13 May 2021

May 13, 2021

Written by REBEL Covid-19, REBEL EM
Background Information: Over one year into the pandemic many therapies to treat COVID-19 have targeted innumerable aspects of the virus. Most recently, the use of corticosteroids to treat the virus’ excessive inflammatory effects has become the front and center of therapy in patients requiring oxygen therapy.1 The RECOVERY trial showed a mortality benefit when using Dexamethasone in severe cases where oxygen therapy or mechanical ventilation was required.2 Interestingly, compared to other corticosteroids, high doses of Methylprednisolone are actually the preferred agent for anti-inflammation in pulmonary diseases as it achieves a more direct effect on cell membrane associated proteins.3 The authors of the following paper sought to investigate the effectiveness of methylprednisolone compared to Dexamethasone in hypoxemic ICU patients with COVID-19.
Medical Categories: Endocrine, Metabolic, Fluid, and Electrolytes, Infectious Disease, Thoracic and Respiratory
5 Likes
5 Apr 2021

April 5, 2021

Written by REBEL Covid-19, REBEL EM

Background Information:

The use of corticosteroids in patients with pneumonia secondary to COVID-19 has been a controversially hot topic, particularly early on in the pandemic. Prior evidence seen in Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome have led some to argue against their use due to delayed viral clearance.1 More recent evidence related to SARS-Cov-2 has specifically shown reduced mortality and reduced need for mechanical ventilation with corticosteroids.2-4 More recently, the RECOVERY Trial showed an improvement in 28-day mortality among patients on oxygen therapy who received Dexamethasone.5 Little information exists in the literature about patients with moderate to severe disease who do not warrant ICU level of care but require hospital admission due to the extent of their illness. The authors of this study designed and conducted a pragmatic, partially randomized control trial to evaluate the possible benefit of methylprednisolone in hospitalized patients with moderate to severe COVID-19 pneumonia.
Medical Categories: Infectious Disease, Thoracic and Respiratory
2 Likes
29 Mar 2021

March 29, 2021

Written by REBEL EM

 Background Information:

Corneal abrasions are responsible for the largest proportion of eye-related chief complaints in patients presenting to emergency departments in the United States. There is substantial variability in physician practice when it comes to pain control. Ophthalmology literature has shown that amore recent studies have favored topical NSAIDs and anesthetics as beneficial without increased complications.3-5 Interestingly, the lack of clinical evidence for topical anesthetic complications, such as corneal melting, has resulted in controversy regarding its non-dilutional use. The authors of this systematic review and meta-analysis sought to compare healing rates, pain control and complications between all topical pain therapies and their control for patients presenting with corneal abrasions.
Medical Categories: Head, Eye, Ear, Nose, and Throat
0 Likes
14 Jan 2021

January 14, 2021

Written by REBEL Crit, REBEL EM
Background Information: Out-of-hospital cardiac arrest (OHCA) remains a diagnostic challenge to providers and a significant burden on healthcare systems globally. Despite the advancement of invasive medical therapies such as percutaneous coronary intervention (PCI) and extracorporeal membranous oxygenation (ECMO) at designated cardiac catherization centers, the majority of these patients sustain poor outcomes due to hypoxic brain injury. Clinical features of neurologic injury are typically delayed until 72 hours after admission. As a result, many neuro-prognostication tools have been developed to assist with clinical decision making as well as reduce expensive futile interventions.1 Some of these neuroprognostication tools include the Cardiac Arrest Hospital Prognosis (CAHP), OHCA and Targeted Temperature Management (TTM) risk tools. Unfortunately, these are complex and time consuming, thus limiting their use in the emergency department (ED). The authors of the following study sought out to develop and validate a point-based risk score to support clinical decision making and predict neurologic outcomes using the cerebral performance category (CPC) scale (Figure 1)
Medical Categories: Cardiovascular, Neurology, Resuscitation
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26 Dec 2020

December 26, 2020

Written by REBEL Covid-19, REBEL EM
Background Information: With rising cases, an increasing death toll, and a significant strain on hospital systems globally, the COVID-19 pandemic seemed to have no end in sight. The aggressive pursuit of a vaccine has led to multiple clinical trials starting before the end of this year. In fact, there are 48 vaccines under clinical evaluation and 11 of these are currently being evaluated in phase 3 clinical efficacy trials.1 Among those includes, the replication-deficient chimpanzee adenoviral vector developed at Oxford University (ChAdOx1). Following the initiation of a phase 1 clinical trial in the UK (COV001), three additional randomized controlled trials were initiated across the UK (COV002), Brazil (COV003) and South Africa (COV005). Upon completion of enrollment, the authors of the following paper sought to perform a combined interim analysis of the four trials to assess ChAdOx1’s efficacy and safety
Medical Categories: Infectious Disease
3 Likes
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