Introduction: We are in the era of novel coronavirus pandemic. Each wave is teaching us something new about the disease pathology, long term prognosis. Nonetheless, COVID-19 is giving rise to new challenges to the clinicians every day with its new found complications, long haul Covid symptoms. Secondary spontaneous pneumothorax has been reported to be a rare complication, seen in 1%-2% of COVID-19 patients with a mean time occurrence of 24.3 days from the hospital admission during the early phase of intubation. Case discussion: We report a case series of four patients in post COVID period presented with sudden onset respiratory distress and hypoxia, diagnosed with spontaneous secondary pneumothorax. Out of three only one patient received NIV support during his past treatment for COVID-19 and others were treated with oxygen. Therefore, barotrauma secondary to positive pressure ventilation and rupture of cystic bulla cannot be a sole cause of this complication. Persistent chronic inflammatory process and ischemic damage of alveoli are other possible etiologies. Conclusion: We highlight in our case series the importance of clinical examination, especially chest auscultation, which most clinicians circumvent owing to the trepidation of contracting COVID-19. We also proposed large researches to identify causal association with pneumothorax and previous use of steroids to treat COVID-19, persistent inflammation, age, gender, comorbidity etc to prevent it, as it can be debilitating and fatal. A clinician should always keep pneumothorax as a differential in sudden deteriorating breathlessness and hypoxia in post COVID period as it may happen as late as >40 days from primary COVID diagnosis.
Objective/Hypothesis:Objective of this study was to find out the diagnostic accuracy made by emergency physician , this will ensure improvement in patients care and Will help to implement better accuracy in determining diagnostic accuracy . Background:Department of emergency medicine is a specialized care facility in tertiary health care centre whose main function is to take care of patients with immediate and emergent health issues.In view limited literature in EM in India a study between PD vs FD was performed for future reference in continuous quality improvement . Methods:A prospective,observational study was done among 200 patients between provisonal diagnosis made in emergency department vs final discharge diagnosis. Results:Majority of the patients ( n=153 , 76.5%) were from the age group of patients between 15-64 followed by (n=40 , 20% ) in the age group with patients of >65 years age , followed by (n= 7 , 3.5%) in the age group of 1-14 years .Most patients were from department of internal medicine (18.5%) followed by department of cardiology (16%) , followed by department of neuromedicine (13%).it was found that 81% (n=162) cases were accurately ( matched ) diagnosed during Emergency department admission , while there was unmatched diagnosis of 19% cases (n=38). Conclusion:Result obtained suggests that the provisional diagnosis was made by the emergency physicians were mostly matched with final discharge diagnosis that was made by the concerned specialist doctors. This shows that the choice of treatment done in the ER were a prompt and accurate treatment . This has a positive effect on the prognosis , mortality and outcome in patients.Department of internal medicine had more diagnostic errors. Improving history taking of patients with proper clinical evaluation will improve diagnosing patients in the ER. Early availability in blood reports during emergency stay will help as a better diagnostic interpretation of disease. it is required to upgrade clinical skills of emergency physicians in diagnosing pediatric age group.
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