Impact of COVID-19 on Inpatient Clinical Emergencies and Summer 2021 Digest

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headshot of Jose L. Pascual, MD
Jose Pascual, MD

Each month, the Penn Physician Blog features a review of recent journal publications by clinical researchers in the Department of Traumatology, Surgical Critical Care and Emergency Surgery at the University of Pennsylvania.

Our featured articles for the Summer 2021 were co-authored by trauma surgeon Jose Pascual, MD, and other clinical colleagues from a host of divisions, departments and centers at the Perelman School of Medicine. The first report describes the processes and adaptations that defined rapid response team (RRT) activation at Penn Medicine during the early months of the COVID pandemic, and second is a case study for using prolonged mechanical rib separation for the prevention of thoracic compartment syndrome in penetrating chest trauma.

Impact of COVID-19 on Inpatient Clinical Emergencies: A Single-center Experience

Soon after the first COVID patient arrived at the Hospital of the University of Pennsylvania in March 2020, the hospital's clinical emergencies leadership team adapted its existing guidelines for rapid response to respiratory distress and inpatient clinical emergencies to address the pandemic. This involved creating simple clinical decision support tools for the application of new guidelines and ensuring their distribution to clinical staff in the hospital to safeguard both patients and hospital staff.

In late 2020, as the pandemic surge waned, a team of clinicians from various departments, divisions and centers at the Perelman School of Medicine -- including trauma surgeon Jose Pascual, MD -- conducted a study to evaluate the effect of these efforts during the early months of the pandemic, with particular attention to the characteristics defining rapid response team (RRT) activations.

Using retrospective data, the authors determined that RRT activations for respiratory distress rose substantially during the rapid COVID-19 surge and plateau. Among other findings, the authors noted that respiratory distress prompted 36% of RRT activations during the COVID era -- compared with 26% during the pre-COVID era -- and that RRT call rates for respiratory decompensation, significantly more common during the study period, were driven by events in COVID-19/PUI patients (persons with a positive SARS-CoV-2 test or those under investigation with a pending test).

The full article is available from Resuscitation Plus: Impact of COVID-19 on Inpatient Clinical Emergencies: A Single-center Experience.

Prolonged Mechanical Rib Separation is a Key Element to Prevent Thoracic Compartment Syndrome in Penetrating Chest Trauma: A Case Report

In this case report, a team of clinicians describe the hemodynamic benefit of mechanical rib separation following penetrating cardiac trauma and massive resuscitation, as well as the techniques used for resuscitation and open chest maintenance.

Authors included Dr. Pascual and Drs. Ng T. Niu, Jeremy W. Cannon and Lewis J. Kaplan, from the Division of Traumatology, Surgical Critical Care & Emergency Surgery, and Emily J. MacKay, MD, of the Department of Anesthesiology & Critical Care.

The full text is available at Trauma Case Reports: Prolonged Mechanical Rib Separation is a Key Element to Prevent Thoracic Compartment Syndrome in Penetrating Chest Trauma: A Case Report.

New Research from Penn Trauma

See other publications from Penn researchers in the Department of Traumatology, Surgical Critical Care and Emergency Surgery at the Perelman School of Medicine

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The Penn Physician Blog is a resource for health care professionals featuring Penn Medicine physicians and their research, innovations, programs and events. 

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