August 27, 2020

The Coronaviridae family and its genera coronaviruses have been implicated as having neurotropic and neuroinvasive capabilities in human hosts (Bohmwald 2018). They have been associated with the development of neuropsychiatric symptoms, seizure activity, encephalomyelitis, acute flaccid paralysis, cerebral venous sinus thrombosis, Guillain-Barré syndrome, as well as cerebrovascular disease (Bohmwald 2018, St Jean 2004). Recently, there has been a growing body of evidence supporting the association of SARS-CoV2 with neurological abnormalities. A systematic review looking at the incidence of secondary neurological disease in patients diagnosed with SARS-CoV2 found rates to vary from 6-36.4% (Herman 2020). At the time of this submission, there have been ten reports of acute transverse myelitis (ATM) attributed to SARS-CoV2, and others are currently being submitted or are in pre-print at this time (See infographic below). ATM has a varied presentation and is associated with significant morbidity and mortality that necessitates increased awareness and vigilance on the part of the clinician. This has become especially important in light of a possible causal link of ATM to SARS-CoV2 with emerging cases during the COVID-19 pandemic. Here, we review the salient features of infectious ATM (both para-infectious and post-infectious) to increase recognition of this disease entity.

August 24, 2020

Background Information:

It is well documented throughout the literature that critically ill patients admitted to the intensive care unit (ICU) with acute kidney injury have a higher morbidity and mortality.1–4 Acute kidney injury may be complicated by acidosis, hyperkalemia and other major metabolic disorders and thus the initiation of renal replacement therapy (RRT) is generally considered beneficial in these patients.5 In patients without these complications, the timing of when to initiate RRT remains unclear and is frequently debated. There are three trials to know before getting to this one: ELAIN, IDEAL and AKIKI. The ELAIN trial was the only one of the three to show reduced 90-day mortality with early vs delayed initiation of RRT and was the smallest in sample size.6 The IDEAL trial concluded that early planned initiation of dialysis in stage V chronic kidney disease was not associated with improvement in survival or clinical outcomes.7 Lastly, the AKIKI trial found no significant difference with regard to mortality between an early and delayed strategy of RRT and actually saw an appreciable number of patients avert the need for RRT in a delayed strategy.8 The authors of the following study sought to investigate whether an accelerated strategy for RRT would result in lower risk of death from any cause at 90 days when compared to a standard strategy of RRT initiation.

August 17, 2020

Background: The most severe SARS-CoV-2 infections result in an intense inflammatory response which can lead to acute lung injury and/or acute respiratory distress syndrome.  Theoretically, potential treatments for severe disease should have anti-inflammatory action without substantial side effects. One candidate medication is colchicine, which has traditionally been used to treat gout and pericarditis. It has yet to be determined if the use of colchicine might improve clinical outcomes by its combination of anti-inflammatory action with an acceptable safety profile in patients with COVID-19.

August 10, 2020

Background: Patients coming to the ED frequently have several interventions performed in their evaluation and management.  Blood draws, for the most part, are venous. Occasionally, however, arterial sampling is used to gauge acid-base status, PaO2, PaCO2, lactate etc.  This is a painful procedure for patients and can be challenging to perform by the staff.  Although rare, ABGs can cause harm in the form of radial artery spasm, infarct, and/or aneurysms. In non-hypoxemic patients, VBGs are less painful and have been shown to have similar results compared to ABGs [2][3][4][5].

August 6, 2020

Background: As the COVID-19 pandemic continues a number of challenges have arisen. Amongst these is the ability of clinicians to predict which patients will suffer from early decompensation. It is well established that there are patients that will rapidly decline while others, who initially present similarly, will continue without disease progression. A clinical decision instrument (CDI) to guide clinicians can be useful placing patients requiring hospital admission at the correct level of care without over-utilizing ICUs or, putting patients on the floors who will suffer from early decompensation.