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Results 1 through 20 out of 151

in category emergency medicine


1: Hydroxychloroquine application is associated with a decreased mortality in critically ill patients with COVID-19

Bo Yu, Dao Wen Wang et al.

13,389 downloads (posted 01 May 2020)

Importance: Coronavirus disease 2019 (COVID-19) is a pandemic with no specific drugs and high mortality. The most urgent thing is to find effective treatments. Objective: To determine whether hydroxychloroquine application may be associated with a decreased risk of death in critically ill COVID-19 patients and what is potential mechanism. Design, Setting and Patients: This retrospective study included all 568 critically ill COVID-19 patients who were confirmed by pathogen laboratory tests despite antiviral treatment and had severe acute respiratory distress syndrome, PAO2/FIO2 <300 with need of mechanical ventilation in Tongji Hospital, Wuhan, between February 1 of 2020 to April 8 of 2020. All 568 patients received comparable basic treatments including antiviral drugs and antibiotics, and 48 of them additionally received oral hydroxychloroquine (HCQ) treatment (200 mg twice a day for 7-10 days). Primary endpoint is mortality of patients, and inflammatory cytokines levels were compared between hydroxychloroquine and non-hydroxychloroquine (NHCQ) treatments. MAIN OUTCOMES AND MEASURES: In-hospital death and hospital stay time (day) were obtained, level of inflammatory cytokine (IL-6) was measured and compared between HCQ and NHCQ treatments. RESULTS: The median age of 568 critically ill patients is 68 (57, 76) years old with 37.0% being female. Mortalities are 18.8% (9/48) in HCQ group and 45.8% (238/520) in NHCQ group (p<0.001). The time of hospital stay before patient death is 15 (10-21) days and 8 (4 - 14) days for the HCQ and NHCQ groups, respectively (p<0.05). The level of inflammatory cytokine IL-6 was significantly lowered from 22.2 (8.3-118.9) pg/mL at the beginning of the treatment to 5.2 (3.0-23.4) pg/ml (p<0.05) at the end of the treatment in the HCQ group but there is no change in the NHCQ group. CONCLUSIONS AND RELEVANCE: Hydroxychloroquine treatment is significantly associated with a decreased mortality in critically ill patients with COVID-19 through attenuation of inflammatory cytokine storm. Therefore, hydroxychloroquine should be prescribed for treatment of critically ill COVID-19 patients to save lives.


2: AutoTriage - An Open Source Edge Computing Raspberry Pi-based Clinical Screening System

Chaitra Hegde, Zifan Jiang et al.

7,235 downloads (posted 11 Apr 2020)

With the recent COVID-19 pandemic, healthcare systems all over the world are struggling to manage the massive increase in emergency department (ED) visits. This has put an enormous demand on medical professionals. Increased wait times in the ED increases the risk of infection transmission. In this work we present an open-source, low cost, off-body system to assist in the automatic triage of patients in the ED based on widely available hardware. The system initially focuses on two symptoms of the infection - fever and cy...


3: Oxygen and mortality in COVID-19 pneumonia: a comparative analysis of supplemental oxygen policies and health outcomes across 26 countries.

The Gibraltar COVID-19 Research Group: Health Systems, Daniel Goyal

7,017 downloads (posted 04 Jul 2020)

Introduction Hypoxia is the main cause of morbidity and mortality in COVID-19. During the COVID-19 pandemic some countries have reduced access to supplemental oxygen (e.g. oxygen rationing), whereas other nations have maintained and even improved access to supplemental oxygen. We examined whether such variation in the access to supplemental oxygen had any bearing on mortality in COVID-19. Methods Three independent investigators searched for, identified and extracted the nationally recommended target oxygen levels for th...


4: Association of infected probability of COVID-19 with ventilation rates in confined spaces: a Wells-Riley equation based investigation

Hui Dai, Bin Zhao

5,198 downloads (posted 24 Apr 2020)

Background: A growing number of epidemiological cases are proving the possibility of airborne transmission of coronavirus disease 2019 (COVID-19). Ensuring adequate ventilation rate is essential to reduce the risk of infection in confined spaces. Methods: We obtained the quantum generation rate by a COVID-19 infector with a reproductive number based fitting approach, and then estimated the association between infected probability and ventilation rate with the Wells-Riley equation. Results: The estimated quantum generati...


5: Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation Documented by EMS During the COVID-19 Crisis in Tijuana, Mexico

Joseph Friedman, Alheli Calderon-Villarreal et al.

3,532 downloads (posted 18 May 2020)

Objective: Emergency medical services (EMS) may serve as a key source of rapid data about the evolving health of COVID-19 affected populations. A study in Italy reported that EMS-documented out-of-hospital cardiac arrest rose by 58% during the peak-epidemic. EMS and hospital reports from several countries have suggested that silent hypoxemia-low oxygen saturation (SpO2) in the absence of dyspnea-is associated with COVID-19 outbreaks. It is unclear, however, how these phenomena can be generalized to low-and-middle-income...


6: Comparison Between Influenza and COVID-19 at a Tertiary Care Center

Michael W Donnino, Ari Moskowitz et al.

3,524 downloads (posted 22 Aug 2020)

ABSTRACT Background: Widespread reports suggest the characteristics and disease course of coronavirus disease 2019 (COVID-19) and influenza differ, yet detailed comparisons of their clinical manifestations are lacking. Objective: Comparison of the epidemiology and clinical characteristics of COVID-19 patients with those of influenza patients in previous seasons at the same hospital Design: Admission rates, clinical measurements, and clinical outcomes from confirmed COVID-19 cases between March 1 and April 30, 2020 were ...


7: Validation of home oxygen saturations as a marker of clinical deterioration in patients with suspected COVID-19

Matt Inada-Kim, Francis P Chmiel et al.

2,969 downloads (posted 07 Nov 2020)

BackgroundThe early identification of deterioration in suspected COVID-19 patients managed at home enables a more timely clinical intervention, which is likely to translate into improved outcomes. We undertook an analysis of COVID-19 patients conveyed by ambulance to hospital to investigate how oxygen saturation and measurements of other vital signs correlate to patient outcomes, to ascertain if clinical deterioration can be predicted with simple community physiological monitoring. MethodsA retrospective analysis of ro...


8: High incidence of asymptomatic SARS-CoV-2 infection, Chongqing, China

Yang Tao, Panke Cheng et al.

2,818 downloads (posted 23 Mar 2020)

BackgroundSARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection. MethodsIn this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiolo...


9: A Novel Triage Tool of Artificial Intelligence Assisted Diagnosis Aid System for Suspected COVID-19 pneumonia In Fever Clinics

Cong Feng, Zhi Huang et al.

2,624 downloads (posted 20 Mar 2020)

Currently, the prevention and control of COVID-19 outside Hubei province in China, and other countries has become more and more critically serious. We developed and validated a diagnosis aid model without CT images for early identification of suspected COVID-19 pneumonia (S-COVID-19-P) on admission in adult fever patients and made the validated model available via an online triage calculator. Patients admitted from Jan 14 to Feb 26, 2020 with the epidemiological history of exposure to COVID-19 were included [Model devel...


10: Aerosol-spread during chest compressions in a cadaver model

Matthias Ott, Alfio Milazzo et al.

2,516 downloads (posted 06 Apr 2020)

ObjectiveTo evaluate aerosol-spread in cardiopulmonary resuscitation (CPR) using different methods of airway management. Knowledge about Aerosol spread is vital during the SARS-CoV-2-Pandemic. MethodsTo evaluate feasibility we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a second approach we applied nebulized detergents into human cadavers by an endotracheal tube and detected aerosol-...


11: Utah-Stanford Ventilator (Vent4US): Developing a rapidlyscalable ventilator for COVID-19 patients with ARDS

Hongquan Li, Ethan Li et al.

2,454 downloads (posted 22 Apr 2020)

We describe a minimum, rapidly scalable ventilator designed for COVID-19 patients with ARDS. Our design philosophy is not only to try to address potential ventilator shortages, but also to account for uncertainties in the supply chains of parts commonly used in traditional ventilators. To do so we employ a modular design approach and broadly explore taking advantage of parts from non-traditional supply chains. In our current prototype, we demonstrate volume control with assist control on a test lung and present a linear...



Adrian Soto-Mota, Braulio A. Marfil Garza et al.

1,914 downloads (posted 27 May 2020)

ABSTRACT - Importance: Many COVID-19 prognostic factors for disease severity have been identified and many scores have already been proposed to predict death and other outcomes. However, hospitals in developing countries often cannot measure some of the variables that have been reported as useful. - Objective: To assess the sensitivity, specificity, and predictive values of the novel LOW-HARM score (Lymphopenia, Oxygen saturation, White blood cells, Hypertension, Age, Renal injury, and Myocardial injury). - Design: Demo...


13: Laboratory findings, signs and symptoms, clinical outcomes of Patients with COVID-19 Infection: an updated systematic review and meta-analysis

Mina Ebrahimi, Amal Saki Malehi et al.

1,744 downloads (posted 30 Mar 2020)

Background and AimCoronaviruses disease 2019 (COVID-19), for the first time detected in Wuhan, China, rapidly speared around the world and be a Public Health Emergency of International Concern (PHEIC). The aim of the current survey is collecting laboratory findings, analysis them and reporting a specific pattern for help to COVID-19 diagnosis. MethodsTo collect laboratory characteristics, we searched "PubMed" electronic database with the following keywords: "COVID-19" "2019 novel coronavirus" "laboratory findings" "cli...


14: A Rapidly Deployable Negative Pressure Enclosure for Aerosol-Generating Medical Procedures

Anthony M. Chahal, Kenneth Van Dewark et al.

1,560 downloads (posted 18 Apr 2020)

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic presents significant safety challenges to healthcare professionals. In some jurisdictions, over 10% of confirmed cases of COVID-19 have been found among healthcare workers. Aerosol-generating medical procedures (AGMPs) may increase the risk of nosocomial transmission, exacerbated by present global shortages of personal protective equipment (PPE). Improved methods for mitigating risk during AGMPs are therefore urgently needed. Methods The Aerosol Contai...


15: Impact of the COVID-19 pandemic on Suicide and Self Harm among Patients Presenting to the Emergency Department of a Teaching Hospital in Nepal

Roshana Shrestha, Shisir Siwakoti et al.

1,519 downloads (posted 20 Oct 2020)

BackgroundThe COVID-19 pandemic is a global challenge that is not just limited to the physical consequences but also a significant degree of a mental health crisis. Self-harm (SH) and suicide are its extreme effects. The aim of this study was to provide an overview of the impact of the COVID-19 pandemic on the occurrence and clinical profile of suicide and SH in our ED. MethodsThis is a cross-sectional observational study conducted in the ED of a tertiary care center. Records of all fatal and nonfatal SH patients prese...


16: Estimated Sp02/Fio2 ratio to predict mortality in patients with suspected COVID-19 in the Emergency Department: a prospective cohort study

Johannes von Vopelius-Feldt, Daniel Watson et al.

1,518 downloads (posted 02 Jun 2020)

Background This study examined whether the presence and severity of Type 1 Respiratory Failure (T1RF), as measured by the ratio of pulse oximetry to estimated fraction of inspired oxygen (SpO2/eFiO2 ratio), is a predictor of in-hospital mortality in patients presenting to the ED with suspected COVID19 infection. Methods We undertook a prospective observational cohort study of patients admitted to hospital with suspected COVID-19 in a single ED in England. We used univariate and multiple logistic regression to examine wh...


17: Chest X-Ray Has Poor Diagnostic Accuracy and Prognostic Significance in COVID-19: A Propensity Matched Database Study

Aditya Borakati, Adrian Perera et al.

1,425 downloads (posted 07 Jul 2020)

Objectives: To identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and computed tomography (CT) for diagnosis of COVID-19 in the general emergency population in the UK and to find the association between imaging features and outcomes in these patients. Design: Retrospective analysis of electronic patient records Setting: Tertiary academic health science centre and designated centre for high consequence infectious diseases in London, UK. Participants: 1,198 patients who attended the emergency...


18: A low-cost, rapidly scalable, emergency use ventilator for the COVID-19 crisis

Samuel J. Raymond, Trevor Wesolowski et al.

1,423 downloads (posted 25 Sep 2020)

For the past 50 years, positive pressure ventilation has been a cornerstone of treatment for respiratory failure. Consensus surrounding the epidemiology of respiratory failure has permitted a relatively good fit between the supply of ventilators and the demand. However, the current COVID-19 pandemic has increased demand for mechanical ventilators well beyond supply. Respiratory failure complicates most critically ill patients with COVID-19 and is characterized by highly heterogeneous pulmonary parenchymal involvement, p...


19: Utility of Lung Ultrasound in COVID-19: A Systematic Scoping Review

Michael Trauer, Ashley Matthies et al.

1,295 downloads (posted 16 Jun 2020)

Lung ultrasound (LUS) has an established evidence base and has proven useful in previous viral epidemics. An understanding of the utility of LUS in COVID-19 is crucial to determine its most suitable role based on local circumstances. A scoping review was thus undertaken to explore the utility of LUS in COVID-19 and guide future research. 33 studies were identified which represent a rapidly expanding evidence base for LUS in COVID-19. The quality of the included studies was relatively low. However LUS appears to be a hig...


20: Accuracy of ECG Chest Electrode Placements by Paramedics; an observational study

Pete Gregory, Stephen Lodge et al.

1,235 downloads (posted 03 Jul 2019)

BackgroundThe use of the 12-lead ECG is common in UK paramedic practice but its value depends upon accurate placement of the ECG-electrodes. Several studies have shown widespread variation in the placement of chest electrodes by other health professionals but no studies have addressed the accuracy of paramedics. The main objective of this study was to ascertain the accuracy of the chest lead placements by registered paramedics. MethodsRegistered paramedics who attended the Emergency Services Show in Birmingham in Septe...