April 30, 2020

Background: Currently, there are no approved medications for the treatment of COVID-19, but,  there are many investigational agents that have shown antiviral activity against SARS-CoV-2 in vitro.  Unfortunately in vitro studies do not always extrapolate to clinical care  In vitro studies of remdesivir demonstrate inhibition of  human and animal coronaviruses tested including SARS-CoV-2.  However, the clinical and antiviral efficacy of remdesivir in COVID-19 remains to be established. The title of this post is, "two more trials just published on Remdesivir," but in reality it is 1.5 trials as we don't have the full release of the 2nd trial (see discussion).

April 28, 2020

Early reports have shown that COVID-19 is most likely causing a hypercoagulable state, however the prevalence of acute VTE and exactly how to treat it is an evolving area.  Limited data suggest pulmonary microvascular thrombosis may play a role in progressive respiratory failure.  However, most evidence is limited to small retrospective trials.  As we wait for more evidence, clinical decisions have to made at the bedside and decisions about pharmacological prophylaxis are starting to emerge.  In this episode I sit down with a special guest that is new to REBEL Cast to talk about the dilemmas involving COVID-19 and thrombosis.

April 27, 2020

Background: In patients with stable coronary artery disease the goals of treatment are to reduce the risk of death, ischemic events, and to improve quality of life. In order to achieve those objectives all patients with coronary artery disease should be treated with guideline based medical therapy. Currently, many of them undergo elective angiography and placement of stents if needed when they have abnormal stress tests. Before the widespread use of drug-eluting stents, trials evaluating incremental effects of revascularization added to medical therapy did not show a reduction in the rates of death or MI. However, those trials did not include sufficient numbers of participants, and only included those with known coronary anatomy prior to randomization.

April 24, 2020

In this episode of REBEL Cast,I sit down with Richard Levitan and talk about some ideas from his experience in New York, where he spent 10 days during the surge of the COVID-19 pandemic. And the lessons he took away were, I think, invaluable for how we’re going to manage these patients going forward.

April 19, 2020

Many facilities are using COVID-19 screening protocols to determine how to cohort patients in the ED. Although this sounded like a good idea initially, this strategy is destined to fail.  Early on in the pandemic, we thought we could identify potential COVID-19 patients based on the presence of fever and cough. However, multiple studies are coming out showing a high prevalence of asymptomatic patients with positive tests for SARS-CoV-2.  Identifying asymptomatic patients is important to improve outpatient quarantine (i.e. maximize physical distancing) and to improve staff safety (i.e. incorrectly admitting patients to the wrong area of the hospital). In most regions, there are simply not enough tests to test everyone, but a universal testing strategy needs to be implemented, especially for admitted patients as this can have major ramifications to staff and patient safety.
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