Management of acute stroke is challenging under normal circu | Figure 1
Management of acute stroke is challenging under normal circumstances, but a confluence of factors related to the COVID-19 pandemic has made it particularly challenging in recent weeks in the United States.
Beyond affecting millions of people worldwide, the COVID-19 pandemic is exerting real but poorly understood impacts on the treatment of other medical emergencies, including acute stroke. Some of these effects are illustrated by two cases we managed in the first weeks after the pandemic’s emergence in Northeast Ohio.
Case 1
One patient called emergency medical services after nine days of experiencing symptoms of aphasia and right hemiparesis. During evaluation on our mobile stroke treatment unit, the patient was asked about the long delay in seeking care and responded that it was due to being “afraid to come out due to the coronavirus.”
Case 2
A second patient was transferred to Cleveland Clinic for mechanical thrombectomy after presenting with right middle cerebral artery syndrome. She had a history of flu-like symptoms over the prior 10 days. In view of these symptoms, the patient was managed as if she had possible COVID-19 and precautionary measures were taken, which included intubation prior to thrombectomy, to prevent aerosol spread, and the use of personal protective equipment (N95 respirators, surgical masks, gowns and protective eyewear) for all providers in the procedure room. As a result, treatment initiation was delayed.
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A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.
He had a history of hypertension, long-term smoking, and a sedentary lifestyle. Physical examination revealed bibasilar crackles noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.
A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back.
She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.
A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.
Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.
Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history.
Are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?