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Introduction: Coronavirus 2019 (COVID-19) inequitably impacted minority populations and regions with limited access to healthcare resources. The Barnes-Jewish Emergency Department in St. Louis, MO, serves such a population. The COVID-19 vaccine is an available defense to help achieve community immunity. The emergency department (ED) is a potential societal resource to provide access to a vaccination intervention. Our objective in this study was to describe and evaluate a novel ED COVID-19 vaccine program, including its impact on the local surrounding underserved community.Methods: This was a retrospective, post-protocol implementation review of an ED COVID-19 vaccination program. Over the initial six-month period, we compiled data on all vaccinated patients out of the ED to evaluate demographic data and the impact on underserved regional areas.Results: We report a successful ED-based COVID-19 vaccine program (with over 1,000 vaccines administered). This program helped raise regional and state vaccination rates. Over 50% of the population that received the COVID-19 vaccine from the ED were from defined socially vulnerable patient populations. No adverse effects were documented.Conclusion: Operation CoVER (COVID-19 Vaccine in the Emergency Room) Saint Louis was able to successfully vaccinate a socially vulnerable patient population. This free, COVID-19 ED-based vaccine program with dedicated pharmacy support, was novel in emergency medicine practice. Similar ED-based vaccine programs could help with future vaccine distribution.

Introduction: Management of sedation, analgesia, and anxiolysis are cornerstone therapies in the emergency department (ED). Dexmedetomidine (DEX), a central alpha-2 agonist, is increasingly being used, and intensive care unit (ICU) data demonstrate improved outcomes in patients with respiratory failure. However, there is a lack of ED-based data. We therefore sought to: 1) characterize ED DEX use; 2) describe the incidence of adverse events; and 3) explore factors associated with adverse events among patients receiving DEX in the ED. Methods: This was a single-center, retrospective, cohort study of consecutive ED patients administered DEX (January 1, 2017–July 1, 2019) at an academic, tertiary care ED with an annual census of ~90,000 patient visits. All included patients (n= 103) were analyzed for characterization of DEX use in the ED. The primary outcome was a composite of adverse events, bradycardia and hypotension. Secondary clinical outcomes included ventilator-, ICU-, and hospital-free days, and hospital mortality. To examine for variables associated with adverse events, we used a multivariable logistic regression model. Results: We report on 103 patients. Dexmedetomidine was most commonly given for acute respiratory failure, including sedation for mechanical ventilation (28.9%) and facilitation of non-invasive ventilation (17.4%). Fifty-four (52.4%) patients experienced the composite adverse event, with hypotension occurring in 41 patients (39.8%) and bradycardia occurring in 18 patients (17.5%). Dexmedetomidine was stopped secondary to an adverse event in eight patients (7.8%). Duration of DEX use in the ED was associated with an increase adverse event risk (adjusted odds ratio, 1.004; 95% confidence interval, 1.001, 1.008). Conclusion: Dexmedetomidine is most commonly administered in the ED for patients with acute respiratory failure. Adverse events are relatively common, yet DEX is discontinued comparatively infrequently due to adverse events. Our results suggest that DEX could be a viable option for analgesia, anxiolysis, and sedation in ED patients.

Keywords: boarding; critical care medicine; emergency department; emergency department intensive care unit; intensive care unit EN boarding critical care medicine emergency department emergency department intensive care unit intensive care unit 1265 1267 3 07/18/22 20220801 NES 220801 Emergency department (ED) utilization over the last decade has exploded. Emergency department, intensive care unit, boarding, critical care medicine, emergency department intensive care unit ED-based solutions, such as implementing standard inpatient order sets and offering inpatient services to ED patients, have been shown to be an available harm reduction strategy that can mitigate some deleterious effects of surge conditions ([12]). Whether RCU care was better than ICU care was not the question (nor should it be): patients admitted to the RCU were not boarding in a busy ED with staff focused on new admissions and patient flow. [Extracted from the article]

Background: The propagation of remote "telemedicine" has allowed intensivists (and other medical professions) to expand their ability to provide critical care medicine services to intensive care units (ICUs). The physical exam is a pertinent skill that all providers learn early in their medical careers. Key components of the physical exam can help a clinician narrow the differential diagnosis. Even with modern monitoring devices and high-powered imaging, it is hard to replicate the physical exam on a critical care patient from a tele-medicine center. Case presentation: An experienced intensivist working in a telemedicine (Tele-ICU) center reviewed the daily chest radiograph on a patient with a complex prolonged ICU course. The radiograph was immediately recognized as being concerning for an acute case of pneumomediastinum in a patient with recent tracheostomy manipulation. However, the intensivist was unable to corroborate his suspicions with a good physical exam as the differential diagnosis list was explored. Conclusions: Acute pneumomediastinum is a severe disease process arising from numerous etiologies that can be life threatening. This disease process can often times be diagnosed from plain chest radiography alone. However remote telemedicine patient care should never supersede a direct bedside physical exam. Every good clinician knows that the fundamental physical exam truly is fundamental. [ABSTRACT FROM AUTHOR]

Introduction: Ocular emergencies are not a common presentation in the intensive care unit. Intensivists should have a broad differential for the "red eye" and involve ophthalmology appropriately for ocular emergencies. Background: Ocular emergencies can lead to permanent vision loss if not identified in a timely fashion. Case description: A patient with hyponatremia and bacteremia admitted to the intensive care unit (ICU) developed an acute painful red eye. Physical exam findings and images are shared. Conclusion: Due to an acute ocular emergency, this critically-ill patient required transfer to a higher level of care and subspecialty management. Clinical significance: Education about ocular emergencies is provided for the intensivist; including diagnosis, management, and complications. [ABSTRACT FROM AUTHOR]

The article informs about a 70-year-old male presented to the hospital after having been trapped under a piece of industrial equipment for several hours. Topics discussed include patient subsequently underwent emergent definitive management with a bedside decompressive laparotomy; and abdominal compartment syndrome is an increase in intra-abdominal pressure, compromising blood flow and resulting in organ failure.

The article presents a case study of a 63-year-old male who was brought to the Emergency Department (ED) with the problem of progressive shortness of breath (SOB). Topics discussed include ejection fraction, medical optimization for heart failure, and placement of an Impella ventricular assist device for severe heart failure on hospital day.

The article presents a case study of an 80-year-old female diagnosed with diagnosis of a mucus plug in mid-trachae . Topics discussed include her medical history of chronic obstructive pulmonary disease (COPD) and hospital admission for a surgery of inguinal hernia; post-operative complications due to pelvic hematoma, her placement on non-invasive positive pressure ventilation due to respiratory failure, and needle decompression and thoracostomy tube placement for treatment of pneumothorax.