therapeutics to treat vancomycin-resistant organisms necessitates proper stewardship. The results of
this study demonstrate the utility of MRSA nares intervention to guide appropriate antibiotic use.
TRENDS IN THE MOST COMMON CHIEF COMPLAINTS IN NATIONAL EMERGENCY DEPARTMENTS, WITH A DEEPER FOCUS ON CHEST PAIN, 2005-2021 Husayn F. Ramji MD1, Joshua Bundy Ph.D MPH2, Keith C. Ferdinand, MD1; Department of Medicine1, Department of Epidemiology, Tulane University, New Orleans, LA.
Introduction: The chief complaint is a key aspect of acute patient care and management. It is also a fundamental part of the presentation of acute and chronic conditions. Therefore, gaining a better understanding of the burden and distribution of the most common chief complaints in the nation can reveal trends and guide prospective healthcare strategies. Study: This retrospective project sought to trend the three most common chief complaints in national emergency departments (ED) from 2005-2021: Abdominal Pain, Chest Pain, and Shortness of Breath. Chief complaint, demographic, and regional data was gathered from the National Hospital Ambulatory Medical Care Survey (NHAMCS), with Chest Pain being analyzed further. From 2005 to 2021, there were increases in ED visits related to Abdominal Pain, Chest Pain, and Shortness of Breath, both in the number of the visits, and as a percentage of all ED visits in each year. The Southern USA had the greatest
burden of national Chest Pain related ED visits from 2005 to 2021. All regions have seen roughly the same percentage of Chest Pain related visits when compared to all ED visits in their respective regions (4.99 patients per 100 ED visits, 95% CI 4.86-5.13). The average age of males and females presenting to the ED for Chest Pain in each region was not found to differ significantly. However, there has been a noticeable decrease in the average age of males and females presenting with Chest Pain from 2019 to 2021, suggesting significant direct and indirect implications of the SARS-CoV-2 pandemic on the medical decision making of patients requiring emergency care. Discussion: The more we understand of the burden and trends in these chief complaints, their associated diagnoses, the populations most affected, and the long-lasting effects of the pandemic on the healthcare system, the better we can tailor our efforts in prevention, management, and care.
A NOVEL APPROACH TO VEGETATION ASPIRATION IN NATIVE VALVE INFECTIVE ENDOCARDITIS WITH THE ALPHAVAC SYSTEM Luke Sharrock DO, Sepehr Sadeghi DO, Walter Bradley Rentrop MD, Scott Laura MD, Frank Smart MD; Department of Medicine, LSU Health New Orleans, New Orleans, LA.
Introduction: Vegetative valvular endocarditis from non-sterile injections in opioid-dependent patients presents a challenging dilemma in healthcare. Even when meeting guideline criteria, these patients are often not deemed an appropriate candidate for valvular replacement/repair. Therefore, these patients are often treated conservatively with long- term intravenous antibiotics alone. Alternatively, with the advancement of endovascular aspiration thrombectomy, providers have been able to use this more novel approach to remove vegetations without the need for surgical intervention. Case: A 45 year-old female presented with fever and chills for one week. The patient had opioid dependence and self-reported receiving a non-sterile
dose of intravenous heroin the week prior. She was septic on arrival and blood cultures were positive for methicillin sensitive staph aureus (MSSA). Computed Tomography of her chest was suspicious for bi-apical septic emboli, and a Trans-thoracic echocardiogram (TTE) revealed a 1.7 cm mobile vegetation on the anterior leaflet of her native tricuspid valve (TV). She was evaluated by cardiothoracic surgery, which deemed her not an appropriate surgical candidate due to a history of intravenous drug abuse. Without the possibility of surgical intervention, the patient was informed of her options including endovascular aspiration of the vegetation. She ultimately consented to the procedural removal of the vegetation via the novel AlphaVac system. The vegetation was successfully aspirated and the 16
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