Since COVID-19-associated coagulopathy is a very dynamic process, the phenotype can change during the course of infection and in response to anticoagulation therapy. Data from published literature provide evidence that the combination of rotational thromboelastometry and SCT analysis is helpful in detecting hemostasis issues, guiding anticoagulant therapy, and improving outcomes in COVID-19 patients. However, more research is needed to develop evidence-based guidelines and protocols.A previously healthy 12-month-old girl presented to the emergency department with vomiting of water beads (superabsorbent polymer). The girl did not have clinical or radiographic signs of residual foreign bodies or intestinal obstruction. Point-of-care ultrasound showed well-demarcated, round, and hypoechoic materials in the stomach and first part of the duodenum, indicating ingested beads. Subsequently, the beads were retrieved by the esophagogastroduodenoscopy. Because water beads can be readily found with point-of-care ultrasound, the use of this imaging modality can expedite endoscopic intervention and avoid surgical removal of foreign bodies.A 25-year-old man presented to the emergency department with acute-onset chest pain and shortness of breath. A physical examination revealed coarse crackles in the both lower lungs. Consolidation and ground-glass opacities suggesting viral infection were detected in the right lower lobe on chest computed tomography. Laboratory findings revealed elevated troponin, leukocytosis, and lymphopenia. Electrocardiography revealed ST segment elevation with PR depression in leads I, aVL, V5, and V6, and ST depression and PR elevation in aVR. Echocardiography revealed diffuse cardiac hypokinesia and a decreased left ventricular ejection fraction. Suspecting coronavirus disease 2019 (COVID-19)-related myopericarditis, the patient was hospitalized. After one week of empirical antibiotics, antivirals, and supportive therapy, his condition improved. Antibody testing for COVID-19 was positive on hospitalization day 8. The presentation of myopericarditis can be vague and mislead physicians during the COVID-19 pandemic. Myopericarditis should be included as a differential diagnosis for patients with suspected COVID-19.The coronavirus disease 2019 (COVID-19) pandemic mandated rapid, flexible solutions to meet the anticipated surge in both patient acuity and volume. learn more This paper describes one institution’s emergency department (ED) innovation at the center of the COVID-19 crisis, including the creation of a temporary ED-intensive care unit (ICU) and development of interdisciplinary COVID-19-specific care delivery models to care for critically ill patients. Mount Sinai Hospital, an urban quaternary academic medical center, had an existing five-bed resuscitation area insufficiently rescue due to its size and lack of negative pressure rooms. Within 1 week, the ED-based observation unit, which has four negative pressure rooms, was quickly converted into a COVID-19-specific unit, split between a 14-bed stepdown unit and a 13-bed ED-ICU unit. An increase in staffing for physicians, physician assistants, nurses, respiratory therapists, and medical technicians, as well as training in critical care protocols and procedures, was needed to ensure appropriate patient care. The transition of the ED to a COVID-19-specific unit with the inclusion of a temporary expanded ED-ICU at the beginning of the COVID-19 pandemic was a proactive solution to the growing challenges of surging patients, complexity, and extended boarding of critically ill patients in the ED. This pandemic underscores the importance of ED design innovation with flexible spacing, interdisciplinary collaborations on structure and services, and NP ventilation systems which will remain important moving forward.

Alcohol use is associated with high levels of morbidity and mortality. Alcohol problems are common in emergency departments (EDs). This study investigated the effect of screening and a new brief intervention (BI) protocol on alcohol consumption of ED patients.

The participants of this study were those aged 18 years or older who visited the ED due to injury over 12 weeks. BI was offered to patients with a score of 8 or higher on alcohol use disorders identification test (AUDIT) screening. Follow-up telephone assessments were conducted at one week, one month, and three months.

The risk drinker (RD) group (AUDIT 8-15) comprised 101 patients, and the alcohol use disorder (AUD) group (AUDIT >16) comprised 41 patients. Before the BI, the weekly mean alcohol intake amount for the RD group was 180.90±98.34 g and for the AUD group was 358.00± 110.62 g. Alcohol consumption was reduced to 132.39±75.87 g in the RD group and 181.86± 78.11 g in the AUD group in the 3-month follow-up assessment. Alcohol consumption in the AUD group reduced significantly compared to the RD group (P<0.001).

Alcohol screening and BI contributed to alcohol intake reduction in ED patients. Specifically, the BI effect was greater in the AUD group than the RD group. The ED can be an effective place to begin implementing screening and intervention for alcohol use patients at risk.

Alcohol screening and BI contributed to alcohol intake reduction in ED patients. Specifically, the BI effect was greater in the AUD group than the RD group. The ED can be an effective place to begin implementing screening and intervention for alcohol use patients at risk.

The utilization of emergency medical services (EMS) varies widely among communities. In this study, we aimed to evaluate the relationship between the use of EMS by patients with ST-elevation myocardial infarction (STEMI) and the individual and neighborhood characteristics of these patients.

We performed a secondary analysis of data from the Cardiovascular Disease Surveillance project, which included patients diagnosed with STEMI at 29 emergency centers in South Korea. Our analysis included only patients living in Seoul, and the primary outcome measured was the use of EMS. While the clinical variables of the patients were collected from the Cardiovascular Disease Surveillance registry, the 2010 National Census data was used to identify neighborhood variables such as population density, income, age, and residence type. We used a 3-level hierarchical logistic regression to estimate the effects of neighborhood-level factors on EMS use by individual patients.

We evaluated 1,634 patients with STEMI from 2007 to 2012.