Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), also known as COVID-19, has rapidly spread across the globe resulting in a worldwide pandemic. This disease has such varying presentation within the population. Although rare, multisystem inflammatory syndrome in children (MIS-C) is a potentially fatal complication of SARS-CoV2 infection and can be easily missed in the early stages. Because emergency department (ED) providers are often the initial treating providers, knowledge of the clinical manifestations and treatment of MIS-C is essential. The purpose of this article is to present a case of MIS-C in a rural ED, describe the subtle signs of disease, and educate clinicians on this rare and potentially deadly disease.Spontaneous retropharyngeal emphysema (SRE) is a rare condition, occurring in the absence of trauma. Symptoms usually include acute-onset odynophagia and dyspnea. This is an interesting case of a young, healthy woman who presented to an emergency department with benign upper respiratory symptoms but took a drastic turn while in the waiting room after being triaged. The features and implications of SRE are discussed in this case, including emergent thoracic surgery consultation and additional testing.Malignant hyperthermia (MH) is caused by a genetic disorder of the skeletal muscle that induces a hypermetabolic response when patients are exposed to a triggering agent such as volatile inhaled anesthetics or depolarizing neuromuscular blockers. Symptoms of MH include increased carbon dioxide production, hyperthermia, muscle rigidity, tachypnea, tachycardia, acidosis, hyperkalemia, and rhabdomyolysis. Common scenarios for triggering agents are those used are during surgery and rapid sequence intubation. Hypermetabolic symptoms have a rapid onset; hence, prompt recognition and treatment are vital to prevent morbidity and mortality. The first-line treatment agent for an MH response is dantrolene. Further treatment includes managing complications related to a hypermetabolic response such as hyperkalemia and arrhythmias. This review is focused on the recognition and treatment considerations of MH in the emergency department to optimize therapy and improve patient morbidity and mortality.The Research to Practice column presents an analysis of current and controversial research findings with implications for practice change relevant to emergency care settings. This review critiques Johnson et al.’s (2016) investigation, titled “The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias,” that examined emergency department characteristics and stressors and their effects on physician racial bias and decision making. Their findings suggest that unconscious biases can affect clinical decisions when providers experience increased cognitive stress. The implications are significant for emergency providers as resources are especially strained during the COVID-19 pandemic and as the adverse effects of unconscious bias on health disparities and patient outcomes have become clearly apparent. Implicit bias training (IBT) is recommended for emergency providers and has significant implications for medical and nurse educators in executing and evaluating IBT outcomes.

Hypophosphatemia in critically ill patients is a common electrolyte disturbance associated with a myriad of adverse effects. Critically ill patients requiring continuous renal replacement therapy (CRRT) are at high risk of hypophosphatemia and often require phosphate supplementation during therapy. The aim of this study was to evaluate the association of phosphate versus non-phosphate containing CRRT solutions with incident hypophosphatemia in critically ill patients requiring CRRT.

This is a single-center, retrospective, cohort study at a tertiary academic medical center of 1,396 adult patients requiring CRRT during their intensive care unit stay comprising 7,529 (phosphate containing) and 4,821 (non-phosphate containing) cumulative days of CRRT. Multivariable logistic regression was used to model the primary outcome of hypophosphatemia during CRRT according to exposure to phosphate versus non-phosphate containing CRRT solutions.

Incident hypophosphatemia during CRRT, serum phosphate <2.5 mg/dL or 0.81 mmol/L, was significantly higher in the non-phosphate versus phosphate containing solution group 304/489 (62%) versus 175/853 (21%) (p < 0.001). Cumulative phosphate supplementation was also significantly higher in the non-phosphate versus phosphate containing solution group 79 (IQR 0-320) versus 0 (0-16) mmol (p < 0.001). Non-phosphate solutions were associated with an 8-fold increase in the incidence of hypophosphatemia (adjusted OR 8.05; 95% CI 5.77, 11.26; p < 0.001).

The use of phosphate containing CRRT solutions was independently associated with reduced risk of incident hypophosphatemia and decreased phosphate supplementation during CRRT. selleck chemicals Interventional studies to confirm these findings are needed.

The use of phosphate containing CRRT solutions was independently associated with reduced risk of incident hypophosphatemia and decreased phosphate supplementation during CRRT. Interventional studies to confirm these findings are needed.

International Turner syndrome (TS) Clinical Practice Guidelines recommend screening for neurodevelopmental (ND) and mental health (MH) concerns in girls with TS; however, it remains unclear whether this is implemented in current practice. The objective of this mixed methods study was to assess screening practices for ND and MH in girls with TS from the perspective of pediatric endocrinologists.

Pediatric Endocrine Society members who provide care for girls with TS were invited to complete an electronic survey on screening practices. Descriptive statistics were used to summarize quantitative results concurrently with thematic analysis of free-text survey responses.

A total of 124 surveys were completed (86% attending pediatric endocrinologists, 81% at academic institutions). Overall, 25% of providers reported their patients with TS received both ND and MH screenings. Only 9 (9%) respondents endorsed screening for ND concerns themselves, while more providers (26%) reported they screen for MH concerns. Multiple barriers to screening for ND and MH concerns within the clinical setting were endorsed.