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BackgroundCardiopulmonary Resuscitation (CPR) or Code status discussion usually happen late in the hospital admission. Lack of clear communication, various level of training of providers and discrepancy in health literacy among patient act as barrier in proper understanding of code status understanding. In this study we utilized brief video and validated survey to determine if viewing a short, educational video could improve patient understanding of CPR and code status at Robert Packer Hospital.MethodThis study was conducted as single center randomized study at Guthrie Robert Packer Hospital. Total number of participants was 150. Participants were randomly assigned (1:1) to Intervention group where they viewed brief educational video. The primary end point was the composite score ranging from 0 to 15 generated based on correct responses to the questionnaire (supplemental file). ResultThere was statistically significant high understanding of code status among intervention group with mean composite score of 8.6 with a significant difference between the video group (10.3) and control group (6.9) with a p-value < 0.001. The multivariate linear model had a significant F-statistic with a p-value of < 0.001. We found age and randomization group significantly changes the composite scores. On average, the composite score of the intervention group was 3.36 points higher than the control group with 95% confidence interval of 2.36 – 4.35, pConclusionUnderstanding of cardiopulmonary resuscitation status holds important place in guiding management of a patient. Use of short video explaining CPR and code status was found to be effective in improving patient understanding of these issues. It has the potential to save time and improve patient’s understanding if incorporated into code status discussions with hospitalized patients.

INTRODUCTION: COVID-19 typically presents with a febrile illness and respiratory symptoms There are some reports of mild gastrointestinal involvement but no cases have been reported on severe gastrointestinal symptoms, especially in the immunosuppressed host CASE DESCRIPTION/METHODS: A 72-year-old male with a past medical history of poorly differentiated adenocarcinoma of the lower esophagus and gastroesophageal junction (Stage III) is undergoing cancer treatment with a curative intent via neoadjuvant chemoradiation (carboplatin and taxol) weekly He presents with nausea, vomiting, bloody diarrhea, hypotension and a fever of 104° Fahrenheit He was pancytopenic and his absolute neutrophil count (ANC) was low at 1 64 K/μL CT Chest/Abdomen/Pelvis with contrast revealed a significant amount of new portal venous gas with abnormal mucosal enhancement and edema in the ileum, cecum, and ascending colon in conjunction with air seen within the mesenteric vessels;this was highly concerning for bowel ischemia The CT scan showed completely clear lungs His abdominal pain and distension worsened;surgery was necessary Prior to surgery, SARS-CoV-2 virus testing was required, and he tested positive Repeat CT scan showed spontaneous resolution of portal venous gas within hours of his initial CT The exploratory laparotomy showed a 90 cm long thickened ileus, consistent with neutropenic enterocolitis A complete infectious work up yielded negative results;only the COVID-19 test was positive and he did not improve with IV antibiotics Thus, we diagnosed him with COVID-19 induced neutropenic enterocolitis, which is typically associated with a bacterial superimposed infection DISCUSSION: COVID-19 manifests primarily as a respiratory disease There have been no reports of bloody diarrhea and/or neutropenic enterocolitis as a manifestation of COVID-19, making this a novel presentation Additionally, studies show that neutropenic enterocolitis develops with an ANC 1000/μL, which our patient had To add to the rarity of this presentation, he had extensive portal venous gas concerning for bowel ischemia which spontaneously resolved on its own This case highlights that immunosuppressed individuals are at greatest risk of morbidity and mortality with regards to COVID-19 and that atypical and non-respiratory manifestations of COVID-19 in immunosuppressed individuals may occur