April 17, 2020

There are lots of mixed messages flying around social media about COVID-19 lung injury.  Although social media is a very powerful way to get information across, it can also amplify messages that are incorrect or not based in quality research and data.  Two pervasive messages have been that COVID19 lung injury is the same as high altitude pulmonary edema (HAPE) and that COVID19 pneumonia is simply typical acute respiratory distress syndrome (ARDS).

April 17, 2020

The SARS-CoV-2 pandemic has strained our available healthcare resources and caused unprecedented stress in the lives of our healthcare workers.  With the advent of COVID-19 and the resultant deaths of our colleagues, it has become painfully clear that our profession has become inherently dangerous.  It is ethically sound to expect the provision of appropriate personal protective equipment (PPE) before treating patients with infectious diseases.1  To borrow from our pre-hospital counterparts, when responding in dangerous situations the utmost priority is your personal safety and the safety of your teammates, and only once these have been assured are we able to attend to the needs of the victim/patient.  However, we cannot be frozen by fear and through the proper and appropriate use of PPE, clinicians can safely uphold the sacred duty to care for the ill.  Following the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, a study analyzed the nosocomial infections in Hong Kong healthcare workers.  Standardized PPE contact and droplet precautions included a mask, gloves, gowns, and handwashing.  Notably, none of the personnel who utilized all four measures were infected with SARS.  Contrastingly, all of the healthcare workers with nosocomial infection had failed to implement at least one of the PPE methods.2  We have confidently and effectively employed PPE against airborne, droplet, and contact pathogens for years (e.g. Mycobacterium tuberculosis, H1N1 influenza A, Clostridium difficile).  Now, as we battle COVID-19, similar to lessons learned on the battlefield and taught in Tactical Combat Casualty Care, we must first engage in suppression of the threat prior to initiating patient care.3

April 13, 2020

Chronic sleep deprivation can affect health, performance, and safety.  There are many causes of sleep deprivation including stresses of daily life, shift work, and unrecognized sleep disorders.  In this talk from Rebellion in EM 2019, Arlene Chung, MD, facts about sleep deprivation, strategies to decrease sleep deprivation for shift workers, and reviews policy statements from the American College of Emergency Physicians (ACEP).

April 9, 2020

The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019.  The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic.  The spread of this virus is now global with lots of media attention.  The virus has been named SARS-CoV-2 and the disease it causes has become known as coronavirus disease 2019 (COVID-19).  This new outbreak has been producing lots of hysteria and false truths being spread, however the data surrounding the biology, epidemiology, and clinical characteristics are growing daily, making this a moving target.  This post will serve as a summary of thrombosis and hemoglobin in regard to COVID-19.

April 9, 2020

Background: Most guidelines recommend prehydration prior to iodine-based contrast media to prevent postcontrast acute kidney injury (PC-AKI) in patients with CKD.  There is, however, a lack of evidence for the effectiveness of this as well as the potential adverse effects from the hydration itself (i.e. congestive heart failure exacerbation). We have covered the AMACING trial on REBEL EM which was a randomized clinical trial evaluating prehydration with 0.9% normal saline vs no prehydration in patients with estimated glomerlular filtration rates of 30 – 59mL/min/1.73m2.  In that study there was no difference in their primary outcome of contrast induced nephropathy (now called postcontrast acute kidney injury - PC-AKI) at 2 – 6 days after IV contrast (2.7% with prehydration vs 2.6% without prehydration). The trial we are are covering today, the Kompas trial, directly compared prehydration with sodium bicarbonate vs no prehydration prior to non-emergent intravenous contrast-enhanced CT in patients with CKD stage 3.
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