: A Serious Complication of Unknown Type II Diabetes Mellitus in Adolescent
Elisa, MD and Pratiwi Woro R, MD PhD
Article Type: Case Report | First Published: February 11, 2022
Hyperglycemic crisis is life threatening condition in diabetic patients. Traditionally, diabetic ketoacidosis (DKA) has been associated with decompensated type 1 diabetes (T1D) and Hyperosmolar Hyperglycemic State (HHS) became a hallmark of type 2 diabetes (T2D). However, DKA is increasingly being reported in patients with T2D. We reported a case of DKA with some features of HHS, as an initial presentation, in a boy with unknown T2D at young age. Prompt diagnosis and acute critical care approach...
Emergency Medical Rescue Services in Dhaka City, Bangladesh: A Situational Analysis and Needs Assessments
Mohammad Mojahidul Hossain, Axel Kroeger, Kamelia Pervin, George Norwood, Be-Nazir Ahmed, Manzur Kadir Ahmed and Hans-Joerg Busch
Article Type: Original Article | First Published: February 10, 2022
Deaths and disabilities due to the lack of proper Emergency Medical Rescue Services (EMRS) is a global public health concern, also in Dhaka city, Bangladesh. The study aimed at contributing to improve the EMRS in Dhaka city by assessing and identifying major shortcomings with possible solutions. The study was conducted in July/August 2017, after analyzing medical and relevant records, a one week observational study was conducted in 4 purposively selected hospitals in Dhaka city. The Mode of tran...
Need for Trauma Intervention and Improving Under-Triaging in Geriatric Trauma Patients: Under-Triaged or Misclassified
Gabriel Beam, MSN, RN, Kimberly Gorman, DNP, AG-ACNP-BC, CNL, CCRN, CNRN, TCRN, Siddhartha Nannapaneni, MD, Jami Zipf, BSN, RN, Thomas Simunich, MS, MBA and Russell Dumire, MD
Article Type: Original Research | First Published: January 24, 2022
Combining the Need for Trauma Intervention (NFTI) calculation with the Cribari Matrix Method (CMM) more accurately determines appropriate triage, particularly of geriatric trauma patients. These patients (>/= age 65 years) have comorbidities, increased frailty, and decreased overall functional capacity. The CMM alone does not address their increased risk of mortality secondary to inappropriate or suboptimal care; performance improvement efforts to decrease the risk of under-triage have prompted ...
A Case of Wernicke’s Encephalopathy in a Post-Bariatric Surgery Patient in a Community Emergency Department
Daniel S Steinberg, MD and Christopher Wilbert, MD
Article Type: Case Report | First Published: January 23, 2022
A 22-year-old woman with a history of idiopathic intracranial hypertension who presented to our emergency department with acute onset strabismus and bilateral sixth nerve palsy in the setting of recent sleeve gastrectomy and vomiting. Further testing revealed multiple vitamin deficiencies, including thiamine, leading to a diagnosis of Wernicke’s encephalopathy. Her symptoms resolved after vitamin and nutritional repletion. Incidence of similar presentations is increasing in the setting of risi...
Using Point-of-Care Ultrasound for Early Identification of Central Retinal Artery Occlusion
Farhan Qadeer, MD, Ramzan Judge, PharmD, BCCCP and Alina Chiccarine
Article Type: Case Report | First Published: January 22, 2022
Central Retinal Artery Occlusion (CRAO) is the partial or complete blockage of the central retinal artery presenting as acute painless monocular vision loss with increased risk in those with cardiovascular disease. Diagnosis of CRAO requires a dilated fundoscopic exam performed by an Ophthalmologist. In resource limited hospitals, access to these expertise and resources may be difficult. Early recognition of CRAO in the emergency department (ED) can lead to reduced negative consequences and redu...
Modified HScore Predicts Increased Length of Stay but not Mortality in ICU Patients with COVID-19- A Retrospective Cohort Study
Jaskirat K Gill, MD, Megan G Anders, MD, MS, Adnan T Bhutta, MD, Miranda Gibbons, BS, Peter Rock, MD MBA, Thomas Scalea, MD and Ali Tabatabai, MD
Article Type: Cohort Study | First Published: January 12, 2022
Hemophagocytic Lymphohistiocytosis (HLH) is an acute and rapidly progressive systemic inflammatory disorder that can be classified into primary HLH (pHLH), which is a pediatric disease, and secondary HLH (sHLH), which can be associated with infection, malignancy, systemic diseases or drugs. The disease is characterized by cytopenia, excessive cytokine production, and hyperferritinemia, and clinically presents with ongoing fevers, lymphadenopathy, hepatosplenomegaly, and multiorgan failure. Of th...