Many public officials are calling for increased testing for the 2019 novel coronavirus disease (COVID-19), and some governments have taken extraordinary measures to increase the availability of testing. However, little has been published about the sensitivity and specificity of the reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs that are commonly used for testing.
As an emergency and wellness physician, scientist, father, and 55-year-old man, I have a keen interest in the coronavirus and the resulting COVID-19/severe acute respiratory syndrome (SARS) CoV2 illness. Based on all I have heard from the scientific community, a review of the literature, and a review of historical facts related to other epidemics, I believe we are missing some key points, particularly with regard to how we are approaching prevention of morbidity and mortality.
As clinicians and support personnel struggle with their responsibilities to treat during the current COVID-19 pandemic, several ethical issues have emerged.
During the current COVID-19 pandemic, the limited surge capacity of the healthcare system is being quickly overwhelmed. Similar scenarios play out when an institution’s systems fail, or when local or regional disasters occur. In these situations, it becomes necessary to use one or more alternative care sites (ACS).
In disasters such as the COVID-19 pandemic, we need to use all available resources to bolster our healthcare workforce. Many factors go into this process, including selecting the groups of professionals we will need, streamlining their licensing and credentialing processes, identifying appropriate roles for them, and supporting their health and well-being.
The ongoing spread of COVID-19, also known as the novel coronavirus, has created significant concerns often leading to panic throughout the world as to its virulence and lethality. Regularly published media track newly infected patient rates and deaths further driving public panic, which invariably leads to people seeking information.
The global novel coronavirus (COVID-19) pandemic continues to worsen and has become one of the largest clinical and operational challenges faced by emergency medicine since its inception as a specialty. As the virus spreads across the United States, our emergency departments (ED) continue to see increased volumes of infected patients, many of whom are not only critically ill, but acutely aware and fearful of their circumstances and potential mortality.
On March 10, 2020, the World Health Organization declared a global pandemic due to widespread infection of the novel coronavirus 2019 (COVID-19). We report the preliminary results of a targeted program of COVID-19 infection testing in the ED in the first 10 days of its initiation at our institution.
The National Institutes of Health is conducting a Phase 1 clinical trial to evaluate for a potential vaccine and the recipients have started to receive the investigational vaccine.2 We present a brief overview of the potential prophylactic and treatment agents under investigation, some which could be initiated in the ED if proven effective.
Angiotensin-converting enzyme 2 (ACE2) and its role in viral transmission and associated morbidity has also been a topic of recent COVID-19 associated discussion. ACE2 receptors on pulmonary endothelium serve as a main entry point for coronavirus.
Our objective was to narratively summarize 15 apps that address physical and cognitive limitations and have the potential to improve OAs’ quality of life, especially during social distancing or self-quarantine.
The lack of COVID-19 testing capacity threatens the ability of both the United States (US) and low middle income countries (LMIC) to respond to this growing threat, The purpose of this study was to assess the effectiveness through participant self-assessment of a rapid response team (RRT) mobile laboratory curriculum.
Extubation is infrequently performed in the ED, and a paucity of outcome data exists. Our objective was to descriptively analyze characteristics and outcomes of patients extubated in an ED-ICU setting.
Prior literature has shown that as many as 40% of ED patients do not receive lung protective ventilation. Our goal was to determine whether differences exist between the percent of males vs females who are ventilated at ≥ 8 milliliters per kilogram (mL/kg) of predicted body weight.
We performed a crossover study first year emergency medicine residents and third and fourth year medical students. After a brief instructional video followed by hands on practice, participants performed both techniques in random order on a simulated model for two minutes each. Returned tidal volumes and peak pressures were measured.
Basilar artery occlusion (BAO) may be clinically occult due to variable and non-specific symptomatology. We evaluated the qualitative and quantitative determination of a hyperdense basilar artery (HDBA) on non-contrast computed tomography (NCCT) brain for the diagnosis of BAO.
Pulmonary hypertension (PH) is a common, yet under-diagnosed, contributor to morbidity and mortality. Our objective was to characterize the prevalence of PH among adult patients presenting to United States (US) emergency departments (ED) and to identify demographic patterns and outcomes of PH patients in the ED.
Multiple studies have shown the tidal volumes typically delivered by the adult BVM are often higher than recommended for lung-protective ventilation protocols. In this study we measure and compare the ventilation parameters delivered by the adult and pediatric BVM ventilators.
Interest is growing in specialty-specific assessments of student candidates based on clinical clerkship performance to assist in the selection process for postgraduate training. The most established and extensively used is the emergency medicine (EM) Standardized Letter of Evaluation (SLOE), serving as a substitute for the letter of recommendation.
With the unpredictable future of the coronavirus disease 2019 (COVID-19) pandemic, institutions have begun altering the clinical experience for students and instituting travel bans for both their faculty and students.1 On March 17, 2020, a joint recommendation from the Association of American Medical Colleges and the Liaison Committee on Medical Education was issued, which supported suspending clinical activities for medical students for a two-week minimum
The COVID-19 pandemic has generated enhanced focus on the safety of healthcare providers and efforts to mitigate the risks of viral transmission.1 Reports of previous viral epidemics have described substantially increased risk to providers performing laryngoscopy and tracheal intubation in patients infected with the virus.
Across the world, efforts are underway to contain the spread and mitigate the impact of COVID-19. These include social distancing efforts such as working from home and meeting via teleconferences.8 The nature of public safety both necessitates that first-responder personnel be present at the station and requires vigilance to keep them healthy to provide essential services to the community. As a result, the fire station represents a front line in the COVID-19 mitigation efforts.
The primary goal of this study was to describe the quantity of and reasons for calls for medical direction. We also sought to determine time diverted from emergency physicians due to OLMD. Finally, we hoped to identify any areas for potential improvement or additional training opportunities for EMS providers.
Most research on drug use occurs in clinics or hospitals; few studies have evaluated the impact of opioid use on emergency medical services (EMS) or the EMS response to opioid use disorder (OUD). This study describes the perceived burden of disease, data collection, and interventions in California local EMS agencies (LEMSA).
We describe our experience treating patients with midazolam for behavioral emergencies in a large urban EMS system. We hypothesized that using midazolam for acute agitation leads to improved clinical conditions without causing significant clinical deterioration.
