COVID-19 Incidence After Emergency Department Visit.

Background: The emergency department (ED) at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS) saw a decrease in the number of visits during the early stages of the COVID-19 pandemic. Little is known whether risk mitigation procedures may help reduce the spread of COVID-19 infections for veterans visiting the ED. Therefore, we reviewed patient visits to the ED for diagnoses other than COVID-19 to assess whether these patients had an increased COVID-19 positivity rate within 21 days of the initial visit. Observations: Risk mitigation procedures instituted by the VAGLAHS ED included a COVID-19 outdoor testing tent, immediate isolation of persons under investigation for COVID-19, disinfection protocols between high-risk patient encounters, dedicated training in donning and doffing personal protective equipment, implementation of 2-physician airway teams for COVID-19 intubations, use of electronic tablets to communicate with COVID-19 patients, and implementation of social distancing initiatives in the waiting room to minimize COVID-19 exposures. The average positivity rate at the VAGLAHS ED during this time frame was 0% to 6.7%, compared with 6.9% to 33.3% within the wider VAGLAHS. Conclusions: Implementing risk mitigation procedures in the VAGLAHS ED helped minimize exposure and subsequent diagnosis of COVID-19 for veterans who visited the VAGLAHS ED for symptoms not associated with COVID-19 infection. Seeking acute medical care in the ED did not put patients at higher risk of contracting COVID-19.

Reversal of Dabigatran with Idarucizumab in Acute Subarachnoid Hemorrhage.

Dabigatran etexilate mesylate is a direct thrombin inhibitor used for reducing the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Dabigatran belongs to a new generation of oral agents for anticoagulation - the direct oral anticoagulants (DOACs). The DOACs also include the factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. In the case of major or life-threatening bleeding and/or the need for emergent invasive procedures, a reversal agent is needed if a patient is taking one of these medications. Research has shown the efficacy of idarucizumab as an antidote in healthy volunteers, but data in the case of life-threatening bleeds remains limited. We report a case of a patient who suffered a traumatic subarachnoid hemorrhage and received effective treatment with idarucizumab. Along with other reports, our case demonstrates that dabigatran-related major and/or life-threatening bleeds may be effectively counteracted by idarucizumab. This provides an option to emergency department providers in managing clinically significant bleeds in patients taking dabigatran.