We report a case of bifacial weakness with paresthesia, a recognized Guillain-Barré syndrome subtype characterized by rapidly progressive facial weakness and paresthesia without ataxia or other cranial neuropathies, which was temporally associated with antecedent coronavirus 2019 (COVID-19). This case highlights a potentially novel but critically important neurologic association of the COVID-19 disease process. Herein, we detail the clinicoradiologic work-up and diagnosis, clinical course, and multidisciplinary medical management of this patient with COVID-19. This case is illustrative of the increasingly recognized but potentially underreported neurologic manifestations of COVID-19, which must be considered and further investigated in this pandemic disease. ABBREVIATIONS: BFP ¼ bifacial weakness with paresthesia; CN ¼ cranial nerve; COVID-19 ¼ coronavirus 2019; GBS ¼ Guillain-Barré syndrome; HSV ¼ herpes simplex virus; Ig ¼ immunoglobulin; PCR ¼ polymerase chain reaction; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2 S evere Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) is the novel coronavirus responsible for the pandemic coronavirus disease 2019 (COVID-19). First identified in Wuhan, China, in late December 2019, 1 global transmission increased rapidly, with the first case of COVID-19 reported in the United States on January 19, 2020 2 and .1.34 million cases and nearly 81,000 deaths reported in the United States as of May 12, 2020. 3 While the typical presentation is respiratory symptoms (dry cough and dyspnea), a number of other associated symptoms have been described, including fever, diarrhea, abdominal pain, fatigue, and altered mental status. Potential neurologic manifestations are increasingly recognized but may be underreported. 4-8 A potential association between COVID-19 and Guillain-Barré syndrome (GBS) has been suggested in 2 recent editorial correspondences; 7,8 however, the temporal relationship of GBS antecedent to COVID-19 symptomatology raised a question of causality in 1 report. 7 In this brief report, we detail a case of bifacial weakness with paresthesia subtype

Background: Severe acute respiratory syndrome coronavirus 2 is a novel coronavirus first diagnosed in U.S. hospitals in January 2020. Typical presenting symptoms include fever, dry cough, dyspnea, and hypoxia. However, several other symptoms have been reported, including fatigue, weakness, diarrhea, and abdominal pain. We have identified a series of patients with diabetic ketoacidosis (DKA) likely precipitated by coronavirus disease 2019 (COVID-19). Case Series: We describe 5 patients with previously known type 2 diabetes and no history of DKA, who presented to the emergency department with new-onset DKA and COVID-19. Why Should an Emergency Physician Be Aware of This?: Diabetes mellitus is a known risk factor for poor outcomes in viral respiratory illnesses, including COVID-19. Infection may precipitate DKA in patients with type 2 diabetes. Aggressive management of these patients is recommended; however, management guidelines have not yet been put forth for this unique subset of patients.

Objectives: Many physicians complete residency training during optimal childbearing years. The literature shows that working nights or on call can lead to pregnancy complications including miscarriage, preterm labor, and preeclampsia. In addition, infant-parent bonding in the postpartum period is crucial for breastfeeding, health, and well-being. No national standards exist for flexible scheduling options for pregnant or new parent residents. Our project objectives are 1) to describe a policy for scheduling pregnant and new parent residents in an emergency medicine (EM) residency and 2) to report pilot outcomes to assess feasibility of implementation, resident satisfaction, and pregnancy outcomes.Methods: An EM residency task force developed a proposal of scheduling options for pregnant and new parent residents based on best practice recommendations and resident input. The policy included prenatal scheduling options for pregnant residents and postpartum scheduling options for all new resident parents. Resident support for the policy was evaluated via an anonymous survey. It was piloted for 2 months in an EM residency program.Results: Policy development resulted in 1) an opt-out prenatal pregnancy work hour option policy with no nights or call during the first and third trimesters, 2) a 6-week new parent flexible scheduling policy, and 3) clarified sick call options. A majority of residents approved the new policy. During the 2-month pilot period, four residents (of 73 total) utilized the policy. The chief residents reported no added burden in scheduling. Of the residents who utilized the policy, all reported high satisfaction. There were no reported pregnancy or postpartum complications. Conclusions:We successfully adopted a new scheduling policy for pregnant residents and new parents in one of the largest EM residency training programs in the country. This policy can serve as a national model for other graduate medical education programs.

The authors studied the knowledge base of surgical faculty concerning frozen section consultations at a university hospital to determine whether it had any relationship to the appropriateness of frozen section requests. To accomplish this, the reasons for performing frozen sections during a 3-month period were analyzed, and those request that seemed ambiguous or inappropriate were identified. Simultaneously a 15-item questionnaire was distributed to faculty and housestaff dealing with factual information concerning the technique and limitations of frozen section diagnosis (Questions 1-8), as well as appropriateness of frozen section requests in a number of clinical situations (Questions 9-15). The collective score on items of general information (Questions 1-8) was 69%, whereas scores on Questions 9-15 ranged from 39% on the gynecologic question related to evaluation of a cystic ovarian mass to 81% on the general surgery question regarding evaluation of a soft tissue mass. Of 914 frozen sections, 95% were performed for appropriate reasons, which included evaluation of margins (46%), establishing a primary diagnosis (43%), determining adequacy or viability of tissue (3%), or satisfying immediate patient/family concerns ( < 1%). Five percent of frozen sections were performed for ambiguous or seemingly inappropriate reasons. Because fewer than five faculty members were responsible for the inappropriate frozen section request, the authors did not find that the results of the questionnaire predicted or anticipated situations in which inappropriate requests occurred. Nonetheless, the results of the questionnaire indicate there is important general information concerning frozen sections that is not uniformly shared by surgical faculty, such as the types of tissue that cannot be cut on a cryostat, the reasons for deferred frozen sections, and the situations in which fresh tissue is needed for special studies. The authors suggest the inappropriate frozen section could be diminished by an educational initiative targeted at a relatively small segment of clinical faculty, whereas enhancement of general information regarding frozen section should ideally occur in the broader context of clinical conferences using illustrative case material.

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