Adult Female With Abdominal Distention.

Gastric outlet obstruction (GOO) is a rare diagnosis that can be challenging to make as its symptoms, which include abdominal distention, nausea, and persistent vomiting, often overlap with many other acute abdominal pathologies. Point-of-care ultrasound (POCUS) can help the clinician identify gastric outlet obstruction in patients who present to the emergency department (ED). Sonographic identifiers include a markedly dilated stomach that is filled with both hyper- and hypoechoic contents and may extend into the lower abdomen in the pelvic views.

The emergency department care for hemodialysis patient during the COVID-19 pandemic.

The COVID-19 pandemic poses significant challenges to patients with end-stage kidney disease who receive treatment in outpatient dialysis centers. These patients represent a fragile population that is at higher risk for both infection and transmission. At the start of the pandemic, many suspected COVID-19 dialysis patients were diverted to the emergency department (ED) for testing/treatment, placing a tremendous burden on the ED and inpatient dialysis units. Several recommendations and guidelines have been established to optimize patient care while also decreasing the burden on the ED and inpatient dialysis units and maximizing the ability to perform outpatient hemodialysis. As the pandemic continues, dialysis facilities will have an increasing burden to provide safe and accessible dialysis, while also being able to direct patients to the ED for either emergent dialysis or COVID-19 treatment/testing. We reviewed opinions, recommendations and guidelines developed by professional organizations and dialysis facilities for the management of "patients under investigation" (PUIs) and COVID-19 positive patients that depend on whether the suspicion occurs while the patient is at home vs. at the dialysis center.

Non-respiratory presentations of COVID-19, a clinical review.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) is a highly infectious viral syndrome currently threatening millions of people worldwide. It is widely recognized as a disease of the pulmonary system, presenting with fever, cough, and shortness of breath. However, a number of extrapulmonary manifestations have been described in the literature. OBJECTIVE: In this review, we seek to provide a comprehensive summary of the hematologic, gastroenterological, renal, dermatologic, neurologic, and psychiatric manifestations of COVID-19. DISCUSSION: Hematological presentations of COVID-19 include laboratory abnormalities such as decreased total lymphocyte count, prolonged prothrombin time (PT), elevated d-dimer, and increased lactate dehydrogenase (LDH). Several of these findings are associated with increased mortality among infected patients. The most common gastrointestinal symptoms include nausea, vomiting, diarrhea, and abdominal pain. Furthermore, presence of viral RNA in patient stool suggests the possibility of additional testing modalities for COVID-19. Nephrological findings such as proteinuria, hematuria, and elevated BUN and creatinine levels have been observed. Additionally, several studies demonstrated that patients with COVID-19 who developed acute kidney injury (AKI) had a greater risk of mortality. The virus can also present with cutaneous symptoms such as erythematous rashes, urticaria, and chicken pox-like lesions. Neuropsychiatric symptoms have been described in the literature, and patients can exhibit findings consistent with viral encephalitis, cerebral vascular disease, peripheral nerve disorders, and psychosis. CONCLUSION: Although COVID-19 does usually present primarily with respiratory symptoms, the extra-pulmonary manifestations of the virus are unpredictable and varied. Better understanding and awareness of these symptoms can lead to more efficient diagnosis, rapid treatment, isolation, and decreased spread of the disease.

Redesigning emergency department operations amidst a viral pandemic.

As shown by the current COVID-19 pandemic, emergency departments (ED) are the front line for hospital-and-community-based care during viral respiratory disease outbreaks. As such, EDs must be able to reorganize and reformat operations to meet the changing needs and staggering patient volume. This paper addresses ways to adapt departmental operations to better manage in times of elevated disease burden, specifically identifying areas of intervention to help limit crowding and spread. Using experience from past outbreaks and the current COVID-19 pandemic, we advise strategies to increase surge capacity and limit patient inflow. Triage should identify and geographically cohort symptomatic patients within a designated unit to limit exposure early in an outbreak. Screening and PPE guidelines for both patient and staff should be followed closely, as determined by hospital administration and the CDC. Equipment needs are also greatly affected in an outbreak; we emphasis portable radiographic equipment to limit transport, and an upstocking of certain medications, respiratory supplies, and PPE.