Code Stroke Patient Referral by Emergency Medical Services During the Public COVID-19 Pandemic Lockdown.

BACKGROUND: The COVID-19 pandemic caused public lockdowns around the world. We analyzed if the public lockdown altered the referral pattern of Code Stroke patients by Emergency Medical Services (EMS) to our Comprehensive Stroke Center. METHODS: Retrospective single-center study at a Bavarian Comprehensive Stroke Center. Patients who were directly referred to our stroke unit by EMS between the 1st of January 2020 and the 19th of April 2020 were identified and number of referrals, clinical characteristics and treatment strategies were analyzed during the public lockdown and before. The public lockdown started on 21st of March and ended on 19th April 2020. RESULTS: In total 241 patients were referred to our center during the study period, i.e. 171 before and 70 during the lockdown. The absolute daily number of Code Stroke referrals and the portion of patients with stroke mimics remained stable. The portion of female stroke patients decreased (55% to 33%; p = 0.03), and stroke severity as measured by the National Institutes of Health Stroke Scale (median 3 (IQR 0-7) versus 6 (IQR 1-15.5) points; p = 0.04) increased during the lockdown. There was no difference of daily numbers of patients receiving thrombolysis and thrombectomy. CONCLUSIONS: Referral of Code Stroke patients by EMS could be maintained sufficiently despite the COVID-19 pandemic lockdown. However, patients' health care utilization of the EMS may have changed within the public lockdown. EMS remains a useful tool for Code Stroke patient referral during lockdowns, but public education about stroke is required prior to further lockdowns.

Aspiration and injection-based technique for incision and drainage of a sacrococcygeal pilonidal abscess.

The incision and drainage of a sacrococcygeal abscess is a common procedure in the Emergency Department (ED) both to decrease a patient's pain and to improve the local wound conditions for subsequent definitive surgical therapy. However, the local infiltration of anesthetics is often problematic due to the unacceptable and unavoidable pain resulting from the injection itself, as well as the inability to achieve a complete anesthetic response. Therefore, standard textbooks generally recommend the concomitant use of local and systemic analgesics in the treatment of sacrococcygeal abscesses. We describe herein an alternative technique to administer local analgesia after the aspiration of an abscess for incision and drainage of a sacrococcygeal abscess that is safe and rapid. The patient is placed in the prone position and the buttocks are separated from the midline with adhesive tape. The technique involves needle aspiration of the abscess with consecutive slow injections of the same amount of local anesthetic into the abscess cavity via the same needle, followed by abscess drainage by incision and gentle curettage. This method therefore eliminates multiple infiltrations of the abscess and the surrounding area and obviates the associated pain due to the low volume of anesthetic required. The described technique is well tolerated by the patient and reduces the frequently encountered difficulty with incision and drainage of coccygeal abscesses in the ED.