February 19, 2021

Update: This article was removed from the Lancet server on February 19th, 2021 (Link)

Background: Vitamin D deficiency is common amongst critically ill patients and there has been ample speculation about a possible role for supplementation (with calcifediol) in the treatment of patients with COVID19. Calcifediol is cheap, readily available and, has minimal side effects making it an ideal therapeutic - if it works. To date, there is limited high-quality evidence on efficacy.

February 13, 2021

Background: Science by press release. Not the way any of us would choose to operate but, the COVID pandemic has made this a reality. It’s vital that we understand that while pharmaceutical companies have a responsibility to release this information, we as clinicians should not be practicing medicine based on press releases. Of course, these press releases don’t only originate from pharma. On January 22nd, 2021, the Montreal Heart Institute released a statement about the results from the COLCORONA study investigating the use of colchicine in COVID-19. The press release painted a very positive picture but, does the pre-peer reviewed publication stand up?

February 10, 2021

Take Home Points
  • Consider ruptured AAA in patients (especially those > 50 years of age) with unexplained hypotension, back or abdominal pain
  • All ruptured AAAs should be considered unstable regardless of vital signs as rapid deterioration is common
  • A ruptured AAA is 100% fatal without surgical or endovascular intervention. Mobilize your surgical colleagues early

January 27, 2021

Take Home Points
  • Frostbite is a severe, localized cold-induced injury due to freezing and thawing of tissue.
  • We usually see these injuries affecting the ears, nose, cheeks, chin, fingers, and toes. Patients will complain of cold, numb or stiff sensations and discoloration of the skin.  
  • Critical ED treatment starts with rewarming in a warm, NOT HOT, water bath, analgesia and wound care.
  • More extensive treatments include blister debridement, tPA, prostacyclin analogues and fasciotomy.  Patients with severe frostbite will likely require multidisciplinary care with surgery and critical care so consider early consults.
  • And last, be sure to check the patients core temp and treat hypothermia complications, such as diuresis
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