Introduction: The epidemiology of Emergency Department (ED) visits provides important data regarding demand for the medical resources. The aim: To present changes in the visits to ED of University Hospital during the early stage of Covid-19 state of epidemic. Matrial and Methods: All ED visits during the 3 periods each lasting one weeks in 2018, 2019, and 2020 respectively were analysed. The data related to patients ’visits in the emergency department were gathered. Results: The percentage of patients admitted between 23-29.03 in 2020 year was 23.7% of the study group and constituted a significantly lower percentage than those admitted in 2028 who constituted 37.2% and 2019 who constituted 39.1% p<0.001. There was no significant differences between percentages of patients admitted to ED and brought by EMS among studied periods. The percentage of patients admitted to other ward of the hospital was higher in 2020 than in 2018 and 2019. Conclusions: 1. During early stage of COVID-19 epidemic state the number of ED significantly decreased both patients brought by EMS and non EMS pathway. 2. Patients admitted to ED are more often admitted to other ward of the hospital. 3. The mortality during ED stay is similar than in similar periods in previous years.

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases the risk of atrial fibrillation/flutter (AF/AFL) incident. The study aimed to present the characteristics of admissions to the emergency department (ED) due to AF/AFL incidents during the third COVID-19 pandemic wave. (2) Methods: A retrospective analysis of the medical records of the ED patients: 8399 during 3 months of the second and 11,144 during the 3 months of the third pandemic wave. (3) Results: SARS-CoV-2 positive patients there were 295 (3.5%) during the second wave and 692 (6.2%) during the third wave (p < 0.001). Among patients with SARS-CoV-2 infection, there were 44 (14.9%) patients with known AF/AFL during the second wave and 75 (10.8%) during the third wave, respectively (0.07). There were 116 visits with a diagnosis of AF/AFL incident during the third wave (study group) and 76 visits during the second wave (control group). The SARS-CoV-2 test was positive in 11 (9.5%) visits in the study group and in 1 (1.3%) visit in the control group p = 0.047. During the third wave, the patients with AF/AFL incidents with positive tests were older and more often had new-onset AF/AFL than those with negative tests: 76.3 (13.2) years vs. 71.8 (12.6) years; and 4 (36.4%) patients vs. 7 (7.6%) patients, respectively. (5) Conclusions: During the third pandemic wave, the number of patients with SARS-CoV-2 infection increased in comparison to the second wave. Additionally, among patients with AF/AFL incidents, the percentage of SARS-CoV-2-positive patients increased. During the third wave, the patients with positive tests and AF/AFL incident were older and more often had new-onset AF/AFL than those with AF/AFL incident and negative test which indicate the arrhythmogenic effect at the onset of the disease, especially in the older population.

Background: Even though coronary artery disease (CAD) is considered an independent risk factor of an unfavorable outcome of SARS-CoV-2-infection, the clinical course of COVID-19 in subjects with CAD is heterogeneous, ranging from clinically asymptomatic to fatal cases. Since the individual C2HEST components are similar to the COVID-19 risk factors, we evaluated its predictive value in CAD subjects. Materials and Methods:In total, 2183 patients hospitalized due to confirmed COVID-19 were enrolled onto this study consecutively. Based on past medical history, subjects were assigned to one of two of the study arms (CAD vs. non-CAD) and allocated to different risk strata, based on the C2HEST score. Results: The CAD cohort included 228 subjects, while the non-CAD cohort consisted of 1956 patients. In-hospital, 3-month and 6-month mortality was highest in the high-risk C2HEST stratum in the CAD cohort, reaching 43.06%, 56.25% and 65.89%, respectively, whereas in the non-CAD cohort in the high-risk stratum, it reached: 26.92%, 50.77% and 64.55%. Significant differences in mortality between the C2HEST stratum in the CAD arm were observed in post hoc analysis only for medium- vs. high-risk strata. The C2HEST score in the CAD cohort could predict hypovolemic shock, pneumonia and acute heart failure during hospitalization, whereas in the non-CAD cohort, it could predict cardiovascular events (myocardial injury, acute heart failure, myocardial infract, carcinogenic shock), pneumonia, acute liver dysfunction and renal injury as well as bleedings. Conclusions: The C2HEST score is a simple, easy-to-apply tool which might be useful in risk stratification, preferably in non-CAD subjects admitted to hospital due to COVID-19.

The aim: To diagnose patients with suspected pulmonary embolism is to assess eTCO2 in two lateral decubitus positions and to compare them between each other and with PaCO2. Material and methods: An approval of the bioethics commission was obtained to study eTCO2 in different positions in patients with suspected PE (583/2019). Consecutive ED patients referred for computed tomography pulmonary angiography (CTPA) due to a suspicion of pulmonary artery embolism are asked to take part in the study. Exclusion criteria are the inability to give informed consent, shock or hypotension, inability to change position (an elevation of the upper body to 30 degrees is allowed). The other available laboratory data like D-dimer concentration, troponin, arterial blood gases analysis, creatinine, sodium, potassium, NT-proBNP, hemoglobin, C-reactive protein, and glycemia are noted. CTPA in the case of pulmonary embolism is assessed to determine differences between embolism to both lungs. Results: The difference between eTCO2 on the left lateral decubitus position was found. Contrary to this finding in a healthy person there was no differences between eTCO2 obtained in both lateral positions. Stress tests are known methods for examining patients whose underlying conditions are normal or inconclusive. In the case of capnography, such a load could be a change in body position, which is a simple procedure that does not require much physical effort. Conclusions: Intensifying efforts to disseminate knowledge on the use of eTCO2 in clinical practice and to find new applications for this study seems particularly important.

Aim: To determine the presence and the importance of a difference in end tidal carbon dioxide between lateral decubitus positions for pulmonary embolism prediction. Material and methods: There were 32 patients aged 65.7±14.4 (16M, 16F) with pulmonary embolism and 15 patients aged 56.7±20.3 (10M, 5F) with excluded pulmonary embolism Capnography was performed in supine, left and right lateral decubitus position. The absolute value of the difference in end tidal carbon dioxide concentration between left and right decubitus position was called the delta index. Demographics and clinical data were collected. Results: The delta index was significantly higher in patients with pulmonary embolism vs those with excluded pulmonary embolism: 4 (3-5.5) mmHg vs 1 (1-2) mmHg p<0.001. Area under curve for the delta index was 0.92; 95% CI 0.83-1.0 p 3 mmHg to predict PE the sensitivity and specificity was 66% and 100%, respectively. Conclusions: The patients with pulmonary embolism had increased variability of end tidal carbon dioxide concentration while changing their position.