Emergency Medicine

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Emergency Medicine

Resources for managing ER patients

15  articles in this collection
Written by Mathias Castonguay, Angie Shen, Noémie Desgagnés, Johann Graham, 

Is Diarrhea a Frequent Symptom?

The incidence of diarrhea is varying from 2% to 33% and may be underestimated in clinical publications ACE2, a known receptor used by SARS-CoV2 to enter cells, is more expressed in proximal and distal enterocytes SARS-CoV2 appears to invade mucosal cells of the stomach, small intestine and colon where it multiplies and creates virions.2 SARS-CoV […]

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04/06/2020

Pediatric Multi-System Inflammatory Syndrome: A New Clinical Presentation in Children

The United States (including New York City) and the United Kingdom have recently reported cases of multi-system inflammatory syndrome in children and adolescents potentially associated with COVID-19. The NYC Health Department reported 15 patients hospitalized between April 17 and May 1 with symptoms consistent with this syndrome. The presentation varies between a typical Kawasaki disease, […]

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05/17/2020

Are NSAIDs Safe with Children?

Fever in pediatric patients is usually managed using antipyretic medication like acetaminophen and ibuprofen; A review of case-control studies² proposed that NSAIDs could increase the risks of complications in cases of respiratory disease. The hypothesis lies in the inhibiting effect on cyclo-oxygenase, which diminishes white cells recruitment and making harder for the inflammation to resolve; No […]

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05/04/2020

Lab Tests and Severity of Infection in Children

A progressive lymphopenia < 1000 seems to be associated with a more severe disease; CRP (C-Reactive Protein) appears to be elevated in some cases, but could be explained by bacterial co-infection. Elevated PCT (procalcitonin) levels could also point out to a coinfection and should be included in the blood work. These patients might be more […]

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03/28/2020

Anosmia as a Marker of Infection

Anosmia/hyposmia and ageusia are present in a majority of Covid-19 patients (5, 6) These symptoms are significantly more frequent in COVID-19 patients than influenza patients(1) and influenza-like patients. (6) They usually have an acute onset and commonly present as an initial manifestation. (1,5) Most patients reported complete or partial recovery of smell and taste. (1,6) […]

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03/26/2020

DIC a Prognostic Factor of Mortality

DIC (Disseminated Intravascular Coagulation) is highly associated with death, as the majority of patients (71%) who died from NCP (novel coronavirus pneumoniae) met the criteria for DIC (with median time of four days after admission) compared to few survivor (0.6% developing DIC). Coagulation parameters (mainly D-dimers) should be done at baseline and followed throughout the […]

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03/27/2020

Hematologic Parameters and Need of ICU Care

Lymphopenia is frequent1,2 and severe lymphopenia may be useful to identify patients that will need ICU care1,2,3. Patients requiring ICU tend to have higher LDH (lactate dehydrogenase) and higher ANC (absolute neutrophil count)1,2,3. Thrombocytopenia is frequent2,3, but does not seem to correlate the need of ICU care.1,2,3. Hemoglobin, monocyte, prothrombin time, activated partial thromboplastin time […]

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04/01/2020

Lymphopenia as a Classification and Prediction Tool

The LYM% (blood lymphocyte percentage) can be used as a reliable indicator to classify the infection as moderate, severe and critical independently of any other auxiliary indicators. TML (Time-LYM%-model) is a tool of classification and prognosis prediction. TML-1 is defined as the LYM% at day 10-12 after symptom onset and TML-2 is the LYM% at […]

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04/01/2020

Stratifying the Risk Among Cancer Patients

Prior anti-tumor treatment within 14 days before COVID-19 diagnosis is a major risk factor for developing severe events.1 Patchy consolidation on the first CT on admission is a major risk factor for developing severe events.1 Patients with blood cancer and metastatic cancer seem to have a higher risk of severe events compared to patients without […]

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03/29/2020

First Case of Cardiac Tamponade

Cardiac tamponade may be a potential symptom of SARS-CoV2 infection   This case report demonstrates the first case of COVID-19-related cardiac tamponade. The 47-year-old Afro-Caribbean patient was admitted in March 2020 at the King’s College Hospital, London, UK. Initial echocardiogram showed small to moderate pericardial effusion. Upon deteriotation of patient, repeat echocardiagram showed cardiac tamponade […]

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04/06/2020

The Impacts on STEMI Care

Patients who suffered from STEMI presented a delay of 4 hours from symptom onset to first medical contact, as compared to the same patient population from the prior year. Potential causes to the delays are reluctance to seek medical care, not seeking care at all, or precaution measures after hospital arrival, delaying access to catheterization laboratories […]

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03/28/2020

Review of Imaging Findings

Bilateral multilobar ground-glass opacification with a peripheral or posterior distribution is found in COVID-19. Generally in lower lobes and less frequently the right middle lobe.  Atypical initial imaging can be found mainly in the elderly population Greatest severity of CT scan found around day 10 of symptom onset.  Less common findings that may be seen […]

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03/29/2020

High-Flow Nasal-Oxygenation-Assisted Fiberoptic Tracheal Intubation

The intubation time in the high-flow nasal oxygenation (HFNO) group was significantly shorter than in the standard mask oxygenation (SMO) group (69 seconds versus 76 seconds) There was a lower use of rescue face-mask ventilation in the HFNO group than in the SMO group (4% versus 27%) The desaturation rates (SpO2)  were lower in the HFNO group […]

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03/27/2020

Dengue Fever as a Differential Diagnosis

Initial dengue IgG and IgM serology results might be falsely positive in the early-onset presentation of COVID-19 Dengue fever and early onset of SARs-COV-2 infection may present with similar symptoms. Thrombocytopenia and lymphopenia are laboratory findings presented in two patients who tested positive for COVID-19 after having a false positive dengue serology result.    This […]

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03/28/2020

Are 0-3 Years Old More at Risk ?

In pediatric patients, fever and dry cough were the most common symptoms. Less frequent symptoms included diarrhea, nasal congestion, dyspnea, abdominal pain and vomiting. Most children had mild symptoms.  The highest incidence of COVID-19 was found in children of less than three years old. Moreover, the two children who developed severe illness were in this […]

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03/26/2020