The novel coronavirus disease 2019 has had a profound impact on healthcare systems around the world. The emergency department (ED) in particular has become the frontline for the identification and care of these patients. While its effects on respiratory symptoms are well recognized, neurologic manifestations have been rarer. We report the case of a patient who presented in cardiac arrest with the return of spontaneous circulation (ROSC). The patient was found to have subarachnoid hemorrhage and later tested positive for COVID-19.

Background Nontraumatic intracranial hemorrhages (ICH) are serious cerebrovascular events with high morbidity and mortality. They occur in about two million people a year worldwide. While ICH continues to be a focus of research in the medical community, there is little data on the differences in outcomes by gender. We aimed to further investigate these differences in our study. Methods This analysis involves a de-identified dataset of all adult patients who presented to one of our hospital system's emergency departments with ICHs as one of the top three discharge diagnoses. This study was considered exempt by our medical school's Institutional Review Board (IRB). Our hospital system comprises over 176 hospitals in the United States with over 8.6 million emergency department visits annually. Logistic regression analyses were performed using JMP 14.1. Outcome variables included the length of stay, mortality, and disposition.

Aortic dissection is a well-known, but relatively uncommon diagnosis in the emergency department (ED). With a mortality rate as high as 30 percent, it is important to be able to diagnose quickly and accurately. Definitive diagnosis with imaging studies such as computed tomography angiogram (CTA) can be expensive and time-consuming and may not always be available in the community. Herein, we discuss a case of a 59-year-old man presenting with severe chest pain, hypotension, and bradycardia who was diagnosed with aortic dissection first by bedside ultrasound. This expedited the CTA and a cardiothoracic surgery consult, leading to a successful emergent aortic repair.

We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. MethodsThis was a cross-sectional survey study of American emergency medicine (EM) physicians with a selfadministered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. ResultsThere were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). ConclusionBarriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings.