November 21, 2020

Background: Face masks can reduce transmission of respiratory viruses by both being a potential physical barrier and by reducing droplet transmission.  Additionally, the presence of a mask reduces the users frequency of touching their face which may also reduce transmission.  Despite strong, consistent public health messaging about the utility of wearing masks, their use continues to be debated. Both the CDC and WHO strongly recommend the use of masks as a means of source control, but the WHO acknowledges the lack of robust evidence in healthy persons.

November 19, 2020

Background Information: Central venous catheterization is a common procedure performed in the ICU for the purposes of drug administration and resuscitation. The subclavian vein is the more preferred access site given its fixed puncture location, ease for nursing access and low incidence of infections.1 Landmark guided catheterization has a widely variable success rate and has been shown to increase the risk of complications such as hematoma formation and pneumothoraxes.2,3 The use of real-time ultrasound guidance has thus led to more central lines being placed in the internal jugular and femoral lines, however there is substantial debate regarding its use in subclavian vein catheterization.4,5 The authors of this study sought to compare the efficacy and safety of static ultrasound-guided puncture with traditional anatomic landmark guided subclavian vein puncture.

November 16, 2020

Background Information:

US vs Landmark for Radial Arterial LinesUltrasound guided peripheral and central venous access has become more common while simultaneously decreasing complications and increasing first pass success. Landmark guided palpation has historically been considered the standard of care when placing arterial lines, however the use of ultrasound is challenging that notion as anatomic landmarks are not helpful in 30% of patients.1 Additionally, increasing obesity and hemodynamic instability can make radial arterial line placement even more difficult when using landmark-guided palpation alone. The literature comparing the different methods of arterial line placement is limited to two prospective studies. The first assessed second- and third-year emergency medicine residents while the second study evaluated only four emergency medicine attendings, all with extensive ultrasound training and experience.2,3 The authors of this study sought to compare radial arterial line placement using ultrasound vs landmark guided palpation performed by novice emergency medicine interns with respect to overall success.

November 13, 2020

Background: There have been lots of trials sitting on my computer desktop awaiting my review, but like many of you time has been thin from clinical work and increasing cases of COVID-19 where I work.  I thought it might be more effective to give you the Cliff’s Notes highlights of each since the time for deep dives remains elusive.  As always, I urge you to read each of the papers yourselves and come to your own conclusions. Thus far in the pandemic, there have been few treatment options available to manage COVID-19. Many clinicians have been using repurposed drugs with scant data as well as other non-drug interventions.  Let’s get into some recent data behind these interventions.

November 12, 2020

Background: The well-established, standard treatment for acute appendicitis is surgical appendectomy.  However, recent research has challenged the dominance of the surgical approach in looking at antibiotics alone. The available literature on non-operative treatment of appendicitis (NOTA) has important limitations: exclusion of patients with appendicoliths, small sample size and predominance of open appendectomy over laparoscopic appendectomy. While data on NOTA is intriguing, it is clear that additional studies are needed.