RESUMO
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus identified after widespread pneumonia cases in Wuhan, China at the end of 2019. This virus has been deemed a global pandemic and there remain many unknowns regarding the pathogenesis, management, treatment, and outcomes. This case report highlights a rare condition that possibly developed from the novel virus. A 68-year-old Hispanic male with hypertension and gastroesophageal reflux disease, presented with two weeks history of fevers, chills, cough, and progressive shortness of breath. He was found to be positive for the novel SARS-CoV-2 upon admission. He rapidly developed severe acute respiratory distress syndrome (ARDS) secondary to his coronavirus disease 2019 (COVID-19) pneumonia requiring intubation and full ventilator support associated with acute anuric renal failure requiring emergent hemodialysis catheter placement and continuous renal replacement therapy (CRRT). Two weeks after being on mechanical ventilation and CRRT, he developed episodes of hypotension and tachycardia. A chest radiograph and computed tomography (CT) scan diagnosed pneumopericardium. In the case presented, the patient's CT of his thorax demonstrated bilateral ground-glass opacities and bilateral reticulations consistent with intraparenchymal injuries, most likely from his ARDS secondary to his initial SARS-CoV-2 infection. To date, there remains an unknown association between COVID-19 and causation of pneumomediastinum and pneumopericardium. There continues to be reports of clinically significant findings of pneumomediastinum and pneumopericardium in COVID-19 patients. It is known that COVID-19 causes dysregulated inflammation leading to diffuse alveolar damage and rupture, as well as myocarditis which may be the precipitant to the development of pneumomediastinum and pneumopericardium. This case highlights the findings of pneumopericardium and pneumomediastinum in the novel SARS-CoV-2 virus. Given the multiple reported cases with similar time frames to the development of spontaneous pneumomediastinum in COVID-19 patients, an association between COVID-19 and spontaneous pneumomediastinum should be further studied.
RESUMO
Purpose To investigate the feasibility of adjunct critical care ultrasound (CCUS) curriculum via Facebook, and evaluate its impact on fellow's interest and knowledge acquisition. Materials and methods All University of Southern California (USC), Pulmonary, Critical Care and Sleep Medicine (PCCM) fellows were provided the usual CCUS curriculum. The intervention group provided access to an adjunct CCUS curriculum delivered via Facebook. Results Out of a total of 21 fellows, 10 (47.6%) participated in the Facebook group. The mean number of posts viewed was 24 with a range of 8 to 36 (total 41). Of those who responded, 56% responded Facebook was effective, 89% felt the content was moderate to very useful, 56% responded it enhanced their CCUS education, and 44% stated it motivated them to learn. Pre- and post-testing was done using paired t-tests; the average pre and post-intervention raw score means (of a total of 41 questions) for controls were 35.4±2.9 and 38.2±1.75 (p=0.005). Intervention scores were 37.56±1.94 and 38.0±1.50 (=0.602). Conclusions Evaluating the feasibility of the adjunct CCUS curriculum using social media, we found that Facebook may be acceptable to fellows, however, there was no significant improvement in knowledge. For learners, social media is easily accessible, widely available, and may motivate increased interest in learning and its potential uses warrants further study.