Noninvasive ventilation reduces the need for intubation and mortality in patients with acute cardiogenic pulmonary edema. Although the level of evidence is higher for CPAP, there are no significant differences in clinical outcomes when comparing CPAP vs NIPSV.
In patients with cardiogenic pulmonary oedema, arterial blood gas disturbances may be estimated from peripheral venous samples. By monitoring SpO2 simultaneously, arterial punctures could often be avoided.
Background
The overburdening of the health care system during the COVID-19 pandemic is driving the need to create new tools to improve the management of inter-hospital transport for patients with a severe COVID-19 infection. The aim of this study was to analyse the usefulness of the application of a prioritisation score (IHTCOVID19) for inter-hospital transport in patients with severe COVID-19.
Methods
The study has a quasi-experimental design and was conducted on the Medical Emergency System, the prehospital emergency department of the public company belonging to the Autonomous Government of Catalonia that manages urgent healthcare in the region. Patients with severe COVID-19 infection requiring inter-hospital transport were consecutively included. The pre-intervention period was from 1 to 31 March 2020 and the intervention period with the IHTCOVID19 score was from 1 to 30 April 2020 (from 8 am to 8 pm). The prioritisation score comprises four priority categories, with Priority 0 being the highest and 3 the lowest. Inter-hospital transfer management times (alert-assignment time, resource management time and total central management time) and their variability were evaluated according to whether or not the IHTCOVID19 score was applied.
Results
A total of 344 inter-hospital transfers were included, 189 (54.9%) in the pre-intervention period and 155 (45.1%) in the post-intervention period. The majority of patients were male and the most frequent age range was between 50 and 70 years. According to the IHTCOVID19 score, 12 (3.5%) transfers were classified as Priority 0, 66 (19.4%) as Priority 1, 247 (71.8%) as Priority 2 and 19 (5.6%) as Priority 3. Overall, with the application of the IHTCOVID19 score, there was a significant reduction in total central management time [from 112.4 minutes (IQR 281.3) to 89.8 (IQR 154.9); p=0.012]. This significant reduction was observed in Priority 0 patients [286.2 minutes (IQR 218.5) to 42.0 (IQR 58); p=0.018] and Priority 1 patients [130.3 minutes (IQR 297.3) to 75.4 (IQR 91.1); p=0.034]. After applying the IHTCOVID-19 score, the average time of the process decreased by 22.6 minutes and variability was reduced from 618.1 min to 324.0 minutes.
Conclusion
The application of the IHTCOVID19 score in patients with a severe COVID19 infection reduces inter-hospital transfer management times and variability.
Kidney infarction is a rare pathology with a low incidence registered, however it is most likely that the real incidence is quite higher because many cases are not diagnosed. The clinical presentation varies from nausea to a complete kidney failure when involves most of the parenchyma, therefore affecting the proper kidney function. As for the treatment several option might be considered. The in-situ artery thrombosis is one of the best options followed by anticoagulation or endovascular therapy. There are no standard options for a monorenal patient facing the pathology described, especially with an unsuspected final diagnose is involved.
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