VERISHA KHANAM JURGENA TUSHA DANYAL TAHERI ABKOUH LAITH AL-JANABI VESNA TEGELTIJA AND SARWAN KUMAR PURPOSE: Throughout the years, several scoring systems have been established to measure disease severity in efforts to predict patient mortality and help guide management. In patients with sepsis, organ failure has been proven to worsen outcome, therefore utility of scores such as Sequential Organ Failure Assessment (SOFA) has helped determine the severity of disease and predict mortality. Patients infected with SARS COV-2 were observed to have varying disease progression with multiorgan involvement. Through this study, we intend to investigate the use of the SOFA score in predicting mortality in critically ill patients who tested positive for SARS COV-2. The aim of this study is to determine if the SOFA score is a strong predictor of mortality in critical care patients admitted with SARS-COV2 infection.
An influx of SARS-COV2 infection has led to several unanswered questions, one such question raised was how to risk stratify these patients in order to better direct further management. The MuLBSTA score recently developed by Guo L. et al. in Shanghai, China is designed to predict 90-day mortality in patients with viral pneumonia. Since very little is known regarding patients with SARS COV-2 infection and COVID-19 disease, we aim to explore the applicability of MuLBSTA score in predicting disease severity and risk of mortality in these patients.
, a viral pneumonia associated with a new coronavirus SARS COV-2 emerged in Wuhan, China and quickly spread throughout the world causing high mortality rates. As of May 30th,2020, coronavirus disease 2019 (COVID-19) has been confirmed in 56,884 people in Michigan, with case fatality rate of 10%. Since very little is known regarding patients with COVID-19 disease, we aim to describe the clinical characteristics and outcomes of patients hospitalized in a Michigan community hospital. METHODS: A single centre, retrospective chart review of 163 hospitalized patients with confirmed cases of COVID-19 at a community hospital from March 15 to April 10, 2020. Cases were confirmed by real-time polymerase chain reaction testing of nasopharyngeal samples. Epidemiological, demographic, laboratory and overall outcomes were obtained from electronic medical record. Data collected was then analysed using SPSS software. RESULTS: A total of 163 patients were reviewed and included in the study. Median age of patient with confirmed SARS-COV2 infection was 70 years (mean 68, range, 30-101), of which 52.8% were female, 60.7% white and 33.7% African American. The most common comorbidities were hypertension (112, 68.7%), obesity (79, 48.6%), and hyperlipidemia (54, 33.1%). Patients presented with shortness of breath (109, 66.9%), cough (107, 65.6%) and fever (99, 60.7%). Gastrointestinal symptoms were found in 81 (49.6%) of patients with the most common symptom being diarrhea in 44 (27%) patients. There were 66 (40.5%) patients with fever >100.4F on admission. Multilobe infiltrates were found in chest x-ray of 115 (70.6%) patients. Within one-month, overall mortality was noted to be 29.5%. Mean length of stay of non-intensive care unit (ICU) patients was 6.46 days (range 1-19) when compared 15.5 days (range 3-46) for ICU patients. During hospitalization, 55 patients (33.7%) (median age 68 years, 54.5% female, 60.1% white) were treated in the ICU of which 43(78.2%) required mechanical ventilation and 28 (50.9%) died. For patients requiring mechanical ventilation, 27 (62.8%) died and 16 (37.2%) were discharged alive. CONCLUSIONS: This study provides insight into presenting characteristics, demographics and overall outcome of patients hospitalized with COVID-19 in a Michigan community hospital. CLINICAL IMPLICATIONS: In medical emergencies like the COVID pandemic, it is important to analyze patient demographics in order to help identify the population most at risk. Knowledge of the most vulnerable population not only allows us to come up with strategies to help control the spread of disease but also helps us risk stratify the patients for better resource allocation. It is crucial to learn from an outbreak like this so we can be better prepared for the future.
Case Presentation: A 19 year old male presented with sudden onset chest pain radiating to back. He was a smoker and denied using cocaine since his last hospitalization for cocaine-induced myocardial infarction 2 years ago. UDS was negative. EKG showed normal sinus rhythm with no ST-T wave changes. Initial troponin was 0.850. Potassium levels were low at 2.9 mmol/L but other labs were normal. Chest CT angiography ruled out aortic dissection. He was started on heparin drip. Stat Echocardiogram showed LVEF of 55-60% with no wall motion abnormalities. Repeat potassium levels normalized after replacement, however, his troponins were trending up from 3.9 and 11.5. He continued to complain of severe chest pain, so underwent cardiac catheterization which showed normal coronary arteries and LVEF 55-60%. Heparin drip was discontinued and NSAIDs and colchicine were started. Cardiac MRI (see Figure) was done that showed patchy mid-wall and epicardial delayed gadolinium enhancement involving the basal inferolateral wall, with mild hyperintense signal on the triple IR sequence, suggestive of myocarditis. On further probing, he reported receiving a second dose of Moderna COVID vaccine 3 days prior to presentation. Discussion: In December 2019, a novel RNA virus causing COVID-19 infection was reported, which quickly reached a pandemic level. COVID-19 vaccines were granted emergency use authorization by FDA. With millions of people receiving COVID-19 vaccinations worldwide, rare adverse effects are now being reported. The benefits of vaccination undoubtedly outweigh any minor side effects. However major adverse effects like this are potentially fatal. This case report warrants further investigation into the association of myocarditis with COVID-19 vaccinations and further recommendations regarding vaccination in younger adults.
Malignant hyperthermia is a rare reaction of extreme fever and muscle rigidity to agents used for sedation and anesthesia. Typically, the reaction is within minutes of anesthesia administration. In this case report, we will discuss a 35year-old male who had a reaction 11 hours postoperatively. CASE PRESENTATION:A 35-year-old male with a history of HIV, anemia, and alcohol abuse came to the hospital due to right hip fracture sustained during a seizure episode at home, he was also found to be in alcohol withdrawal. On day 2 early morning, he underwent total hip replacement and was extubated post-op successfully. Sevoflurane and Rocuronium were used to achieve anesthesia. Post op, patient was hemodynamically stable with hydromorphone for pain control along with dexmedetomidine for withdrawal. In the evening at 2000h, the patient became agitated with muscular rigidity. His rectal temperature was 107 F. His labs were CK-1000, K-4.4, Mg-1.2. Peripheral smear showed no hemolysis. Rectal acetaminophen and dantrolene and cool saline were administered while blood cultures drawn and empiric antibiotics were started for suspected infection. The patient responded to therapy promptly and remained afebrile throughout the night. Due to improving symptoms, empiric antibiotics were discontinued. The patient remained afebrile after 24 hours and was transferred out of the ICU.DISCUSSION: Malignant hyperthermia is a rare but life-threatening reaction to commonly used inhaled anesthetics and depolarizing muscle relaxants. It is mediated by an autosomal dominant mutation in the gene RYR1 (ryanodine receptor), heterozygous mutation for RYR1 receptor has been associated with delayed onset of malignant hyperthermia.CONCLUSIONS: Cases of malignant hyperthermia have been reported to occur as late as four days after depolarizing muscle relaxant administration. Therefore, it is important to consider malignant hyperthermia as a cause of hyperpyrexia in patients who have undergone recent surgery.
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