Emergency Medicine Commons^™

Clinical Characteristics And Laboratory Biomarkers For Patients With Suspected Covid-19 Infection Within Hca Healthcare, Scott Gutovitz, Justin Hanson, Christian Vandever, Dietrich Jehle

HCA Healthcare Journal of Medicine

Background

The coronavirus infection (COVID-19), also known as the Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2), caused significant illness and a worldwide pandemic beginning in 2020. Early case reports showed common patient characteristics, clinical variables and laboratory values in these patients. We compared a large population of American COVID-19 patients to see if they had similar findings to these smaller reports. In addition, we examined our population to identify any differences between mild or severe COVID-19 infections.

Methods

We retrospectively accessed a de-identified, multi-hospital database managed by HCA Healthcare to identify all adult emergency department (ED) patients that were tested …

Early Aggressive Hydration Is Associated With Decreased Opioid Use And Readmission In Mild Acute Pancreatitis, Shreyans Doshi, Hong Liang, Hale Z. Toklu, Selina Fritze, Sue-Wei Luu

HCA Healthcare Journal of Medicine

Background: Acute pancreatitis (AP) is one of the most common causes of hospital admissions due to gastrointestinal disorders. No pharmacologic agents have been proven to impact the prognosis, and the treatment still remains supportive with intravenous fluids for hydration. Although early hydration has been recommended for the management of mild AP, there is no consensus on the type, rate, and amount of the fluid replacement.

Objective: In this study, we aimed to investigate the outcome of aggressive hydration in patients with AP.

Methods: Retrospective data from patients admitted to 12 hospitals (2015–2017) was used for analysis. Five hundred patients who …

Investigation Of A Peculiar Case Of Childhood Lymphadenopathy, Chade Aribo, Alonso Al, Allison Woodall, Tommy Y. Kim

HCA Healthcare Journal of Medicine

Introduction: Lymphadenopathy is a common physical finding often associated with an infectious etiology. We present a case of a patient with generalized cervical and supraclavicular lymphadenopathy diagnosed with a rare malignancy. Health care providers should be aware of some uncommon historical or physical examination findings that warrant further investigation.

Clinical Findings: A 16-year-old female presented to the emergency department with 3 days of a fever, congestion and sore throat with swelling around the jaw. Her physical examination findings included bilateral mandibular swelling and generalized cervical lymphadenopathy with palpable supraclavicular lymph nodes.

Outcomes: Complete blood count showed pancytopenia with a white …

Low Dose Clenbuterol Toxicity: Case Report And Review Of Literature, Kenneth Lan, Adarsh Saheba, Paul Mathew

HCA Healthcare Journal of Medicine

Clenbuterol is a long-acting β-agonist used in oral and inhaled form for asthma treatment outside the U.S. and in veterinary medicine within the U.S. It is also used off-label for anabolic effects worldwide. Toxicity with clenbuterol is increasingly seen in U.S. hospitals, primarily in younger individuals using the drug for competitive athletics or bodybuilding. We present a case of a young patient who presented after an intentional overdose and discuss the relevant literature. Presentations do not correlate with the dosage ingested. Signs and symptoms can range from simple nausea to myocardial ischemia, rhabdomyolysis and cardiogenic shock. Treatment of overdose is …

Prehospital Antibiotics Improve Morbidity And Mortality Of Emergency Medical Service Patients With Sepsis, Thomas Martel, Monica N. Melmer, Samuel M. Leaman, Nicole Kassen, Seth Kozlowski, Jonathan Pangia, Scott Gutovitz, Dietrich Jehle

HCA Healthcare Journal of Medicine

Background: Severe sepsis is a major cause of mortality in patients evaluated in the Emergency Department (ED). Early initiation of antibiotic therapy and IV fluids in the ED is associated with improved outcomes. We investigated whether early administration of antibiotics in the prehospital setting improves outcomes in these patients with sepsis.

Methods: This is a retrospective study comparing outcomes of patients meeting sepsis criteria in the field by EMS, who were treated with IV fluids and antibiotics. Their outcomes were compared with controls where fluids were administered prehospital and antibiotics were initiated in the ED. We compared morbidity and mortality …

Assessing For Gender Disparities In The Selection Of Chief Residents Of Emergency Medicine Residency Programs, Emilio G. Volz, Justin Steinberg, Tony Zitek

HCA Healthcare Journal of Medicine

Introduction: Although the number of women physicians has been increasing, there may be gender disparities in the assessment of female emergency medicine residents. This study sought to determine if female emergency medicine residents are less likely to become chief residents than males.

Methods: In July 2017, an anonymous survey was distributed to the program coordinators of all accredited emergency medicine residency programs in the United States. The survey requested the number of males and females in each graduating class from 2015 to 2017. The percentage of female residents who were chief residents was calculated and compared to that for males. …

The Great Imitator Strikes Again: A Case Of A Lupus Flare-Up Presenting Like An Acute Abdomen, Emmanouil Kiriakopoulos, Vanessa Perez, Robyn Hoelle

HCA Healthcare Journal of Medicine

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting all age groups and can manifest in various forms, often making the initial or successive presentations difficult to diagnose. Peritonitis secondary to lupus is a rare manifestation of this disease and the prevalence is said to be much lower in children. We present a case report of an adolescent male with a known history of lupus who presented to the emergency department with a clinical picture consistent with an acute surgical abdomen and underwent an appendectomy. Subsequent workup identified the culprit as a lupus-related peritonitis requiring corticosteroids for resolution.