scholarly journals Just the Facts: Airway management during the coronavirus disease 2019 (COVID-19) pandemic

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 440-444 ◽  
Author(s):  
George Kovacs ◽  
Nicholas Sowers ◽  
Samuel Campbell ◽  
James French ◽  
Paul Atkinson
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Airway Management ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Upper Respiratory Tract ◽  
Upper Respiratory

A previously healthy 42-year-old male developed a fever and cough shortly after returning to Canada from overseas. Initially, he had mild upper respiratory tract infection symptoms and a cough. He was aware of the coronavirus disease-2019 (COVID-19) and the advisory to self-isolate and did so; however, he developed increasing respiratory distress over several days and called 911. On arrival at the emergency department (ED), his heart rate was 130 beats/min, respiratory rate 32 per/min, and oxygenation saturation 82% on room air. As per emergency medical services (EMS) protocol, they placed him on nasal prongs under a surgical mask at 5 L/min and his oxygen saturation improved to 86%.

scholarly journals Silent hypoxia: a frequently overlooked clinical entity in patients with COVID-19

2020 ◽  
Vol 13 (9) ◽  
pp. e237207 ◽  
Author(s):  
Atanu Chandra ◽  
Uddalak Chakraborty ◽  
Jyotirmoy Pal ◽  
Parthasarathi Karmakar
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Wide Spectrum ◽  
Severe Pneumonia ◽  
Upper Respiratory Tract ◽  
Low Oxygen ◽  
Severe Hypoxaemia ◽  
Upper Respiratory

COVID-19 caused by SARS-CoV-2 may present with a wide spectrum of symptoms ranging from mild upper respiratory tract infection like illness to severe pneumonia and death. Patients may have severe hypoxaemia without proportional features of respiratory distress, also known as ‘silent’ or ‘apathetic’ hypoxia. We present a case of a 56-year-old man with COVID-19 who presented to the fever clinic of our institution with fever and cough without any respiratory distress but low oxygen saturation. The patient deteriorated over the next 2 days but eventually recovered of his illness in due course of time. This case demonstrates ‘silent hypoxia’ as a possible presentation in COVID-19 and emphasises the importance of meticulous clinical examination including oxygen saturation measurements in suspected or confirmed patients.

Cultural "latrogenic" Cleft Palate

PEDIATRICS ◽  
1986 ◽  
Vol 78 (3) ◽  
pp. 511-511
Author(s):  
AMIN Y. BARAKAT ◽  
USAMA ITANI ◽  
GEORGE M. ZAYTOUN
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Distress ◽  
Cleft Palate ◽  
Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Difficulty Breathing ◽  
Congenital Cleft ◽  
Upper Respiratory ◽  
Feeding Difficulty

Pediatricians are familiar with congenital cleft palates and those occurring as a part of a multisystem abnormality. We have encountered a child with a cultural "iatrogenic" cleft palate. The patient is a 5-year-old girl who appeared normal until 4 months of age, at which time she became febrile and had difficulty breathing as a result of an upper respiratory tract infection. She was not attended to by a physician, but a uvulectomy, supposedly to prevent respiratory distress, was performed by a laywoman considered by the villagers to be a "specialist" in the procedure. Following the uvulectomy, the infant experienced feeding difficulty, choking on solid and liquid foods.

How Evidence-Based is our Practice in a Hong Kong Emergency Department?

2003 ◽  
Vol 10 (4) ◽  
pp. 202-214
Author(s):  
PKM Pang ◽  
B Lim ◽  
KP Lee ◽  
CL Lok ◽  
CS Chung ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Daily Practice ◽  
Upper Respiratory Tract Infection ◽  
Evidence Based ◽  
Upper Respiratory Tract ◽  
Positive Interventions ◽  
Upper Respiratory

Objective To evaluate how evidence-based our daily practice was. Design Retrospective study. Setting Emergency department of a public district hospital. Patients and Methods Between 1st August 2000 to 7th August 2000, 91 patients' records were chosen at random. A chief diagnosis was assigned for each patient. Corresponding treatments were reviewed by searching relevant randomised controlled trials (RCTs), systematic reviews and meta-analyses. Each patient had only one chief diagnosis but could have multiple interventions for that diagnosis. Results Out of 91 records, 14 were discarded. All of them had not been given any intervention and 11 required admission. For the remaining 77 records, there were 38 subjects in medical, paediatric, or gynaecological specialties and 39 in surgical or orthopaedic specialties. Intervention(s) given for each subject were then searched electronically through our hospital Knowledge Gateway and the results were expressed as either EBM-positive or EBM-negative. “EBM-positive” interventions denoted a support by RCTs. “EBM-negative” interventions denoted an absence of any supportive RCTs. Each patient might have EBM-positive and/or EBM-negative interventions together if that patient received more than one treatment. There were 52 patients (52/77 = 68%) who had one of their interventions being RCT-supported. The majority were patients with (1) antipyretic use of paracetamol in upper respiratory tract infection, or (2) control of pain by nonsteroidal anti-inflammatory drug, dologesic and paracetamol. There were 25 patients (25/77 = 32%) who did not receive any RCT-supported interventions. Concurrently 53 patients out of 77 (69%) received EBM-negative interventions. The majority were patients with (1) the use of antibiotics, antitussives and antihistamines in upper respiratory tract infection, (2) antispasmodics in gastroenteritis or patients with nonspecific abdominal pain, and (3) the use of analgesic balm in minor orthopaedic complaints. Conclusion Sixty-eight percent of patients had EBM-positive interventions. Thirty-two percent of patients did not receive any EBM-positive intervention. It was quite encouraging as compared to studies in other specialties with similar design. Concurrently 69% of patients had also been given EBM-negative interventions. There were areas for improvement if we were to implement EBM practice in the emergency department.

scholarly journals An Analysis of Unscheduled Return Visits to the Accident and Emergency Department of a General Public Hospital

2003 ◽  
Vol 10 (3) ◽  
pp. 153-161 ◽  
Author(s):  
CP Ng ◽  
CH Chung
Keyword(s):  
Emergency Department ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Related Factors ◽  
Public Emergency ◽  
Upper Respiratory ◽  
Return Visits

Objectives To identify the reasons for unscheduled return visits to a public emergency department and possible strategies to reduce unscheduled return visits. Design Cross-sectional survey. Setting A public emergency department in Hong Kong. Patients Unscheduled return visits within 48 hours in a three-month period from 14 January 2000 to 15 April 2000. Main outcome measures Patients' epidemiological characteristics, reasons, complaints and outcome of the unscheduled return visits. Results During the study period, 3.3% (1,060) of the attendance was unscheduled return visits within 48 hours as recorded in the computerized A&E Information System of the hospital. However, only 738 patients (70%) responded to the questionnaire. These 738 patients formed the study population for further analysis. Illness-related factors accounted for 87% of the total unscheduled return visits. Patient-related factors were responsible for about 10% of unscheduled return visits. Doctor-related factors accounted for about 3% of unscheduled return visits. There was only one system-related unscheduled return visit. For the outcome of return visits, about 76% (559) was discharged after the second consultation. About 5% (40) was referred to specialist clinics. Around 24% (179) of patients was admitted. Of those admitted, 78% (140) was illness-related, 13% (23) was patient-related and 9% (16) was doctor-related. Upper respiratory tract infection was the most frequent complaint (34%), followed by painful conditions (23%) and injuries (10%). For children at or below 10 years of age, upper respiratory tract infection (60%) and febrile illness (15%) were the most frequent complaints. Conclusions The study found that the reasons for return visits were multiple. These “unscheduled return visits” should not be automatically regarded as poor indicator of service. Better patient education, organized family practice system, upgrading of professional training and targeted audit are possible means to reduce unscheduled return visits.

scholarly journals Post-Christmas Blues: A Rare Cause of Cyanosis

2001 ◽  
Vol 8 (1) ◽  
pp. 39-40
Author(s):  
Laurie Barron ◽  
H Jay Biem
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Oxygen Saturation ◽  
Respiratory Tract Infection ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Transcutaneous Oxygen ◽  
Transcutaneous Oxygen Saturation ◽  
Upper Respiratory ◽  
Symptoms And Signs

A patient was referred for urgent evaluation of cyanosis. Although she had symptoms and signs of an upper respiratory tract infection, she had a normal cardiorespiratory examination and normal transcutaneous oxygen saturation. Further evaluation revealed a benign cause for the cyanosis.

scholarly journals Just the Facts: Postintubation sedation in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 764-767
Author(s):  
Hans Rosenberg ◽  
Ariel Hendin ◽  
Erin Rosenberg
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Heart Rate ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Video Laryngoscopy

A 67-year-old male presents to the emergency department (ED) in respiratory distress secondary to pneumonia. His oxygen saturation is 86% on a nonrebreather, respiratory rate is 32 respirations/minute, blood pressure 147/72 mmHg, heart rate 121 beats/minute, and temperature is 38.7° Celsius. The decision is made to intubate the patient. Fentanyl and propofol are used for analgesia and sedation, and rocuronium is used for paralysis. Using video laryngoscopy, the patient is successfully intubated, and now the ED team is awaiting your orders for the postintubation sedation care of this patient.

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