Background The COVID-19 pandemic has pushed us to find better ways to accurately diagnose what can be an elusory disease, preferably in a way that limits exposure to others. The potential for home diagnosis and monitoring could reduce infectious risk for other patients and healthcare providers, limit use of finite hospital resources and enable better social distancing/isolation practices. Case Report We report a case of an otherwise healthy Emergency Physician diagnosed with COVID-19 at home using portable ultrasound, pulse oximetry and antibody testing. Her clinical picture and typical lung findings of COVID-19 on ultrasound, combined with a normal echo and negative DVT study, helped inform her diagnosis. She then monitored her clinical course using pulse oximetry, was able to self-isolate for four weeks and had an uneventful recovery. Her diagnosis was confirmed with a positive IgG antibody test after three weeks. Conclusions Novel times call for novel solutions and our case demonstrates one possible path for home diagnosis and monitoring of COVID-19. The tools used, namely ultrasound and pulse oximetry, should be familiar with most modern emergency physicians. Ultrasound in particular was helpful in eliminating other potential diagnoses, such as pulmonary embolus.

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Visceral artery aneurysms (VAA) are rare, life-threatening disease processes that often affect the celiac, superior mesenteric, or inferior mesenteric arteries and their respective branches. The splenic, hepatic, superior mesenteric, and tripod celiac arteries are most commonly affected and have high rupture and mortality rates. This case describes splenic and celiac artery aneurysms in a patient that led to hemorrhagic shock and multisystem organ failure despite timely diagnosis and ligation. A brief review of the literature further elucidates the key risk factors in identifying patients with VAAs and their treatment course.

Objective Few studies have examined the impact of coronavirus disease 2019 (COVID-19) on the primarily Latinx community along the U.S.-Mexico border. This study explores the socioeconomic impacts which contribute to strong predictors of severe COVID-19 complications such as intensive care unit (ICU) hospitalization in a primarily Latinx/Hispanic U.S.-Mexico border hospital. Methods A retrospective, observational study of 156 patients (≥ 18 years) Latinx/Hispanic patients who were admitted for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at a U.S.-Mexico border hospital from April 10, 2020, to May 30, 2020. Descriptive statistics of sex, age, body mass index (BMI), and comorbidities (coronary artery disease, hypertension, diabetes, cancer/lymphoma, current use of immunosuppressive drug therapy, chronic kidney disease/dialysis, or chronic respiratory disease). Multivariate regression models were produced from the most significant variables and factors for ICU admission. Results Of the 156 hospitalized Latinx patients, 63.5% were male, 84.6% had respiratory failure, and 45% were admitted to the ICU. The average age was 67.2 (± 12.2). Those with body mass index (BMI) ≥ 25 had a higher frequency of ICU admission. Males had a 4.4 (95% CI 1.58, 12.308) odds of ICU admission ( p = 0.0047). Those who developed acute kidney injury (AKI) and BMI 25–29.9 were strong predictors of ICU admission ( p < 0.001 and p = 0.0020, respectively). Those with at least one reported comorbidity had 1.98 increased odds (95% CI 1.313, 2.99) of an ICU admission. Conclusion Findings show that age, AKI, and male sex were the strongest predictors of COVID-19 ICU admissions in the primarily Latinx population at the U.S.-Mexico border. These predictors are also likely driven by socioeconomic inequalities which are most apparent in border hospitals. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01478-1.

Background Coronavirus Disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most frequently presents with respiratory symptoms such as fever, dyspnea, shortness of breath, cough, or myalgias. There is now a growing body of evidence that demonstrates that severe SARS-CoV-2 infections can develop clinically significant coagulopathy, inflammation, and cardiomyopathy, which have been implicated in COVID-19 associated cerebrovascular accidents (CVAs). Case Report We report an uncommon presentation of a 32-year-old man who sustained a large vessel cerebellar stroke associated with a severe COVID-19 infection. He presented with a headache, worse than his usual migraine, dizziness, rotary nystagmus, and dysmetria on exam but had no respiratory symptoms initially. He was not a candidate for thrombolytic therapy or endovascular therapy and was managed with clopidogrel, aspirin, and atorvastatin. During hospital admission he developed COVID-19 related hypoxia and pneumonia, but ultimately he was discharged to home rehabilitation. Why Should an Emergency Physician Be Aware of This? We present this case to increase awareness among emergency physicians of the growing number of reports of neurological and vascular complications such as ischemic CVAs in otherwise healthy individuals who are diagnosed with SARS-CoV-2 infection. A brief review of the current literature will help elucidate possible mechanisms, risk factors, and current treatments for CVA associated with SARS-CoV-2.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the coronavirus disease of 2019 (COVID-19) pandemic, has been associated with a variety of prothrombotic sequelae. The pathogenesis of this hypercoagulability has not yet been fully elucidated, but it is thought to be multifactorial with overactivation of the complement pathways playing a central role. There is emerging evidence that the resulting complications are not confined to the venous circulation, and even in patients without typical respiratory symptoms or traditional risk factors, there is a significant rate of arterial thromboembolic disease in patients with SARS-CoV-2 infection. Case Report: We describe a patient presenting with bilateral leg pain without any respiratory symptoms or fever who ultimately was found to be COVID-19 positive and had thromboembolism of the aorta and bilateral iliac occlusion. This report reviews available evidence on the prevalence of arterial thromboembolism in COVID-19 patients and some proposed mechanisms of the pathophysiology of COVID-19-associated coagulopathy. Conclusion: It is important that the emergency physician maintain a high degree of suspicion for arterial thromboembolic disease in patients who are infected with COVID-19 even in the absence of typical respiratory symptoms. Additionally, COVID-19 should be considered in patients with unexplained thromboembolic disease, as this may increase the detection of COVID-19. [Clin Pract

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Aortoiliac occlusive disease (AOD) is a rare presentation of thrombosis of the abdominal aorta. Also known as Leriche syndrome, its classic description entails claudication of the buttocks, thighs, and calves, absent femoral pulses, and impotence. AOD risk factors include smoking, hypertension, hyperlipidemia, diabetes, chronic renal insufficiency, and hypercoagulopathy. Ischemic complications of gastrointestinal malperfusion, renal infarction, and paralysis secondary to spinal cord ischemia are also noted. This case describes AOD complicated by a Stanford Type B aortic dissection leading to multi-system organ failure. A brief review of the literature further elucidates the key risk factors in identifying and treating Leriche syndrome.