Brugada syndrome is a rare cardiac arrhythmia which is associated with right bundle branch block pattern (RBBB) and ST-segment elevation in right precordial leads. SCNA5 mutation is the most common genetic abnormality associated with Brugada syndrome. Brugada pattern not related to genetic mutations has been previously reported in the setting of fever, metabolic conditions, lithium use, marijuana and cocaine abuse, ischemia and pulmonary embolism, myocardial and pericardial diseases. Multiple isolated cases of Brugada pattern associated with diabetic ketoacidosis (DKA) have been previously reported. We here present a case of type 1 Brugada pattern in a 23 year-old-male who presented with DKA. Brugada pattern in DKA is attributed to acidosis and multiple electrolyte abnormalities including hyperkalemia which alter ion channel expression in the heart thus leading to Brugada pattern which subsequently resolved with treatment of DKA. In such patients, Brugada pattern is not reproducible on procainamide induction cardiac electrophysiology study (EPS). Our scoping study demonstrates male predominance 20/22 cases of (DELETE this highlighted area) Brugada pattern in DKA, a finding that is consistent with prevalence of this disease among males.
Figure 1. a) Ampulla prior to ERCP on day 2 shows no periampullary abnormality. b) Day 16 -Endoscopic Ultrasound showing narrowing of distal common bile duct with hypoechoic intraductal area. c) Bile casts and bilirubin crystals seen on microscopy.
Background: Inpatient cardiac arrest care had to be adapted to meet the needs of patients and providers during the COVID-19 pandemic. Providers working in the emergency department and in the inpatient setting have acquired extensive experience and expertise in caring for patients with COVID-19 related cardiac arrest. We summarize recent reports relevant to clinicians on inpatient cardiac arrest care, provider and patient safety, and effective use of resources. Methods: We performed literature searches of the PubMed database on inpatient cardiac arrest, COVID-19, healthcare-associated coronavirus transmission, and others. The authors’ collections of lived experience as inpatient care providers and clinically useful materials gathered during the pandemic were included. Results: We summarize current knowledge about cardiac arrest in COVID-19 relevant to hospitalist practice, describe lessons learned to date, and provide practical guidance for addressing cardiopulmonary resuscitation for patients with COVID-19. We discuss literature on risk factors for cardiac arrest in patients with COVID-19; risk of infection for rescuers performing resuscitation in patients with COVID-19 and mitigation strategies; goals of care during cardiac arrest in a patient with COVID-19; reducing the risk of exposure to rescuers (including pre–cardiac arrest care); reducing cross-contamination during cardiac arrest in patients with COVID-19; prioritizing oxygenation and ventilation strategies with lower aerosolization risk; maximizing resources during cardiac arrest in patients with COVID-19; and post–cardiac arrest care. Conclusions: Advances made in the care of inpatient cardiac arrest patients during the COVID-19 include domains of patient risk stratification, provider safety, advance directives, and others. Lessons in the management of inpatient cardiac arrest learned during this pandemic are likely to applicable to future pandemics.
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