Browsing by Author "Luster, Taylor"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Acute Heart Failure in the Setting of Post-Covid MIS-C: A Case Report
    (2023-03-24) Luster, Taylor; Sloat, Brittany; Mederos, Alexa; Karam, Marie; Pavlik, Lauren; Duncan, Francesca
    Introduction: Multi-inflammatory Syndrome in Children (MIS-C) has emerged as a rare, but severe complication of SARS-CoV-2 infection. Patients present with persistent fever, abdominal pain, diarrhea, vomiting, rash, mucocutaneous lesions, and in severe cases, shock. The diagnostic criteria are age < 21, fever, laboratory evidence of inflammation, multi-organ involvement, and a positive COVID-19 test or known exposure 4 weeks prior to symptoms onset. Case Description: A 17-year-old female with a history of prior COVID-19 infection presented complaining of chest pain, shortness of breath, headache, and fevers with a Tmax of 105F for 4 days. The patient was hypotensive, tachycardic, tachypneic, and hypoxic. Pertinent labs included: Na 126, BUN 48, Creatinine 2.1, ALT 62, AST 86, WBC 27.4, Hg 10.5, Troponin 0.96, Lactate 3.3, CRP 60, ESR 85, Procalcitonin 75, D-dimer 2.02, Fibrinogen >1000, COVID PCR negative, and COVID Ig-G reactive. CT chest was notable for bibasilar pulmonary opacites, cardiomegaly, and bilateral pleural effusions. Echocardiogram showed left ventricular ejection fraction of 21% and global hypokinesis. She was ultimately intubated due to respiratory failure and started on milrinone and vasopressors. She was treated with IVIG, aspirin, and methylprednisolone for MIS-C. She clinically improved and repeat echo showed an improved EF of 57% and was discharged after 10 days with a prolonged prednisone taper. Clinical Significance: The incidence of MIS-C is 316 per 1 million pediatric SARS-CoV-2 infections. This case demonstrates need for increased awareness of potential acute cardiac failure in adolescents with a recent history of COVID-19 infection, elevated inflammatory markers, and signs of multi-organ failure so that IVIG, aspirin and corticosteroids can be started immediately to avoid progression of MIS-C into acute cardiac failure. Conclusion: Pediatric presentation of SARS-CoV-2 infection can be mild, but there is a subset of patients that have been reported to develop MIS-C, a more severe post viral syndrome.
  • Thumbnail Image
    Item
    Firearm Injuries during Pregnancy in the USA
    (MDPI, 2023-07-09) Luster, Taylor; Loder, Randall T.; Orthopaedic Surgery, School of Medicine
    Trauma during pregnancy is the leading cause of non-pregnancy-related maternal deaths, with some due to injuries from firearms. It was the purpose of this study to characterize the patterns and presentations of firearm-associated injuries in pregnant women using a national emergency department visit database. Data from the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993–2020 were utilized. The data include age, sex, race, type of firearm, perpetrator of injury, intent of injury (unintentional, assault, suicide, or law enforcement), anatomic location of the injury, incident locale, disposition from the emergency department (ED), and whether the patient was shot or not with the firearm. Of the 3.36 million ED visits over this time span for firearm injuries, 4410 were pregnant women. The mean age of the pregnant cohort was 23.6 years, with more Hispanic and fewer White women in the pregnant group compared to the non-pregnant cohort. Pregnant women were more likely to experience an injury involving the lower trunk and had a higher percentage of fatalities and hospital admissions compared to the non-pregnant cohort. Fetal demise occurred in at least 70% of cases. Nearly one half of the assaults (44%) occurred on Saturdays and Sundays. As the cause of these injuries is complex, prevention will require input from multiple sources, including health care providers, social agencies, government agencies, elected officials, and law enforcement.
  • Thumbnail Image
    Item
    Fractures in Children Due to Firearm Activity
    (MDPI, 2023-03-30) Loder, Randall T.; Luster, Taylor; Orthopaedic Surgery, School of Medicine
    The purpose of this study was to investigate fracture patterns due to pediatric firearm injuries. The data used was from the US Firearm Injury Surveillance Study 1993-2019. Over these 27 years, there were 19,033 children with fractures due to firearm activity with an average age of 12.2 years; 85.2% were boys and the firearm was a powder type in 64.7%. The finger was the most common fracture location, while the tibia/fibula was the most common location for those admitted to the hospital. Children ≤ 5 years of age sustained more skull/face fractures; most spine fractures occurred in the 11-15-year age group. The injury was self-inflicted in 65.2% of the non-powder and 30.6% of the powder group. The injury intent was an assault in 50.0% of the powder and 3.7% of the non-powder firearm group. Powder firearms accounted for the majority of the fractures in the ≤5 and 11-15 year-olds, non-powder firearms accounted for the majority of the fractures in the 6-10 year-olds. Injuries occurring at home decreased with increasing age; there was an increase in hospital admissions over time. In conclusion, our findings support the need for safe storage of firearms in the home away from children. This data will be helpful to assess any changes in prevalence or demographics with future firearm legislation or other prevention programs. The increasing acuity of firearm-associated injuries seen in this study is detrimental to the child, impacts familial wellbeing, and results in significant financial costs to society.
  • Thumbnail Image
    Item
    More Is Not Always Better: A Case Report of Excess Calcium Carbonate Ingestion Causing Milk-Alkali Syndrome
    (2021-03-25) Waller, Sydney; Luster, Taylor; Collins, Angela J.; Raymond-Guillen, Luke
    CASE DESCRIPTION: A 54-year-old female with a medical history significant for CKD stage 4 and alcohol use disorder presented to the Emergency Department with altered mental status. Labs were significant for hyponatremia, hypokalemia, hypochloremia, hypercalcemia, metabolic alkalosis, and Cr 9.3. Lorazepam was given due to concern for alcohol withdrawal. Ultimately, her symptoms were discovered to be due to excessive ingestion of calcium carbonate (aka: Tums), and she was diagnosed with milk-alkali syndrome (MAS). Pt was treated with IV KCl and normal saline, and her labs and mental status normalized over the subsequent 48 hours. | CLINICAL SIGNIFICANCE: MAS is constituted by metabolic alkalosis, acute kidney injury, and hypercalcemia. It is a result of a large intake of calcium and absorbable alkali. The syndrome was first recognized in the early twentieth century, and it essentially disappeared when histamine blockers began being used to treat peptic ulcers in the 1980s. Recently, the syndrome is becoming more common with the increased use of calcium-carbonate in antacids and osteoporosis prevention medications. MAS is the third most common cause of hypercalcemia, after malignancy and hyperparathyroidism. Management involves holding calcium and vitamin D supplements and administering aggressive intravenous hydration. Bisphosphonates and dialysis may be useful in severe cases. Prognosis of MAS is typically good as the condition is reversible. | CONCLUSION: The prevalence of MAS is increasing due to the wide availability of calcium-containing supplements and antacids. In order to counteract this, increased awareness amongst at risk patient populations, such as the elderly and those with renal disease, is vital. Furthermore, increased awareness amongst healthcare professionals may help prevent complications that can arise from untreated MAS.