scholarly journals SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital

2021 ◽  
Vol 17 (4) ◽  
Author(s):  
Greta Barbieri ◽  
Alessandro Cipriano ◽  
Stella Carrara ◽  
Stefano Spinelli ◽  
Francesco Cinotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Failure ◽  
Risk Stratification ◽  
Care Setting ◽  
Small Sample ◽  
Flow Chart ◽  
University Hospital ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Pandemic Wave

SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital Background: COVID-19 patients require early treatment and admission to an appropriate care setting, considering possible rapid and unpredictable to Severe Acute Respiratory Syndrome. Objective: A flow-chart was developed by a multidisciplinary team of Emergency Department (ED) clinicians, intensivists and radiologists aiming to provide tools for disease severity stratification, appropriate ventilation strategy and hospitalization setting identification. Methods: We conducted a retrospective application of our model on 313 hospitalized patients at Pisa University Hospital including 222 patients admitted to ED for respiratory failure between March and April 2020. Risk stratification score was based on respiratory and chest imaging parameters, while management strategy on comorbidities and age.  Results: Age, comorbidities, clinical respiratory and arterial blood gas parameters, semi-quantitative chest computed tomography score were significant predictors of mortality (p<0,05). Mortality rate was higher in patients treated in intensive care units (26,5%) and undergoing endo-tracheal intubation (32,7%), compared to medical area (21,3%). We verified a good concordance (81,7%) between the proposed model and actual evaluation in ED. Outcomes analysis of subgroups of patients homogeneous for baseline features allowed to verify safety of our model: in non-elderly and/or non-comorbid patients (15% mortality) our scheme overestimates the risk in 30% of cases, but it suggests non-intensive management in patients with reduced functional reserve, elderly and with comorbidities (50% mortality). Conclusion: Correct management of respiratory failure COVID-19 patients is crucial in this unexpected pandemic. Our flow-chart, despite retrospectively application in small sample, could represents a valid and safe proposal for evaluation in ED.

scholarly journals The Use of Inhaled Epoprostenol for Acute Respiratory Distress Syndrome Secondary due to COVID-19: A Case Series

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Komal Imtiaz ◽  
Wade Jodeh ◽  
Dave Sudekum ◽  
Bruno DiGiovine ◽  
Jason Hecht
Keyword(s):  
Respiratory Failure ◽  
Small Sample Size ◽  
Case Series ◽  
Small Sample ◽  
Teaching Hospitals ◽  
Arterial Oxygen ◽  
Severe Respiratory Failure ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Pulmonary Vasodilator

Abstract Introduction Inhaled epoprostenol (iEpo) is a pulmonary vasodilator used to treat refractory respiratory failure, including that caused by Coronavirus 2019 (COVID-19) pneumonia. Aim of Study To describe the experience at three teaching hospitals using iEpo for severe respiratory failure due to COVID-19 and evaluate its efficacy in improving oxygenation. Methods Fifteen patients were included who received iEpo, had confirmed COVID-19 and had an arterial blood gas measurement in the 12 hours before and 24 hours after iEpo initiation. Results Eleven patients received prone ventilation before iEpo (73.3%), and six (40%) were paralyzed. The partial pressure of arterial oxygen to fraction of inspired oxygen (P/F ratio) improved from 95.7 mmHg to 118.9 mmHg (p=0.279) following iEpo initiation. In the nine patients with severe ARDS, the mean P/F ratio improved from 66.1 mmHg to 95.7 mmHg (p=0.317). Ultimately, four patients (26.7%) were extubated after an average of 9.9 days post-initiation. Conclusions The findings demonstrated a trend towards improvement in oxygenation in critically ill COVID-19 patients. Although limited by the small sample size, the results of this case series portend further investigation into the role of iEpo for severe respiratory failure associated with COVID-19.

scholarly journals Discharge against medical advice from the emergency department in a university hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feras H. Abuzeyad ◽  
Moonis Farooq ◽  
Salah Farhat Alam ◽  
Mudhaffar Ismael Ibrahim ◽  
Luma Bashmi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
Small Sample ◽  
Medical Advice ◽  
University Hospital ◽  
High Risk Population ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Level 3 ◽  
Collection Form

Abstract Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

Efficacy of Computer-Assisted Management of Respiratory Failure in Neonates

PEDIATRICS ◽  
1986 ◽  
Vol 78 (1) ◽  
pp. 139-143 ◽  
Author(s):  
Waldemar A. Carlo ◽  
Lucia Pacifico ◽  
Robert L. Chatburn ◽  
Avroy A. Fanaroff
Keyword(s):  
Respiratory Failure ◽  
Computer Program ◽  
Computer Assisted ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii ◽  
Assisted Management

We modified an algorithm for mechanical ventilation of infants with respiratory distress syndrome to create an interactive user-friendly computer program. To determine the effectiveness of this computer program, we evaluated the correction of deranged arterial blood gases in three groups of neonates: group I, treated before the introduction of the computer into the nursery; group II, managed by pediatric residents with the guidance of the computer program; group III, treated after the introduction of the computer into the nursery but managed without consideration of the computer output. Arterial blood gas values improved more frequently in the neonates managed with computer consultation (group II, 65/75, 87%) than in both control groups (group I, 37/57, 65%, P &lt; .005; and group III, 46/63, 73%, P &lt; .05). Furthermore, increases in ventilatory support in the presence of normal arterial blood gas values occurred only in patients managed without computer guidance. In a teaching institution, more effective care of neonates with respiratory failure may be facilitated by computer-assisted management of mechanical ventilators.

A Model Pilot

2020 ◽  
pp. 71-76
Author(s):  
Pat Croskerry
Keyword(s):  
Emergency Department ◽  
Respiratory Rate ◽  
Correct Diagnosis ◽  
Anxiety State ◽  
Blood Gas ◽  
Blurred Vision ◽  
Arterial Blood Gas ◽  
The Past ◽  
Arterial Blood ◽  
Eye Examination

In this case, a 43-year-old male presents to the emergency department complaining of blurred vision during the past few days. He appears apprehensive. His eye examination is completely normal. On the basis of his increased respiratory rate and apprehension, a diagnosis of anxiety state is made, and he is discharged home. He returns the next day with continuing symptoms. On this occasion, an arterial blood gas is ordered, which eventually reveals his correct diagnosis.

Successful Treatment of Experimental Neonatal Respiratory Failure Using Extracorporeal Membrane Lung Assist

1986 ◽  
Vol 9 (6) ◽  
pp. 427-432 ◽  
Author(s):  
R. Fumagalli ◽  
T. Kolobow ◽  
P. Arosio ◽  
V. Chen ◽  
D.K. Buckhold ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Pulmonary Ventilation ◽  
Blood Gases ◽  
Blood Gas ◽  
Arterial Blood Gases ◽  
Arterial Blood Gas ◽  
Membrane Lung ◽  
Arterial Blood ◽  
Long Term Survivors

A total of 44 preterm fetal lambs at great risk of developing respiratory failure were delivered by Cesarean section, and were then managed on conventional mechanical pulmonary ventilation. Fifteen animals initially fared well, and 14 of these were long term survivors. Twenty-nine other lambs showed a progressive deterioration in arterial blood gases within 30 minutes of delivery, of which 10 lambs were continued on mechanical pulmonary ventilation (20% survival), while the remaining 19 lambs were placed on an extracorporeal membrane lung respiratory assist (79% survival). Extracorporeal membrane lung bypass rapidly corrected arterial blood gas values, and permitted the use of high levels of CPAP instead of the continuation of mechanical pulmonary ventilation at high peak airway pressures. Improvement in lung function was gradual, and predictable. Early institution of extracorporeal respiratory assist using a membrane artificial lung rapidly corrected arterial blood gas values and significantly improved on neonate survival.

Schizophrenia and Respiratory Symptoms: A Serious, but Overlooked, Comorbidity

CNS Spectrums ◽  
2010 ◽  
Vol 15 (S8) ◽  
pp. 10-13 ◽  
Author(s):  
Peter J. Weiden ◽  
Michael Weiden
Keyword(s):  
Respiratory Failure ◽  
Respiratory Symptoms ◽  
Psychiatric Treatment ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Intramuscular Dose ◽  
Arterial Blood ◽  
Long Time ◽  
History Of ◽  
Physical Danger

Mr. A is 24 years of age with a history of schizophrenia (Slide 1). He has been living with his parents and has been ill for a few years. Police saw him on the street in a state of crisis and brought him to the emergency room (ER). He was very anxious and his delusions of being in great physical danger had worsened. He reported a history of asthma, but it was noted that his asthma occurred a long time ago and was inactive; however, due to his anxiety, his smoking had increased to where it was continuous. At the time he was brought to the ER, Mr. A was triaged to psychiatry and became agitated in the waiting area; hence, security was called. He was about to be restrained and given an intramuscular dose (IM) of lorazepam, but the psychiatrist noted that he was having trouble breathing and stopped the IM before it was given. The psychiatrist noticed that Mr. A was wheezing, had a rapid respiratory rate of 25/minute, was tachycardic, and sweating. His pulse oximeter measurement was 90% saturated, which is considered low.Mr. A was re-interviewed and reported that he previously had asthma. His parents were contacted and agreed that he had active asthma, had stopped his psychiatric treatment several months ago, and, more recently, stopped his asthma medications when his prescriptions were not refilled ∼1 week prior to this episode. An emergency arterial blood gas showed a pH of acidosis at 7.27; a Po2 of 60 (normal is 80); and a Pco2 of 48 (normal is 40). The Pco2 was of particular concern because if he was retaining CO2, respiratory failure was imminent.

Comparison of arterial and capillary blood gas values in poisoning department assessment

2009 ◽  
Vol 28 (10) ◽  
pp. 665-670 ◽  
Author(s):  
Nastaran Eizadi-Mood ◽  
Sam Alfred ◽  
Ahmad Yaraghi ◽  
Chanh Huynh ◽  
Ali Shayesteh Moghadam
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Prospective Study ◽  
Base Excess ◽  
Vital Signs ◽  
Area Under The Curve ◽  
Capillary Blood ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood

The aim of this study was to compare simultaneously obtained arterial and capillary blood gas (CBG) values in comatose-poisoned patients presented with stable vital signs. Forty-five adult patients with a diagnosis of coma because of poisoning and stable vital signs were included in this prospective study. With respect to pH, the arterial blood gas (ABG) and CBG values correlated satisfactorily (r2 = .91) and had an acceptable limit of agreements (LOAs; —0.04 to 0.06). With respect to base excess (BE), the ABG and CBG values correlated well (r2 = .85), but their 95% LOAs seem too wide to allow substitution (—4.4 to 2.7). PCO2 (r2 = .61), HCO3 (r2 = .71) and PO2 (r2 = .53) correlated less reliably. A capillary PCO2 of 51.7 mm Hg had a sensitivity of 100% and a specificity of 95.12% for detecting hypercarbia (area under the curve, 0.99; 95% Confidence Interval, 0.90-0.99; p < .0001). In conclusion, CBG analysis for pH may be a reliable substitute for ABG analysis in the initial evaluation of patients presenting with coma and stable vital signs to the poisoning emergency department (PED). Subsequent ABG may be required in patients with capillary PCO2 > 51.7 mm Hg.

scholarly journals Correlation between arterial blood gas and CT volumetry in patients with SARS-CoV-2 in the emergency department

2020 ◽  
Vol 97 ◽  
pp. 233-235 ◽  
Author(s):  
Gianni Turcato ◽  
Luca Panebianco ◽  
Arian Zaboli ◽  
Christoph Scheurer ◽  
Dietmar Ausserhofer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Gas ◽  
Ct Volumetry ◽  
Arterial Blood Gas ◽  
Arterial Blood

scholarly journals Twenty-Four Hour Noninvasive Ventilation in Duchenne Muscular Dystrophy: A Safe Alternative to Tracheostomy

2013 ◽  
Vol 20 (1) ◽  
pp. e5-e9 ◽  
Author(s):  
Douglas A McKim ◽  
Nadia Griller ◽  
Carole LeBlanc ◽  
Andrew Woolnough ◽  
Judy King
Keyword(s):  
Respiratory Failure ◽  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Noninvasive Ventilation ◽  
Gas Analysis ◽  
Blood Gas ◽  
Safe Alternative ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
The Mean

BACKGROUND: Almost all patients with Duchenne muscular dystrophy (DMD) eventually develop respiratory failure. Once 24 h ventilation is required, either due to incomplete effectiveness of nocturnal noninvasive ventilation (NIV) or bulbar weakness, it is common practice to recommend invasive tracheostomy ventilation; however, noninvasive daytime mouthpiece ventilation (MPV) as an addition to nocturnal mask ventilation is also an alternative.METHODS: The authors’ experience with 12 DMD patients who used 24 h NIV with mask NIV at night and MPV during daytime hours is reported.RESULTS: The mean (± SD) age and vital capacity (VC) at initiation of nocturnal (only) NIV subjects were 17.8±3.5 years and 0.90±0.40 L (21% predicted), respectively; and, at the time of MPV, 19.8±3.4 years and 0.57 L (13.2% predicted), respectively. In clinical practice, carbon dioxide (CO2) levels were measured using different methods: arterial blood gas analysis, transcutaneous partial pressure of CO2and, predominantly, by end-tidal CO2. While the results suggested improved CO2levels, these were not frequently confirmed by arterial blood gas measurement. The mean survival on 24 h NIV has been 5.7 years (range 0.17 to 12 years). Of the 12 patients, two deaths occurred after 3.75 and four years, respectively, on MPV; the remaining patients continue on 24 h NIV (range two months to 12 years; mean 5.3 years; median 3.5 years).CONCLUSIONS: Twenty-four hour NIV should be considered a safe alternative for patients with DMD because its use may obviate the need for tracheostomy in patients with chronic respiratory failure requiring more than nocturnal ventilation alone.

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