Frontiers in Emergency Medicine
Volume:5 Issue: 4, Autumn 2021

The correlation between echocardiographic findings and the outcome of COVID-19 patients is still under debate.

In the present study it has been endeavored to evaluate the cardiovascular condition of COVID-19 patients using echocardiography and to assess the association of these findings with in-hospital mortality.

In this retrospective cohort study, hospitalized COVID-19 patients from February to July 2020 with at least one echocardiogram were included. Data were extracted from patients’ medical records and the association between echocardiographic findings and in-hospital mortality was assessed using a multivariate model. The findings were reported as relative risk (RR) and 95% confidence interval (95% CI).

Data from 102 COVID-19 hospitalized patients were encompassed in the present study (63.7±15.7 mean age; 60.8% male). Thirtypatients (29.4%) died during hospitalization. Tricuspid regurgitation (89.2%), mitral valve regurgitation (89.2%), left ventricular (LV) diastolic dysfunction (67.6%), pulmonary valve insufficiency (PI) (45.1%) and LV systolic dysfunction (41.2%) were the most common findings on patients’ echocardiogram. The analyses of data showed that LV systolic (p=0.242) and diastolic (p=0.085) dysfunction was not associated with in-hospital mortality of COVID-19 patients, whilethe presence of PI (RR=1.85; 95% CI: 1.02 to 3.33; p=0.042) and patients’ age (RR=1.03; 95% CI: 1.01 to 1.08; p=0.009) were the twoindependent prognostic factors of in-hospital mortality.

It seems that LV systolic and diastolic dysfunction was not associated with in-hospital mortality of COVID-19 patients. However, presence and PI and old age are possible prognostic factors of COVID-19 in-hospital mortality. Therefore, using echocardiography might be usefulin management of COVID-19.Key words:Echocardiography; Mortality; Outcome; SARS-CoV-2

Predicting the outcome is one of the most frequent and important issues when approaching patients with intracranial hemorrhage (ICH).

This study aimed to evaluate the correlation of SUSPEKT score variables plus electrocardiogram (ECG) abnormalities with one-month mortality of patients with ICH presenting to emergency department (ED).

In this cohort study, adult patients presenting to the EDs of three educational hospitals, during one year, were followed and their one-month mortality rate as well as independent predictors of outcome among the variables of SUSPEKT score plus electrocardiography findings were evaluated.

One hundred seventy-sevenpatients with the mean age of 63.07±14.89 years were studied (59.9%). The most common locations of intra-parenchymal hemorrhage were basal ganglia (53.7%) and cortex (36.2%). Ninety-two(52.0%) of cases had at least one ECG abnormality. The most frequent ECG abnormalities were ST segment depression (20.3%), T wave inversion (16.4%), and left ventricular hypertrophy (14.7%). Thirty(16.9%) cases died during the 30-day follow-up. Survived and non-survived cases were significantly different regarding the location of intra-parenchymal hemorrhage (p < 0.0001), presence of intraventricular hemorrhage (IVH) (p = 0.007), ST segment elevation (p < 0.0001), bradycardia (p < 0.0001), tachycardia (p <0.0001), arterial fibrillation (p < 0.0001), blood sugar (p = 0.044), and serumlevel of potassium (p = 0.022).

The location of hemorrhage (basal ganglia), higher blood sugar, and presence of ECG abnormalities (ST segment elevation, tachycardia, bradycardia, atrial fibrillation) were among the independent predictors of one-month mortality of ICH patients in this study.

Coronavirus Disease (COVID‐19) has become the most important global health issue, and chest computed tomography (CT) scan can help determine the severity of the infection.

This study aimed to provide an emergency scoring tool for predicting 30-day adverse outcomes in non-critical new-onset COVID-19 patients.

This derivationstudy was conducted on new-onset COVID-19 patients presenting to the emergency department of an urban teaching hospital in Tehran, Iran, between 20 February and 20 March 2020. The total lobe severity score (TSS), age, history of comorbidities, and 30-day adverse outcomes (death, ICU admission or intubation) were taken into account to produce three prediction models.

Overall, 137 patients wereincluded in the study. Their mean age was 59.9±16.8 years and 62% were male. The ground glass nodule, patch B/punctate ground-glass opacity, fibrous stripes, and air bronchogram sign with perihilar distribution, bilateral and ≥ 2 affected lobes were the most common findings. The mean TSS (model 1) was significantly higher in patients with an adverse outcome (9.4±3.2) compared to the discharged patients (7.2±3.3) (p<0.001, AUC: 0.703, sensitivity: 64.4% and specificity: 74.1%). The optimal cut-off point of model 2 (TSS and age) had the following parameters: AUC: 0.721, sensitivity: 71.2% and specificity: 67.2%. The optimal cut-off point of model 3 (TSS, age, comorbidities) had: AUC: 0.755, sensitivity: 79.7% and specificity: 65.5%. The discrimination achieved with model 3 based on Bonferroni’s test was significantly better than that achieved with TSS (p<0.001).

TSS combined with age and history of at least one comorbidity had a better predictive value for adverse outcomes with a cut-off point above 8.

 To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). 

 Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. 

 This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. 

 Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). 

 Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions.

Pre-hospital intubationis a challenging but essential intervention. During intubation, it is difficult to identify vocal cords when using a cervical collar and trauma board. Therefore, the success rate of intubation by paramedics decreases in trauma patients. Video laryngoscopyincreases intubation success rate and has been recommended for difficult airways in studies.

In this study, we compared the intubation success rates when using a video laryngoscope and a direct laryngoscope in a manikin with simulated cervical immobilization.

In this cross-sectional study, the manikin’s neck collar and spine board created a complicated airway model with cervical immobilization. Inexperienced paramedic students tried intubation with both methods, and their trial periods were recorded. Students answered a question evaluating the convenience of the procedure for both methods after the trial.

In this study, 83 volunteers, who were first-year and second-year paramedics, participated;32 (38.6%) of the volunteers were first-year students, while 51 (61.4%) were second-year students. All volunteers had previous intubation experience with direct laryngoscopy, but not with video laryngoscopy. There was a statistically significant difference in the first-attempt success rates of the procedure between the groups in favor of video laryngoscope (p=0.022). Note that there was no significant difference between the groups in terms of first attempt durations (p=0.337).

Video laryngoscopy in airway management can increase the success rate of first-attempt intubation by inexperienced pre-hospital healthcare personnel.

The lack of a fixed and clear protocol causes confusion for nurses resulting in care performance delay in the emergency room (ER). Given that the purpose of triage is to examine the patient upon arrival in ER for the rapid classification and prioritization of emergency patients in need of treatment, it seems that the development and implementation of hospital triage standards can greatly affect this purpose.

The present study was conducted to review the experiences of experts in hospital triage in terms of determining the standards of hospital ER triage.

This qualitative research was conducted through content analysis method based on Donabedian model. Participants include experts (Politician, Nurse Supervisor, Nurse, Midwife, Faculty of Nursing, Emergency Medicine Specialist) working in educational and private hospitals and single-specialized ERs. Data were collected through in-depth and semi-structured interviews lasting between 25-60 minutes. The main interview questions were: What are the structural standards of a good triage? What are the process standards for a good triage? What are the standards of a good triage? Data analyzed through Content Directed Analysis with Shannon and Hsieh approach.

Totally, 21 experts the mean age of 46.9±1.8 (ranged from 30 to 57) years and the mean work experience of 18.9± 8.21 years were participated, of whom 16 (76.2%) persons were male. From the analysis, we extracted 48 codes, 14 subcategories and 3 main categories of "structural standards", "process standards" and "outcome standards".

Guidelines are needed so that the nurse in charge of triage can quickly and accurately undertake the important responsibility of patient triage. Additionally, having structure and process and outcome standards improves triage performance.

In March 2020, the World Health Organization introduced the Coronavirus disease 2019 (COVID-19) pandemic as a global health concern and predicted that without any changes in the transmission process, the disease would reach its peak in April. Hence, it wasnot unreasonable to expect the referral of pregnant women in all trimesters. Since respiratory illnesses can increase the riskof infectious diseases and maternal mortality, it is justifiable to consider COVID-19-positive cases as high-risk pregnancies.

The present study introduced six pregnant women with COVID-19and discussedthe points to consider in managing these patients.

Pregnant women are at increased risk in all epidemics of infectious diseases due to their physiological and immunological changes. Moreover, the safety of the fetus is another important issueto consider.

There is an unmet clinical need to develop simple, easy, rapid, and accessible testing for the detection of SARS-CoV-2. Recent reports suggested that saliva may be a host for the virus. The existence of SARS-CoV-2 in saliva can be associated with oral manifestations in infected patients. A systematic review was conducted as well as a meta-analysis to evaluate the diagnostic accuracy of detecting SARS-CoV-2 in saliva and investigate the association between positive saliva test and oral manifestations of COVID-19.Evidence acquisition: A literature search in MEDLINE via PubMed, Scopus, Web of Science, and Cochrane was done in June 2020 and updated in February 2021 using relevant keywords. We screened studies for eligibility. The extracted data were analyzed using Meta-Disc software.

Eighteen studies were included. Pooled data from eligible studies showed that the sensitivity of diagnosis of SARS-CoV-2 in saliva was 0.86 (95% CI, 0.83–0.89), and the specificity was 0.98 (95% CI, 0.96–0.98). COVID-19 was associated with oral diseases as amblygeustia, dry mouth, dryness, inflammation of the mouth, and enlargement of lymph nodes in the submandibular regions.

Our results showedthat the saliva has a high accuracy in the detection of SARS-CoV-2.

Management of seriously ill patients infected with new corona virus (SARS-CoV-2) is challenging especially in pregnancy and postpartum state.

A 39-year-old primigravid critically ill woman with acute respiratory distress (ARDS) due to confirmed SARS-CoV-2 infection underwent urgent cesarean delivery (a healthy neonate) at 33 weeks and 5/7 of pregnancy. She received treatments including hydroxychloroquine, antivirals and broad-spectrum antibiotics while she was intubated for mechanical ventilation. In spite of all treatments, she developed a critical course after the mild primary clinical improvement. Convalescent plasma transfusion as a rescue treatment was performed and led to an improvement in her general condition and delayed gradual recovery in respiratory function after two months.

The promising role of early treatment with convalescent plasma transfusion in seriously ill pregnant women infected with SARS-CoV-2, needs to be elucidated by further randomized studies.

The possibility of foreign body ingestion should be considered in psychiatricpatients.In some complicated cases, foreign bodies become problematic and require immediate surgical intervention.

A 45-year-old man with schizophrenia swallowed razor blades and pieces of glass resulting in esophageal perforation, pneumothorax, pneumomediastinum and urgent need for surgery. He was presented in shock state but successfully passed post-operative period in the intensive care unit and surgical ward and was ultimately transferred to the psychiatric ward.

Management of asymptomatic patients depends on the demographic factors of patients as well as the site affected in the gastrointestinal tract.