Monday 9 November 2020

The 34th WACEM-ACAIM Weekly Summit: Week 6 of e-EMINDIA2020


Becoming EPIC

Dr. Indrani Sardesai, MBBS, MRCEM
SpR Emergency Medicine
QE Hospital, Gateshead, UK

I was had the honor and pleasure to host this the 34th weekly summit, and was one of two international speakers. Out of many topic choices, by request, I settled on sharing the story of my journey in emergency medicine as well as my proclivity towards art and education. EPIC is an acronym for 'emergency physician in charge'. You can read more about this through RCEM Workforce documents . As a specialty registrar, play the role of the senior decision maker. Years of sincere hard work and dedication to the field along with the blessing of support from amazing personalities has seen me through. Reaching this stage has been a personal achievement, and I still have a ways to go before I become EPIC (in both senses). But what I'm known for, quite happily, is my combination of artistic skills with delivery of education. Just as we are eternal learners, we are also eternal educators. I found a way to step into my comfort zone in order to step away from the crowd, and encourage everyone to find their own signature or niche. To quote Dr. Seuss, 'why fit in when you were born to stand out?'

The Evolution of SARS-CoV-2 and COVID-19

Dr. Sean Downing, MD
Department of Internal medicine
Department of Pediatrics
Sarasota Memorial Hospital, 
Sarasota, Florida, USA

Dr. Sean Downing, yet again, engaged us in his fascinating take and talk about the evolution of SARS-CoV-2. He reminded us of the patterns of SARS-CoV-1, and the similarities shared with the CoV-2. He used a graph to show us the present numbers of the virus in various countries, and interestingly while UK is peaking again with a sharp rise in numbers and USA still on the rise, India seemed to be plateauing. Along with this came the observation that though it seems like the virus is infecting more people, the mortality from the virus have slowed down, though by no means stopped, in comparison to March. There are a number of theories about why this might be, but Dr. Downing subscribes to the theory that the virus is evolving and so is our understanding of it. 

Yashoda Hospitals, 

Secundarabad, Telangana

Extrapulmonary Manifestations of COVID-19 - Cardiac Presentations

Dr. S Raghavendra Goud, MD
Head of Department (EM)

Dr. Goud opened his topic answering the basic question of why it is important to study the extrapulmonary manifestations of COVID-19. In short, it is because COVID-19 can present with symptoms besides the expected acute respiratory illness, sometimes with multisystemic involvement. For us, this means being aware of the need to change our treatment and disposition plans. After a brief recap of the pathophysiology of the virus, Dr. Goud's talk focused on the cardiac presentation of COVID-19. He presented a review of multiple articles which remarked upon the cardiac associations or presentations of the disease, including but not limited to acute MI, arrhythmias, cardiac failure. Further studies emphasized the importance of cardiac biomarkers. A study from Yashoda hospital of a small number of cases with cardiac manifestations in patients who tested positive by RT-PCR showed a male preponderance, and association with co-morbidities (DM, HTN, known CAD). A clear majority of those cases had MI, with smaller numbers of dilated cardiomyopathy, cardiac failure, arrhythmias and unstable angina. 

COVID in CVS Emergencies - Cause or Coincidence?

Dr. Mohammad Qamar Akhtar, 
3rd year DNB EM Resident

Continuing the theme from Yashoda Hospitals, Dr. Mohammad described to cardiac cases. The first patient presented with typical cardiac chest pain, was revealed to have anterior wall myocardial infarction on ECG, and eventually, moderate LV dysfunction and LV RWMA on ECHO. His CT Chest revealed multiple ground glass opacities (CORADS-5). He was treated with heparin in the ED and later had LAD stenting. His RT-PCR for COVID-19 was positive on the day of his PCI, he was thus admitted to an isolation intensive care bed. The patient was also treated for COVID-19 with remdesivir, and had an uneventful recovery. The second patient had four days of intermittent typical cardiac chest pain symptoms, with complete heart block on his ECG. His cardiac markers were negative, ECHO was normal, but CT-chest revealed ground glass opacities and inflammatory markers were raised. After a period of temporary pacing, the patient was fitted with a permanent pacemaker, and also had an unremarkable course of recovery. Neither patients had respiratory symptoms of COVID-19. These cases show us the importance of considering that COVID-19 presents in a myriad presentations, that sometimes will not include the symptoms thought typical of a respiratory virus. It stands to reason that we must maintain a high degree of suspicion and constant vigilance where this virus is concerned.

Jawaharlal Nehru Medical College, 

Wardha, Maharashtra

Trends of Patients attending ED early in COVID, during lockdown, and in the unlock period

Dr. Govind Nagdev,
Dr. Waseem Ilyas,
Dr. Gajanan Umalkar, 
EM residents

The residents from JNMC each spoke about ED presentation trends during different phases of COVID. They looked for instance, at attendances due to road traffic accidents, and noticed a reduction in number of cases during the early and lockdown periods, but a rise during the unlock period. In a pattern that has been seen around the world, there has been a trend of reluctance of hospital attendance by patients with cardiac, neurological and other emergencies, perhaps due to worry of catching the virus, perhaps sympathizing with hospital burden. This of course has its own knock-on effect of delayed presentations. It is hard to pinpoint exactly the reason or combination of reasons leading to this interesting phenomenon, but was noticeable in the trends described by JNMC as well. 

Tune in for more next week...

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