Introduction
The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality. The impact of thrombotic complications has been increasingly recognized as an important component of this disease.
Objective
This narrative review summarizes the thrombotic complications associated with COVID-19 with an emphasis on information for Emergency Medicine clinicians.
Discussion
Thrombotic complications from COVID-19 are believed to be due to a hyperinflammatory response caused by the virus. Several complications have been described in the literature. These include acute limb ischemia, abdominal and thoracic aortic thrombosis, mesenteric ischemia, myocardial infarction, venous thromboembolism, acute cerebrovascular accident, and disseminated intravascular coagulation.
Conclusion
It is important for Emergency Medicine clinicians to be aware of the thrombotic complications of COVID-19. Knowledge of these components are essential to rapidly recognize and treat to reduce morbidity and mortality in these patients.
Peripheral intravenous line placement is a common procedure in emergency medicine. Ultrasound guidance has been demonstrated to improve success rates, as well as decrease complications and pain. This paper provides a narrative review of the literature focusing on best practices and techniques to improve performance with this procedure. We provide an evidence-based discussion of preparation for the procedure, vein and catheter selection, multiple techniques for placement, and line confirmation.
Ultrasound-assisted LPs were associated with higher success rates, fewer traumatic LPs, shorter time to successful LP, fewer needle passes, and lower patient pain scores. Ultrasound should be considered prior to performing all LPs, especially in patients with difficult anatomy. Further studies are recommended to determine whether this effect is consistent in both adult and pediatric subgroups, as well as the impact of transducer type and body habitus on this technique.
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