A Case of Perforating Folliculitis in a Peritoneal Dialysis Patient.

Case Presentation: A 30-year-old male with a past medical history of hypertension and renal failure on peritoneal dialysis presented to the emergency department with a chief complaint of a rash on his anterior trunk for the prior three weeks. Dermatological examination revealed multiple, discrete folliculocentric, erythematous, and hyperpigmented papules, with scattered adjacent angulated erosions. Discussion: Perforating folliculitis is a rare and often difficult to diagnose skin condition classically seen in patients with chronic renal disease or underlying immunodeficiency.

Pediatric headache patient with cerebral abscesses: a brief review of the literature and case report.

BACKGROUND: Pediatric headache is a common cause of pediatric emergency department (ED) visits, and 8.8% of cases require imaging. Alarmingly, 12.5% of imaged cases have a pathologic cause. A pediatric patient with a complicated medical history presented to the pediatric ED with multiple cerebral abscesses. The possible causes and contributors to this rare cause of pediatric headache and a review of pediatric headache emergency management are presented.Case Presentation: A 12-year-old male patient with a complex medical and surgical history, including post-repair pulmonary valve stenosis, visited the pediatric ED for intractable and worsening left frontoparietal headache, refractory to ibuprofen, for 6 days. A physical examination revealed severe photophobia and restlessness secondary to severe head pain. Non-contrast brain computed tomography demonstrated two round, bilateral, parietal hypodense lesions with surrounding vasogenic edema. The lesions were consistent with abscesses on magnetic resonance imaging. Eventually, the patient underwent successful surgical abscess drainage and made a full recovery. The patient was lost to follow-up; therefore, no causative bacterial species was determined. CONCLUSION: Managing pediatric headache in emergency settings requires a robust history and physical examination. Cerebral abscesses are an infrequent but fatal cause of pediatric headache and therefore should be considered among the differential diagnoses.

Assessment of San Antonio refugee health clinic telehealth response and refugees' needs during the COVID-19 pandemic.

In March of 2020, Texas declared a statewide public health emergency in response to the rapidly spreading COVID-19 virus, forcing the shutdown of many critical operations across the state. The pandemic has had a massive impact on the refugee population worldwide, increasing displacement and limiting opportunities for resettlement, work, and aid. In an effort to evaluate and address the holistic needs of the San Antonio's vulnerable refugee community during the pandemic, the San Antonio Refugee Health Clinic (SARHC) created a COVID-19 response team that screened and triaged the population, collected data, and provided telemedicine and other urgent teleservices. The SARHC clinic has served the mostly uninsured and underserved refugee population of San Antonio, Texas for over 10 years as a Student-Faculty Collaborative Practice (SFCP). With the collaboration of the Center for Refugee Services in San Antonio, the clinic utilizes the site of a local church on a weekly basis to serve refugees via teams of nursing, dental, and medical students and faculty. At the height of the COVID-19 lockdown, teams of student and faculty volunteers conducted a cross-sectional study of patients' needs by systematically calling and screening patients. Qualitative data on COVID-19 risk, mental wellness, financial needs, food security, dental needs, and medical needs was collected. Quantitative data on number of patients contacted, country of origin, interpreter use, insurance access, internet access, referrals, appointments, and prescriptions carried out was also collected and analyzed. Of the patients called (N = 216), 57% (n = 123) were successfully reached and completed the survey. 61% (n = 75) required language interpreter services. Only 9% (n = 11) of individuals had health insurance. 46% (n = 52) expressed the need for telemedicine services, and 34% (n = 42) reported access to WiFi. 41% (n = 50) reported a medical concern, 18% (n = 22) reported dental concerns, 41% (n = 51) reported social needs, and 11% (n = 14) reported mental health concerns. 24% (n = 30) of patients requested medication refills. Our snapshot of the San Antonio refugee community during the COVID-19 pandemic captures their social, mental, and physical struggles; the pandemic left many families without access to medications, health services, social services, job, and food security. The telemedicine campaign proved to be an effective method of assessing and addressing a variety of patient needs in a virtual setting. Of concern is the high rates of uninsured families and limited Internet access. These findings reveal important considerations for equitable healthcare delivery to vulnerable populations in the face of prolonged unforeseen events, like the COVID-19 pandemic.

Electrical Cardioversion for Wide Complex Tachycardia.

We present a case of electrical cardioversion used to treat a hemodynamically unstable wide complex tachycardia (WCT). The patient returned to normal sinus rhythm after being cardioverted with 100 joules (J) on the first attempt. He was admitted to the hospital for cardiac evaluation and ultimately discharged home on flecainide and nebivolol after a negative cardiac workup.

Early On-Scene Management of Pediatric Out-of-Hospital Cardiac Arrest Can Result in Improved Likelihood for Neurologically-Intact Survival.

AIM: To evaluate the frequency of neurologically-intact survival (SURV) following pediatric out-of-hospital cardiac arrest (POHCA) when comparing traditional early evacuation strategies to those emphasizing resuscitation efforts being performed immediately on-scene. METHODS: Before 2014, emergency medical services (EMS) crews in a county-wide EMS agency provided limited treatment for POHCA on-scene and rapidly transported patients to appropriate hospitals. After 2014, training strongly concentrated upon EMS provider comfort levels with on-scene resuscitation efforts including methods to expedite protocols on-site and control positive-pressure ventilation. Frequency of SURV (hospital discharge) was compared for the two years prior to initiating the immediate on-scene care strategy to the ensuing two years following implementation. RESULTS: Between 01/01/2012 and 12/31/2015, 94 children experienced POHCA. There were no significant differences before and after the on-scene focus in terms of age, sex, etiology, presenting electrocardiograph, drug infusions or bystander-performed cardiopulmonary resuscitation and total scene times actually remained similar (14.3 vs. 17.67 minutes). SURV increased significantly upon implementation of the immediate on-scene management strategy and was sustained over the next two years (0.0% to 23%; p = 0.0013). Though statistically-indeterminate in this analysis, the improvement was associated with a shorter mean time to epinephrine administration among resuscitated patients (16.6 vs. 7.65 minutes). CONCLUSION: Facilitating immediate on-scene management of POHCA can result in improvements in life-saving. Although a historically-controlled evaluation, the compelling appearance of neurologically-intact survivors was immediate and sustained. Targeted training, more efficient, physiologically-driven procedures, and trusted encouragement from supervisors, likely played the most significant roles and not necessarily extended scene times.

Non-traumatic Retinal Detachment Diagnosed via Bedside Ultrasonography.

The authors report a case of an elderly patient with left eye retinal detachment who presented to the emergency department (ED). Bedside ultrasonography of the retina revealed a hyperechoic, smooth, folded membrane within the vitreous, consistent with a diagnosis of retinal detachment. Ophthalmological consultation was obtained, and the patient healed well after surgical repair.