Slow on the Draw-ED Management of Elevated BP in Older Adults.

PURPOSE OF REVIEW: The purpose of this study is to review data surrounding the emergency department management of elevated blood pressure in older adults, including the management of hypertensive crisis and outpatient management of markedly elevated blood pressure. RECENT FINDINGS: Acute lowering of blood pressure in older adults with markedly elevated blood pressure may lead to serious complications without improvements in hospital length of stay, return visits, or mortality. Older adults presenting with elevated blood pressures without evidence of end-organ damage should be referred for outpatient management of their blood pressure. Treatment of hypertensive emergency should follow standard guidelines with additional considerations for aging physiology. Acute lowering of elevated blood pressure in older adults without evidence of end-organ damage has the potential for harm. If the emergency physician opts to acutely treat, they should consider the increased risk of side effects in older adults and avoid Beers list medications including short-acting nifedipine and clonidine.

The Impact of COVID-19 on Patient Presentations to the Emergency Department.

Introduction As the coronavirus disease 2019 (COVID-19) pandemic continues, it may be useful to elucidate its impact on services in the emergency department (ED). This research project aims to identify and analyze changes in patient presentations and disease severity within the ED at Hurley Medical Center (HMC) in Flint, Michigan, due to the COVID-19 pandemic. Methods The study is a retrospective chart review focusing on adults 18 years and above who presented to HMC's ED. The data collected for the study was obtained from patient charts from February 1, 2019, to July 31, 2019, and from February 1, 2020, to July 31, 2020. Data from the years 2019 and 2020 were analyzed using a combination of independent t-test, chi-square analysis, and regression modeling. Results There were a total of 59,345 visits analyzed within the study; 33,648 ED visits within the study were in 2019 compared to 25,697 visits in 2020. There was a significant difference in patient sex between 2019 and 2020 with a larger percentage of males presenting in 2020 versus 2019 (p<0.001). Dispositions also significantly differed in 2020 compared to 2019 with more patients being admitted or dying in the ED (p<0.001). Patients who presented to the ED often presented with more severe illness in 2020 as reflected in increased length of stay in 2020 (p=0.01) and increased case mix index (p<0.001). Conclusion The COVID-19 pandemic significantly reduced the total number of ED visits to HMC in Flint, Michigan, in 2020 than in 2019. Notably, patients were more likely to have a longer length of stay, present with more severe illness, and be admitted or die in the ED when compared to 2019. The results from this study can be used for future planning for the next public health emergency.

A Case Report of Brown Recluse Spider Bite.

Brown recluse spider is a spider of the genus Loxosceles and also known as violin spider or fiddle-back spider. Brown recluse spider is characterized by having six eyes, with a pair in front, a pair on both sides, and a gap between the pairs. The other spiders have eight eyes in two rows of four. Brown recluse spider bites are challenging to verify but may be clinically diagnosed with consideration of geographic location, seasonality, and clinical characteristics. We present a case that involves a brown recluse spider bite in a 59-year-old female with malnutrition and polysubstance use who developed systemic symptoms and a dermonecrotic wound. Local wound care and intravenous (IV) antibiotics lead to clinical improvement by hospital day three, at which time the patient left against medical advice. The case highlights the challenges of diagnosing a brown recluse spider bites, particularly in a patient with multiple risk factors for necrotizing soft tissue infection. Furthermore, the present case represents one of the few case reports of a brown recluse spider bite in Michigan.