The COVID-19 pandemic has dramatically impacted healthcare delivery worldwide. In hotspot areas such as Wuhan, Lombardy, and New York City, the disease has forced hospitals to focus on COVID-19 patients. Anecdotal reports have suggested that the pandemic has led to a decrease in patients presenting to these hospitals with serious cardiovascular and neurologic diseases such as ST-elevation myocardial infarction (STEMI) and stroke. We sought to measure the impact of the COVID-19 pandemic on emergency transfers for STEMI, stroke, and acute aortic emergencies within our regional health system.

The statements and opinions expressed in COVID-19 Curbside Consults are based on experience and the available literature as of the date posted. While we try to regularly update this content, any offered recommendations cannot be substituted for the clinical judgment of clinicians caring for individual patients.

Renal tubular acidosis is a relatively uncommon clinical syndrome characterized by the inability of the kidney to adequately excrete hydrogen ions, retain adequate bicarbonate, or both. This syndrome can be categorized into 3 separate disorders, each with unique clinical characteristics. Although an uncommon finding, prompt and inexpensive tests can lead to early intervention and subsequently reduce complications from persistent renal dysfunction. The purpose of this article was to bring awareness of the clinical manifestations, diagnosis, and treatments of renal tubular acidosis to critical care nurses.

Aims To determine whether a comprehensive STEMI protocol is associated with reduced sex disparities over 5 years. Methods and Results This was an observational cohort study of 1833 consecutive STEMI patients treated with percutaneous coronary intervention (PCI) before (1/1/2011-7/14/2014, control group) and after (7/15/2014-7/15/2019, protocol group) implementation of a protocol for early guideline-directed medical therapy (GDMT), rapid door to balloon time (D2BT), and use of trans-radial PCI. In the control group females had less GDMT (77.1% vs. 68.1%, p = 0.03), similarly low trans-radial PCI (19.0% vs. 17.6%, p = 0.73), and longer D2BT(104 min [79, 133] vs. 112 min [85, 147], p = 0.02) corresponding to higher in-hospital mortality (4.5% vs. 10.3%, OR 2.44 [1.34-4.46], p = 0.004), major adverse cardiac and cerebrovascular events (MACCE, 9.8% vs. 16.3%, OR 1.79 [1.14-2.84], p = 0.01), and net adverse clinical events (NACE, 16.1% vs. 28.3%, OR 2.06 [1.42-2.99], p < 0.001). In the protocol group, no significant sex differences were observed in GDMT (87.2% vs. 86.4%, p = 0.81) or D2BT (85 min [64, 106] vs. 89 min [65, 111], p = 0.06) but trans-radial PCI was used less in females (77.6% vs. 71.2%, p = 0.03). In-hospital mortality (2.5% vs. 4.4%, OR 1.78 [0.91-3.51], p = 0.09) and MACCE (9.0% vs. 11.0%, OR 1.27 [0.83-1.92], p = 0.26) were similar between sexes, but higher NACE in females approached significance (14.8% vs. 19.4%, OR 1.38 [0.99-1.92], p = 0.05) due to higher bleeding risk (7.2% vs. 11.1%, OR 1.60 [1.04-2.46], p = 0.03). Conclusions A comprehensive STEMI protocol was associated with sustained reductions for in-hospital ischemic outcomes over 5 years, but higher bleeding rates in females persisted.

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