Occupational Injury and Illness Classification Manual
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Cutaneous Manifestations of COVID-19: a Systematic Review and Analysis of Individual Patient-Level Data
Volume 26 Number 12| December 2020 Dermatology Online Journal || Review 26(12):2 Cutaneous manifestations of COVID-19: a systematic review and analysis of individual patient-level data David S Lee1 MD, Paradi Mirmirani2,3 MD, Patrick E McCleskey4 MD, Majid Mehrpouya5 PhD, Farzam Gorouhi6,7 MD Affiliations: 1Department of Dermatology, The Permanente Medical Group, Pleasanton, California, USA, 2Department of Dermatology, University of California, San Francisco, California, USA, 3Department of Dermatology, The Permanente Medical Group, Vallejo, California, USA, 4Department of Dermatology, The Permanente Medical Group, Oakland, California, USA, 5Faculty of Engineering, University of Calgary, Calgary, Alberta, Canada, 6Department of Dermatology, The Permanente Medical Group, South Sacramento, California, USA, 7Department of Dermatology, University of California, Davis, California, USA Corresponding Author: Farzam Gorouhi MD FAAD, Kaiser Permanente, South Sacramento, 6600 Bruceville Road, Sacramento, CA 95823, Tel: 415-298-1345, Email: [email protected] Introduction Abstract In December 2019, reports from Wuhan, China Distinctive patterns in the cutaneous manifestations described new clusters of patients with severe of COVID-19 have been recently reported. We pneumonia linked to a novel coronavirus strain, now conducted a systematic review to identify case reports and case series characterizing cutaneous referred to as severe acute respiratory syndrome manifestations of confirmed COVID-19. Key coronavirus 2 (SARS-CoV-2), [1]. Coronavirus disease demographic and clinical data from each case were 2019 (COVID-19) has since reached pandemic extracted and analyzed. The primary outcome proportions, with over 12·7 million cases worldwide, measure was risk factor analysis of skin related 566,000 deaths, and 188 countries affected at the outcomes for severe COVID-19 disease. -
Dermatologic Manifestations and Complications of COVID-19
American Journal of Emergency Medicine 38 (2020) 1715–1721 Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem Dermatologic manifestations and complications of COVID-19 Michael Gottlieb, MD a,⁎,BritLong,MDb a Department of Emergency Medicine, Rush University Medical Center, United States of America b Department of Emergency Medicine, Brooke Army Medical Center, United States of America article info abstract Article history: The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality. While Received 9 May 2020 much of the focus has been on the cardiac and pulmonary complications, there are several important dermato- Accepted 3 June 2020 logic components that clinicians must be aware of. Available online xxxx Objective: This brief report summarizes the dermatologic manifestations and complications associated with COVID-19 with an emphasis on Emergency Medicine clinicians. Keywords: COVID-19 Discussion: Dermatologic manifestations of COVID-19 are increasingly recognized within the literature. The pri- fi SARS-CoV-2 mary etiologies include vasculitis versus direct viral involvement. There are several types of skin ndings de- Coronavirus scribed in association with COVID-19. These include maculopapular rashes, urticaria, vesicles, petechiae, Dermatology purpura, chilblains, livedo racemosa, and distal limb ischemia. While most of these dermatologic findings are Skin self-resolving, they can help increase one's suspicion for COVID-19. Emergency medicine Conclusion: It is important to be aware of the dermatologic manifestations and complications of COVID-19. Knowledge of the components is important to help identify potential COVID-19 patients and properly treat complications. © 2020 Elsevier Inc. -
Soft Tissue Calcification and Ossification
Soft Tissue Calcification and Ossification Soft-tissue Calcification Metastatic Calcification =deposit of calcium salts in previously normal tissue (1) as a result of elevation of Ca x P product above 60-70 (2) with normal Ca x P product after renal transplant Location:lung (alveolar septa, bronchial wall, vessel wall), kidney, gastric mucosa, heart, peripheral vessels Cause: (a)Skeletal deossification 1.1° HPT 2.Ectopic HPT production (lung / kidney tumor) 3.Renal osteodystrophy + 2° HPT 4.Hypoparathyroidism (b)Massive bone destruction 1.Widespread bone metastases 2.Plasma cell myeloma 3.Leukemia Dystrophic Calcification (c)Increased intestinal absorption =in presence of normal serum Ca + P levels secondary to local electrolyte / enzyme alterations in areas of tissue injury 1.Hypervitaminosis D Cause: 2.Milk-alkali syndrome (a)Metabolic disorder without hypercalcemia 3.Excess ingestion / IV administration of calcium salts 1.Renal osteodystrophy with 2° HPT 4.Prolonged immobilization 2.Hypoparathyroidism 5.Sarcoidosis 3.Pseudohypoparathyroidism (d)Idiopathic hypercalcemia 4.Pseudopseudohypoparathyroidism 5.Gout 6.Pseudogout = chondrocalcinosis 7.Ochronosis = alkaptonuria 8.Diabetes mellitus (b) Connective tissue disorder 1.Scleroderma 2.Dermatomyositis 3.Systemic lupus erythematosus (c)Trauma 1.Neuropathic calcifications 2.Frostbite 3.Myositis ossificans progressiva 4.Calcific tendinitis / bursitis (d)Infestation 1.Cysticercosis Generalized Calcinosis 2.Dracunculosis (guinea worm) (a)Collagen vascular disorders 3.Loiasis 1.Scleroderma -
Title: Drowning and Therapeutic Hypothermia: Dead Man Walking
Title: Drowning and Therapeutic Hypothermia: Dead Man Walking Author(s): Angela Kavenaugh, D.O., Jamie Cohen, D.O., Jennifer Davis MD FAAP, Department of PICU Affiliation(s): Chris Evert Children’s Hospital, Broward Health Medical Center ABSTRACT BODY: Background: Drowning is the second leading cause of death in children and is associated with severe morbidity and mortality, most often due to hypoxic-ischemic encephalopathy. Those that survive are often left with debilitating neurological deficits. Therapeutic Hypothermia after resuscitation from ventricular fibrillation or pulseless ventricular tachycardia induced cardiac arrest is the standard of care in adults and has also been proven to have beneficial effects that persist into early childhood when utilized in neonatal birth asphyxia, but has yet to be accepted into practice for pediatrics. Objective: To present supportive evidence that Therapeutic Hypothermia improves mortality and morbidity specifically for pediatric post drowning patients. Case Report: A five year old male presented to the Emergency Department after pool submersion of unknown duration. He was found to have asphyxial cardiac arrest and received bystander CPR, which was continued by EMS for a total of 10 minutes, including 2 doses of epinephrine. CPR continued into the emergency department. Upon presentation to the ED, he was found to have fixed and dilated pupils, unresponsiveness, with a GCS of 3. Upon initial pulse check was found to have return of spontaneous circulation, with sinus tachycardia. His blood gas revealed 6.86/45/477/8/-25. He was intubated, given 2 normal saline boluses and 2 mEq/kg of Sodium Bicarbonate. The initial head CT was normal. -
Resident Scholarly Work
RESIDENT SCHOLARLY WORK Process Improvement 2020-2021 CPIP Curriculum Ongoing Projects: Alexander Gavralidis, Stephanie tin, Matthew Macey, Allisa Alport, Beenish Furquan, Justin Byrne • Unnecessary laboratory draws in patients at a Community Hospital - evaluating whether inpatients at Salem Hospital staying overnight for a social reason undergo unnecessary laboratory draws Daria Ade, Mayuri Rapolu, Usman Mughal, Eva Kubrova, Barbara Lambl, Patrick Lee • Procalcitonin utilization to tailor antibiotic use at Salem Hospital- part of Antibiotic Stewardship program Sneha Lakshman, Arturo Castro, Ashley So, George Kavalam, Hassan Kazmi, Daniela Urma, Patrick Gordan • Development of a standardized ultrasound guided central venus catheter insertion curriculum Nupur Dandawate, Farideh Davoudi , Usama Talib, Patrick Lee • Inpatient Echo utilization – guidelines updates Anneris Estevez, Usmam Mughal, Zach Abbott, Evita Joseph, Caroline Cubbison, Faith Omede, Daniela Urma • Decrease health disparities for Hispanic community at Lynn NSPG by standardizing diabetes education referral patterns and patient education Imama Ahmad, Usama Talib, Muhammad Akash, Pablo Ledesma, Patrick Lee • Inpatient Telemetry Utilization Usman Mughal, Anneris Estevez, Patrick Lee, Barbara Lambl • Health Disparities & Covid-19 Impact on Minorities, sponsored by Dr. Patrick Lee, Chair of Medicine, Dr. Barb Lambl, Infectious Disease 2017-2020 Alexander Gavralidis, Emre Tarhan, Anneris Estevez, Daniela Urma, Austin Turner, Patrick Lee • Expanded Access to Convalescent Plasma for the Treatment of Patients with COVID-19 – 5/2020 implementing use of Convalescent Plasma to MGB Salem hospital in collaboration with research team. Arturo Castro-Diaz, Dr. Daniela Urma • Improving Hospital Care and Post - acute Care of SARS CoV2 patients 4/2020- 8/2020 Caroline Cubbison, Sohaib Ansari, Adam Matos • Code Status Documentation for admitted patients at Salem Hospital - Project accepted to SHM national meeting to be presented in April 2020 Caroline Cubbison, Coleen Reid, Dr. -
Cutaneous Reactions Reported After Moderna and Pfizer COVID-19 Vaccination: a Registry-Based Study of 414 Cases
Journal Pre-proof Cutaneous Reactions Reported after Moderna and Pfizer COVID-19 Vaccination: A Registry-Based Study of 414 Cases Devon E. McMahon, BA, Erin Amerson, MD, Misha Rosenbach, MD, Jules B. Lipoff, MD, Danna Moustafa, BS, Anisha Tyagi, BA, Seemal R. Desai, MD, Lars E. French, MD, Henry W. Lim, MD, Bruce H. Thiers, MD, George J. Hruza, MD MBA, Kimberly Blumenthal, MD MSc, Lindy P. Fox, MD, Esther E. Freeman, MD PhD PII: S0190-9622(21)00658-7 DOI: https://doi.org/10.1016/j.jaad.2021.03.092 Reference: YMJD 15862 To appear in: Journal of the American Academy of Dermatology Received Date: 23 February 2021 Revised Date: 16 March 2021 Accepted Date: 26 March 2021 Please cite this article as: McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, Desai SR, French LE, Lim HW, Thiers BH, Hruza GJ, Blumenthal K, Fox LP, Freeman EE, Cutaneous Reactions Reported after Moderna and Pfizer COVID-19 Vaccination: A Registry-Based Study of 414 Cases, Journal of the American Academy of Dermatology (2021), doi: https://doi.org/10.1016/ j.jaad.2021.03.092. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. -
WFR Outline.Cwk
WILDERNESS FIRST RESPONDER Nine Days (80 hours) Our Wilderness First Responder course is designed with the outdoor professional in mind. It focuses on developing skills for treating problems outside the “ golden hour” of first response. It is based on the protocols set by the Wilderness Medical Society and instruction encourages the students ability to think through body systems in an effort to determine the best response to traumatic, environmental or medical situations. Classroom sessions are followed with hands on practice to integrate the information in a field setting. 100% attendance is required and there will be a night scenario included. The students will get to see their skills in action as video coverage of intensive scenarios will be reviewed towards the end of the class. A comprehensive written exam is also administered. The course includes American CPR certification. General Syllabus Day 1: Basic Life Support Skills/ Anatomy and Physiology *Opening and Course Paperwork *Course Introduction and Expectations *Student and Instructor Introductions *Medical Legal Overview * Evolution of Patient Care System and how WFR’s fit in *Patient Assessment System (PAS) Part 1 How to approach a scene! General Review of Anatomy and Physiology (All Systems) *Specific exploration of Respiratory System *Hands on practice establishing an airway/airway management *Specific exploration of the Circulatory System * Hands on practice for checking for pulse, controlling bleeding, cpr *Specific exploration of Nervous System * Evaluating Level of Consciousness -
The Post-Mortem Appearances in Cases of Asphyxia Caused By
a U?UST 1902.1 ASPHYXIA CAUSED BY DROWNING 297 Table I. Shows the occurrence of fluid and mud in the 55 fresh bodies. ?ritfinal Jlrttclcs. Fluid. Mud. Air-passage ... .... 20 2 ? ? and stomach ... ig 6 ? ? stomach and intestine ... 7 1 ? ? and intestine X ??? Stomach ... ??? THE POST-MORTEM APPEARANCES IN Intestine ... ... 1 Stomach and intestine ... ... i CASES OF ASPHYXIA CAUSED BY DROWNING. Total 46 9 = 55 By J. B. GIBBONS, From the above table it will be seen that fluid was in the alone in 20 LIEUT.-COL., I.M.S., present air-passage cases, in the air-passage and stomach in sixteen, Lute Police-Surgeon, Calcutta, Civil Surgeon, Ilowrah. in the air-passage, stomach and intestine in seven, in the air-passage and intestine in one. As used in this table the term includes frothy and non- frothy fluid. Frothy fluid is only to be expected In the period from June 1893 to November when the has been quickly recovered from months which I body 1900, excluding three during the water in which drowning took place and cases on leave, 15/ of was privilege asphyxia examined without delay. In some of my cases were examined me in the due to drowning by it was present in a most typical form; there was For the of this Calcutta Morgue. purpose a bunch of fine lathery froth about the nostrils, all cases of death inhibition paper I exclude by and the respiratory tract down to the bronchi due to submersion and all cases of or syncope was filled with it. received after into death from injuries falling The quantity of fluid in the air-passage varies the water. -
Respiratory Physiology for the Anesthesiologist
REVIEW ARTICLE Deborah J. Culley, M.D., Editor ABSTRACT Respiratory function is fundamental in the practice of anesthesia. Knowledge of basic physiologic principles of respiration assists in the proper implemen- tation of daily actions of induction and maintenance of general anesthesia, Respiratory Physiology delivery of mechanical ventilation, discontinuation of mechanical and pharma- cologic support, and return to the preoperative state. The current work pro- Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/130/6/1064/455191/20190600_0-00035.pdf by guest on 24 September 2021 for the Anesthesiologist vides a review of classic physiology and emphasizes features important to the anesthesiologist. The material is divided in two main sections, gas exchange Luca Bigatello, M.D., Antonio Pesenti, M.D. and respiratory mechanics; each section presents the physiology as the basis ANESTHESIOLOGY 2019; 130:1064–77 of abnormal states. We review the path of oxygen from air to the artery and of carbon dioxide the opposite way, and we have the causes of hypoxemia and of hypercarbia based on these very footpaths. We present the actions nesthesiologists take control of the respiratory func- of pressure, flow, and volume as the normal determinants of ventilation, and Ation of millions of patients throughout the world each we review the resulting abnormalities in terms of changes of resistance and day. We learn to maintain gas exchange and use respiration compliance. to administer anesthetic gases through the completion of (ANESTHESIOLOGY 2019; 130:1064–77) surgery, when we return this vital function to its legitimate owners, ideally with a seamless transition to a healthy post- operative course. -
Prioritization of Health Services
PRIORITIZATION OF HEALTH SERVICES A Report to the Governor and the 74th Oregon Legislative Assembly Oregon Health Services Commission Office for Oregon Health Policy and Research Department of Administrative Services 2007 TABLE OF CONTENTS List of Figures . iii Health Services Commission and Staff . .v Acknowledgments . .vii Executive Summary . ix CHAPTER ONE: A HISTORY OF HEALTH SERVICES PRIORITIZATION UNDER THE OREGON HEALTH PLAN Enabling Legislatiion . 3 Early Prioritization Efforts . 3 Gaining Waiver Approval . 5 Impact . 6 CHAPTER TWO: PRIORITIZATION OF HEALTH SERVICES FOR 2008-09 Charge to the Health Services Commission . .. 25 Biennial Review of the Prioritized List . 26 A New Prioritization Methodology . 26 Public Input . 36 Next Steps . 36 Interim Modifications to the Prioritized List . 37 Technical Changes . 38 Advancements in Medical Technology . .42 CHAPTER THREE: CLARIFICATIONS TO THE PRIORITIZED LIST OF HEALTH SERVICES Practice Guidelines . 47 Age-Related Macular Degeneration (AMD) . 47 Chronic Anal Fissure . 48 Comfort Care . 48 Complicated Hernias . 49 Diagnostic Services Not Appearing on the Prioritized List . 49 Non-Prenatal Genetic Testing . 49 Tuberculosis Blood Test . 51 Early Childhood Mental Health . 52 Adjustment Reactions In Early Childhood . 52 Attention Deficit and Hyperactivity Disorders in Early Childhood . 53 Disruptive Behavior Disorders In Early Childhood . 54 Mental Health Problems In Early Childhood Related To Neglect Or Abuse . 54 Mood Disorders in Early Childhood . 55 Erythropoietin . 55 Mastocytosis . 56 Obesity . 56 Bariatric Surgery . 56 Non-Surgical Management of Obesity . 58 PET Scans . 58 Prenatal Screening for Down Syndrome . 59 Prophylactic Breast Removal . 59 Psoriasis . 59 Reabilitative Therapies . 60 i TABLE OF CONTENTS (Cont’d) CHAPTER THREE: CLARIFICATIONS TO THE PRIORITIZED LIST OF HEALTH SERVICES (CONT’D) Practice Guidelines (Cont’d) Sinus Surgery . -
MECAP News April 2021
U.S. Consumer Product Safety Commission MECAPnews MEDICAL EXAMINERS AND CORONERS ALERT PROJECT April 2021 MECAP Reports | Page 2 Asphyxia/Suffocation Carbon Monoxide Poisoning Submersion MECAP Reports | Page 3 Fire All-Terrain Vehicles (ATVs) Electrocution Fatalities Involving Other Hazards MECAP Contact | Page 4 The following pages summarize MECAP reports Yolanda Nash received by CPSC selected for follow-up Program Analyst investigation. The entries include a brief Division of Hazard and Injury Data description of the incident to illustrate the type and Systems Directorate for Epidemiology nature of the reported fatalities. This important information helps CPSC carry out its mission to U.S. Consumer Product Safety protect the public from product-related injuries and Commission deaths. 4330 East-West Highway Bethesda, MD We appreciate your support; please continue to 20814 report your product-related cases to us. [email protected] 1-800-638-8095 x7502 or 301-504-7502 *Cases selected for CPSC follow-up investigation Asphyxiation/ down to sleep in a toddler basement stairs. The Suffocation bed with multiple heavy electric power had been blankets. The next morning, shut off, and the generator *A 7-year-old female was the mother found the was used to provide power. discovered by her mother decedent positioned face EMS measured the carbon unresponsive in bed with a down in the soft bedding monoxide level at 500 ppm. balloon pulled over her face. and blankets. Despite The cause of death was The decedent became emergency efforts, the carbon monoxide poisoning. entangled with a helium infant was pronounced dead balloon tied to her bed and at the hospital. -
A Cluster of Chilblains in Hong Kong
ORIGINAL ARTICLE A cluster of chilblains in Hong Kong Y Chan William YM Tang Objective To report a recent clustering of chilblain cases in Hong Kong. WY Lam Design Case series. Steven KF Loo Setting A regional hospital and a social hygiene clinic in the New Samantha PS Li Territories West, Hong Kong. Angelina WM Au Patients Patients with a clinical diagnosis of chilblains in February 2008. WY Leung Results Eleven patients with chilblains were identified; seven (64%) CK Kwan gave an antecedent history of prolonged exposure to cold. They KK Lo all presented with erythematous or dusky erythematous skin lesions affecting the distal extremities, especially fingers and toes. Laboratory tests revealed elevated antinuclear antibodies titres in two, positive rheumatoid factor in two, presence of cold agglutinins in one, and a raised anti-DNA titre (>300 IU/mL) in one. Skin biopsies were performed in six patients, four of them showed typical histopathological features of chilblains. In the patient with systemic lupus erythematosus, features of vasculitis were suspected, and in the one with pre-existing juvenile rheumatoid arthritis, there were features of livedo vasculitis. In 10 (91%) of the patients, the skin lesions had resolved when they were last assessed (at the end of March 2008), but had persisted in the patient who had pre-existing systemic lupus erythematosus. Conclusion The recent clustering of chilblains was possibly related temporally to the prolonged cold weather at the end of January to mid- February. In our series, most of the patients developed chilblains as an isolated condition and resolved spontaneously within a few weeks.