Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis known to affect the respiratory and renal systems. There are a multitude of clinical manifestations, many of which are not specific to the disease, such as dysfunction of the nasal, sinus, auditory, tracheal, pulmonary, ocular, renal, cardiac, and nervous systems. As a multisystemic illness without a "classic" presentation and insidious progression, it is often a challenging diagnosis. We report and discuss a case of a 10-year-old female with no significant past medical history who presented to the emergency department with a 10-day course of worsening respiratory symptoms. As her respiratory and clinical status began to precipitously decline, the decision was made to intubate the patient, which was performed without issue. Unfortunately, attempts at oxygenating and ventilating the patient were met with extreme resistance and difficulty-an airway situation that could have been catastrophic if not for quick reaction maneuvers performed that would ultimately go on to remedy the issue at hand. We hope to raise awareness regarding the airway challenges posed by GPA and delve into its management as a means of improving recognition and preparing clinicians to treat this condition.
Potentially pathogenic and life-threatening infections such as pseudomonas aeruginosa, VRE, and C. difficile have also been isolated from various studies. Knowing that stethoscopes are vectors of such infections, we aimed to assess the stethoscope cleaning methodology used by health care providers before and after evaluating their patients in a fast-paced level 1 trauma center in Houston, Texas. Methods: Patient-provider interactions were anonymously observed in the Emergency Center, Surgical ICU, and Labor and Delivery rooms. We assessed methods and duration of stethoscope disinfection as well as hand hygiene practices among providers before and after patient encounters. Data was objectively collected and summary statistic analysis was completed. To assess the difference in categorical variables, Wilcoxon-rank sum test and p-values were analyzed using Stata 12.0. Results: A total of 400 interactions were observed. Stethoscope hygiene was only observed in 2% of patient encounters before the patient exam and 16.3% after the patient exam. Of the sanitized stethoscopes, 93.15% were cleaned using a sani-cloth wipe, with the remainder being cleaned using an alcohol pad. Cleaning duration lasted <15 seconds in 90.4% of cases and >15 seconds for the remainder. Hands were sanitized 36 times (9%) before and 80 times (20%) after. Gloves were used in 329 encounters (82.3%). Cleaning of stethoscopes was not practiced for any trauma patients before patient exams. However, 51% of the time, stethoscopes were cleaned after evaluation of trauma patients (p-value <0.05). For patients who were in the isolation unit, stethoscope cleaning was not observed in any of the encounters as there was a dedicated stethoscope provided in the patient room. Conclusions: In a fast-paced and higher acuity setting, hand hygiene is commonly obtained by using gloves. In the ED, ICU, and Labor and Delivery units, only 2% of stethoscopes are cleaned before use. Except trauma resuscitations, after patient contact no stethoscope cleaning occurred in more than 20% of in ED, ICU, or Labor and Delivery patient encounters.
INTRODUCTION Postpartum employment has been recognized as a significant obstacle to breastfeeding continuation rates in the general population. Multiple additional factors can influence emergency medicine (EM) physician mothers’ ability to continue breastfeeding upon return to work. These include the unpredictable nature of emergency room volumes and acuity, absence of protected lactation time or facilities, and varying levels of support from colleagues. This study investigated a sample of female EM physicians’ current perceptions and experiences regarding breastfeeding practices and identified modifiable work-place factors affecting their decision to wean. The authors hypothesized that EM physician mothers would have excellent breastfeeding initiation rates but be largely unable to maintain breastfeeding practices upon returning to work. METHODS A 34-item survey questionnaire evaluated demographics, perceptions, and experiences with breastfeeding with a convenience sample of EM attending and resident physicians from two Michigan academic community hospitals. RESULTS Thirty-nine surveys were completed, representing a participant response rate of 88.6%. Breastfeeding had been initiated by all respondent mothers, all of whom returned to full-time employment after delivery. Upon return to work, 15 (75%) respondents continued to exclusively breastfeed. The goal of participants was to breastfeed for an average of 7.1 months (± 4.1 months), although the average duration children were exclusively breastfed was 5.8 months (± 4.0 months). CONCLUSIONS Based on these results, the reasons for decreased breastfeeding after return to work in an EM residency program setting are multifactorial and include some modifiable interpersonal and institutional influences. These findings support the implementation of work-place strategies and policies to promote successful breastfeeding practices among EM resident and attending physician mothers returning to work.
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