April 29, 2020

Needs Assessment: As the COVID19 pandemic continues to mount, hospitals will rapidly reach maximal capacity. As a result, patients are boarding longer in the ED and, new patients are waiting longer to be seen. This dynamic poses numerous threats to patients safety. While we are seeing a large number of patients with severe and critical COVID19 who require intense monitoring, therapy and even ICU resources, many patients are only in need of supplemental O2 while they deal with their symptoms. The ability to discharge patients home with O2 and proper follow up monitoring can help open up more beds in both the ED and the hospital in general allowing us to deliver the proper resources to patients who need them.

April 26, 2020

Background: Awake proning, or having patients lie on their stomachs, can help oxygenation by helping to recruit posterior portions of the lungs and by helping with perfusion to oxygenated lung segments. The literature around proning centers on intubated patients with adult respiratory distress syndrome in the ICU. However, there are increasing recommendations from front line clinicians and experts about the benefits of proning hypoxemic COVID19 patients who are awake in an effort to improve oxygenation and stave off intubation. While there may be physiologic reasoning, anecdotal experience and application of data from intubated patients, there is an absence of data specifically on COVID19 patients and proning. Fortunately, we now have some literature to look at:

April 22, 2020

Take Home Points
  • N95 masks ideally should be single use but in COVID19 times, safe reuse practices are critical.
  • The best approach to reuse is vaporized H2O2 and UV light decontamination with a total of 3 decon cycles prior to losing mask integrity.
  • A backup method of cycling between 4 masks is likely effective as SARS-CoV-2 cannot survive > 72 hours outside a human host in sufficient numbers to cause infection.
  • Ethanol soaks are effective in decontamination but destroy mask integrity and should not be use.

April 21, 2020

Introduction: N95 filtering facepiece respirators (FFP, from here out referred to as N95) are designed to filter out 95% of airborne particles and are intended for single use. During the COVID19 pandemic, N95s are in short supply forcing us to consider reuse of the devices in order to maintain protection in clinical environments. However, there is only limited data on safe decontamination and reuse practices. As of the writing of this post, it is unclear when adequate supplies of N95s will be available and numerous hospitals have already started reuse protocols. Here, we review the current literature and recommendations. It’s important to recognize that both ability to filter and fit of the N95 are important in terms of use and reuse. Of note, residual virus may be present after any of these methods but, amounts remaining should not produce clinical infection.

April 8, 2020

Take Home Points
  1. Hyperthyroidism can present along a spectrum from the minimally symptomatic to severely decompensated and presentation can vary with age
  2. If there are a lot of interconnecting systems complaints consider obtaibning a TSH, t3 and t4 
  3. Once you’ve diagnosed hyperthyroidism, dont anchor on it. Look for what might have caused it especially in those with comorbidities
  4. If the patient is stable and reliable you can discharge them home with Atenolol. Make sure to have the patient follow up with their PCP or Endocrinologist. If, however, you feel uncomfortable doing that or the patient needs more social support, call your endocrinologist on call and get their recommendations.
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