Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction.

OBJECTIVE: The Novel Coronavirus19 (COVID19) arrived in northern New Jersey (NJ) in early March 2020, peaked at the beginning of April, and then declined. Starting in March, some patients who called 911 and required advanced life support (ALS) may have decompensated more rapidly than would have been expected, possibly because of concomitant COVID19 infection and/or delays in seeking medical care because of fear of exposure to the virus, and social isolation. In this study, our goal was to determine if there was an increase in prehospital ALS pronouncements and a decrease in ED visits for potentially serious conditions such as MI and stroke during the peak of the COVID-19 pandemic in northern NJ. METHODS STUDY DESIGN: Retrospective cohort of prehospital patients pronounced dead by paramedics and patients with MI and stroke in the EDs of receiving hospitals of these paramedics. Study Setting and Population: Ten ground ALS units in northern NJ and nine receiving hospital EDs. Each ALS unit is staffed by two NJ-certified mobile intensive care paramedics and respond with a paramedic flycar in a two-tiered dispatch system. DATA ANALYSIS: We identified prehospital pronouncements using the EMSCharts electronic record (Zoll Medical, Chelmsford, Massachusetts). We tabulated the number of pronouncements by week from January 1 to June 30 in 2019 and 2020. We tabulated the combined total number of pronouncements and ED visits by month along with visits for MI and stroke and calculated the changes during the same timeframe. We used Chi-square to test for statistical significance for the monthly changes from 2019 to 2020. RESULTS: For January through June in 2019 and 2020, there were 12,210 and 13,200 ALS dispatches, and 366 and 555 prehospital pronouncements, respectively. In 2020, pronouncements rose from a weekly baseline of 13 in early March, reached a peak of 45 at the beginning of April, then returned to the baseline level by the end of May. April 2020, the month with the most pronouncements, had 183% more pronouncements than April 2019 but total ED visits and visits for MI and stroke were 49%, 46% and 42% less, respectively (p < 0.0001 for each of these changes). CONCLUSION: Following the arrival of the COVID-19 pandemic in northern NJ, we found pre-hospital ALS death pronouncements increased and ED visits for MI and stroke decreased. Although we have speculated about the reasons for these findings, further studies are needed to determine what the actual causes were.

Case Report: Altered with PRES.

In this case, we discuss a 51-year-old female with history of anxiety, depression, and alcohol abuse who presented for altered mental status, focal neurological deficits, and seizure. She was found to be significantly hypertensive. Non-contrast computed tomography (CT) scan imaging of the head revealed changes suggestive of posterior reversible encephalopathy syndrome (PRES), which was ultimately confirmed by MRI imaging. The patient was treated appropriately with anti-hypertensive therapy and seizure prophylaxis. Due to the prompt recognition of PRES and immediate management, the patient was able to make a favorable neurological recovery. This case highlights the importance of including PRES as part of a wide differential diagnosis for a patient with altered mental status, significantly elevated blood pressure, and focal neurological deficits. Early recognition and treatment of PRES can improve neurological outcomes and quality of life for patients. Topics: Altered mental status, seizure, hypertensive emergency, posterior reversible encephalopathy syndrome, PRES.