Publications by authors named "J Michelle Moccia"

4 Publications

  • Page 1 of 1

Delirium in Older Patients With COVID-19 Presenting to the Emergency Department.

JAMA Netw Open 2020 11 2;3(11):e2029540. Epub 2020 Nov 2.

Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts.

Importance: Delirium is common among older emergency department (ED) patients, is associated with high morbidity and mortality, and frequently goes unrecognized. Anecdotal evidence has described atypical presentations of coronavirus disease 2019 (COVID-19) in older adults; however, the frequency of and outcomes associated with delirium in older ED patients with COVID-19 infection have not been well described.

Objective: To determine how frequently older adults with COVID-19 present to the ED with delirium and their associated hospital outcomes.

Design, Setting, And Participants: This multicenter cohort study was conducted at 7 sites in the US. Participants included consecutive older adults with COVID-19 presenting to the ED on or after March 13, 2020.

Exposure: COVID-19 was diagnosed by positive nasal swab for severe acute respiratory syndrome coronavirus 2 (99% of cases) or classic radiological findings (1% of cases).

Main Outcomes And Measures: The primary outcome was delirium as identified from the medical record according to a validated record review approach.

Results: A total of 817 older patients with COVID-19 were included, of whom 386 (47%) were male, 493 (62%) were White, 215 (27%) were Black, and 54 (7%) were Hispanic or Latinx. The mean (SD) age of patients was 77.7 (8.2) years. Of included patients, 226 (28%) had delirium at presentation, and delirium was the sixth most common of all presenting symptoms and signs. Among the patients with delirium, 37 (16%) had delirium as a primary symptom and 84 (37%) had no typical COVID-19 symptoms or signs, such as fever or shortness of breath. Factors associated with delirium were age older than 75 years (adjusted relative risk [aRR], 1.51; 95% CI, 1.17-1.95), living in a nursing home or assisted living (aRR, 1.23; 95% CI, 0.98-1.55), prior use of psychoactive medication (aRR, 1.42; 95% CI, 1.11-1.81), vision impairment (aRR, 1.98; 95% CI, 1.54-2.54), hearing impairment (aRR, 1.10; 95% CI 0.78-1.55), stroke (aRR, 1.47; 95% CI, 1.15-1.88), and Parkinson disease (aRR, 1.88; 95% CI, 1.30-2.58). Delirium was associated with intensive care unit stay (aRR, 1.67; 95% CI, 1.30-2.15) and death (aRR, 1.24; 95% CI, 1.00-1.55).

Conclusions And Relevance: In this cohort study of 817 older adults with COVID-19 presenting to US emergency departments, delirium was common and often was seen without other typical symptoms or signs. In addition, delirium was associated with poor hospital outcomes and death. These findings suggest the clinical importance of including delirium on checklists of presenting signs and symptoms of COVID-19 that guide screening, testing, and evaluation.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.29540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677760PMC
November 2020

First Report of Survival in Refractory Ventricular Fibrillation After Dual-Axis Defibrillation and Esmolol Administration.

West J Emerg Med 2016 Nov 20;17(6):762-765. Epub 2016 Oct 20.

St. Mary Mercy Hospital, Departments of Graduate Medical Education and Emergency Medicine, Livonia, Michigan.

There is a subset of patients who suffer a witnessed ventricular fibrillation (VF) arrest and despite receiving reasonable care with medications (epinephrine and amiodarone) and multiple defibrillations (3+ attempts at 200 joules of biphasic current) remain in refractory VF (RVF), also known as electrical storm. The mortality for these patients is as high as 97%. We present the case of a patient who, with a novel approach, survived RVF to outpatient follow up.
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http://dx.doi.org/10.5811/westjem.2016.8.30351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102605PMC
November 2016

Using the ECG to identify pulmonary embolism.

Authors:
J M Moccia

Dimens Crit Care Nurs 2000 Sep-Oct;19(5):27-31

St. Mary Hospital, Livonia, Mich., USA.

Pulmonary embolism is frequently unrecognized in postoperative and medical patients. In this article, the author describes how to recognize this "great imitator" and protect patients from potentially fatal complications.
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http://dx.doi.org/10.1097/00003465-200019050-00006DOI Listing
June 2002

Embolism: targeting an elusive enemy.

Nursing 1996 Apr;26(4):26-31; quiz 32

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April 1996
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