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Nasogastric tube (NGT) insertion is a common procedure performed by community nurses, but verifying correct placement can be challenging due to the limitations of conventional methods. This study aimed to investigate the effectiveness of point-of-care ultrasonography (POCUS) for verifying NGT placement and to explore the feasibility of using this imaging modality as the first-line reference for NGT placement verification. The validity of the gastric aspirate pH test was also evaluated. This was a single-centre, retrospective, single-blind study using a convenience sample of patients who required NGT placement in home settings. POCUS was performed by a trained community nurse, and the pH test was performed after tube insertion. The results of the POCUS and pH test were compared. A total of 68 patients with a mean age of 82.13±9.43 years were included. The sensitivity and specificity were found to be 95.45% and 100%, respectively, for POCUS, and 90.91% and 100%, for the pH test. POCUS can provide accurate diagnostic imaging of nasogastric tube position and avoid X-ray controls. This imaging modality can complement pH testing in community settings where X-ray scans are not readily available.

Background In order to mitigate the spread of SARS-CoV-2 and the COVID-19 pandemic, public health officials have recommended self-isolation, self-quarantine of exposed household contacts (HHC), and mask use to limit viral spread within households and communities. While household transmission of SARS-CoV-2 is common, risk factors for HHC transmission are poorly understood. Methods In this prospective cohort study, we enrolled 37 households with at least one reverse transcription polymerase chain reaction-confirmed (RT-PCR) COVID-19 index case from March 2020 - March 2021, in order to calculate secondary attack rates (SAR) and define risk factors for secondary infections. Participants were tested daily for SARS-CoV-2 via RT-PCR, using self-collected lower nasal samples. Households were followed until all members tested negative for seven consecutive days. We collected demographics, medical conditions, relationship to index case, and socioeconomic indicators. Subgroup data analysis was conducted and stratified by positivity status. Results Of 99 enrolled participants, 37 were index cases and 62 were household contacts (HHC), of whom 25 HHC were infected (40.3%). Secondary attack rate (SAR) was highest among adults caring for a parent (n=4/4, 100%) and parents of index cases (5/10, 50%). Households whose income came from service work had greater risk of transmission compared to households whose primary income was technology (n=5/7; 71.4% vs 3/8; 37.5% respectively). Pediatric contacts were at lower risk of infection when compared to adult contacts (n=5/18, 27.8% vs n=20/44, 45.5% respectively). Conclusion This study suggests that household transmission represents a key source of community-based infection of SARS-CoV-2. Allocating resources for education/training regarding prevention among infected individuals and their close contacts will be critical for control of future outbreaks of SARS-CoV-2. Disclosures All Authors: No reported disclosures

Sports-related injuries are a frequent cause of visits to the emergency department (ED) across the United States. A majority of these injuries affect the lower extremities with the ankle as the most frequently reported site. Most sports-related injuries are not severe enough to require inpatient hospitalization; however, they often lead to acute distress and pain which require prompt treatment with analgesics. Approximately 22% of patients who presented to the ED required pharmacotherapy for acute pain management. Opioids have been traditionally used for the management of severe acute pain in the ED; however, there are growing concerns for opioid overuse and misuse. As a result, there is growing controversy regarding the appropriate selection of analgesic agents, optimal dosing, and need for outpatient therapy which has contributed to changes in prescribing patterns of opioids in the ED. Lidocaine, a class 1b antiarrhythmic, has been utilized as an analgesic agent. Its use has been documented for the management of intractable chronic pain caused by cancer, stroke, neuropathies, or nephrolithiasis. However, literature describing the use of intravenous lidocaine for the management of acute pain secondary to trauma is limited to a single case series. This case report describes the use of intravenous lidocaine in a 17-year-old male who presented to the ED in acute distress secondary to ankle dislocation and fracture. This report serves to describe additional clinical experience with intravenous lidocaine for the management of acute pain secondary to ankle fracture in the emergency department.