The World Health Organization categorized coronavirus disease 2019 (COVID-19) as a pandemic due to its high contagion rate and widespread infectivity in February 2020. In the United States, one of the public health concerns is the adequacy of resources to treat infected cases. We describe a case of a previously well, 9-year-old obese boy who presented to the emergency department with shortness of breath, fever, abdominal pain, and cough with chest pain. He was diagnosed with COVID-19 through significant family contact, confirmed by polymerase chain reaction and found to be at high risk of venous thromboembolism due to abnormal d-dimer. Lung point-of-care ultrasound (POCUS) in the emergency department observed significant lung pathology, including pleural thickening, consolidation, and B lines. A chest X-ray found bilateral ground glass opacities and interstitial prominences consistent with viral pneumonia. Our case suggests that lung POCUS can provide adequate and rapid imaging to assess lung pathology of COVID-19 in a pediatric patient. As there is limited literature on use of lung POCUS in pediatric patients infected with SARS-CoV-2, our case emphasizes its function as a potentially efficient modality in bedside assessment.
The 2014 Academic Emergency Medicine consensus conference has taken the first step in identifying gender-specific care as an area of importance to both emergency medicine (EM) and research. To improve patient care, we need to address educational gaps in this area concurrent with research gaps. In this article, the authors highlight the need for sex-and gender-specific education in EM and propose guidelines for medical student, resident, and faculty education. Specific examples of incorporating this content into grand rounds, simulation, bedside teaching, and journal club sessions are reviewed. Future challenges and strategies to fill the gaps in the current education model are also described.ACADEMIC EMERGENCY MEDICINE 2014;21:1453-1458© 2014 by the Society for Academic Emergency Medicine C linicians have observed sex and gender differences in patient care for decades. However, these differences have been formally recognized only in recent years. The American Medical Association style guide defines sex as the classification of living things as male or female according to their reproductive organs and functions assigned by chromosomal complement. 1 This chromosomal complement affects a patient's vulnerability to disease and his or her response to medications and treatments. Gender, however, refers to a person's self-representation as man or woman or how that person is responded to by social institutions on the basis of the person's gender presentation. Frequently confined to reproductive health, sex-and gender-specific medicine (SGM) also addresses why some diseases, such as cardiovascular diseases or strokes, are more common in men versus women and whether these differences affect treatment and prognosis. In 1994, the field of SGM gained new momentum as Congress mandated the recognition of sex-and gender-based research and education for every organ system. 2 As a result of these mandates, sex and gender differences in the etiology, diagnosis, progression, outcomes, treatment, and prevention of many conditions have been described that affect care for both women and men patients in the acute care setting. Some examples of sex differences include strokes and cardiovascular conditions are more common in men and yet mortality is worse in women for the same conditions, digoxin causes more adverse events in women being treated for congestive heart failure, Brugada syndrome is 10 times more common in men due to the effect of testosterone on cardiac sodium channels, the slower metabolism of zolpidem in women puts them at increased risk for sleep-associated motor vehicle crashes, aspirin is variably effective in the treatment of myocardial infarction and stroke in men compared to women, and men have an increased susceptibility to sepsis. [3][4][5][6] Despite recent advances in gender-specific medicine, this information is largely ignored in current emergency medicine (EM) research and clinical practice. 7 The 2013 RAND Corporation report has independently documented the central role of EM in health care delivery i...
Dyspnea is a common complaint in patients who present to the emergency department and can be due to numerous etiologies. This case report details a 90-year-old female with a history significant for hypertension, hyperlipidemia, and new diagnosis of ovarian malignancy whose symptoms increased over the past three days. Point-of-care Ultrasonography showed multiple B-lines, a plethoric IVC without respiratory variation, a markedly low EF and a lack of RV dilation. There was also no evidence of effusion which led the emergency medicine team to the diagnosis of acute decompensated heart failure. This quick diagnosis was possible due to using the standardized POCUS approach guided by the BEE FIRST algorithm. BEE FIRST can help physicians remember: B -lines are indicative of interstitial thickening, E ffusion such as pericardial or pleural should be checked for, E jection F raction is useful in assessing for heart failure , I VC /I nfection/ I nfarct correlates with central venous pressure, and can be used to assess volume status, check for enlargement, evidence of pneumonia, subpleural consolidation “shred sign”, hepatization of lung, and/or pulmonary infarction related to pulmonary embolism, R ight Heart Strain can indicate pulmonary embolism or pulmonary hypertension, S liding Lung can assess for pneumothorax and pleural characteristics, and lastly, T hrombosis/ T umor can assess for myxoma and interrogation of lower extremities for deep vein thrombosis can aid in dyspnea differentiation. In this report, we demonstrate how the framework BEE FIRST offers a standardized stepwise approach to the utilization of POCUS in a patient with acute dyspnea in the ED setting.
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