December 10, 2020

Background: Acute migraine headaches are a common presentation to emergency departments.  Treatment can be challenging: multiple medications are often required and allergies can limit options. Oral timolol maleate is approved by the FDA for migraine prophylaxis but is not typically effective once the migraine has started.  There are some case reports of topical timolol in the treatment of acute migraine headaches [2][3] and a research letter [4] describing the use of timolol eyedrops in the treatment of acute migraine headaches. The research letter was a randomized trial of 10 patients that was not masked and therefore no definitive conclusions could be made.

December 7, 2020

Background: SARS-CoV-2 infection has resulted in a high mortality rate, with the majority of deaths resulting from respiratory failure. As waves of the pandemic continue to overwhelm healthcare systems throughout the world, a pragmatic risk stratification tool that would allow for the early identification of patients with COVID-19 infection who are at the highest risk of death could help guide the management of individual patients as well as resource utilization.  In a systematic review from April 2020, Wynants et al found that prediction models have rapidly entered the literature since the start of the covid-19 pandemic, but that they are of questionable quality and at high risk of bias, and as such are not ready for general use.  A prediction model based on a large cohort with high quality methods would be of great value to the medical community.  

December 5, 2020

Background: Despite limited high-quality evidence, many institutions are currently using convalescent plasma therapy (CPT) in the treatment of COVID-19.  The majority of the evidence for CPT comes from observational studies lacking placebo arms (US Expanded Access Program). Convalescent plasma therapy isn’t a novel treatment modality and has been used in the treatment of other infectious diseases (SARS, MERS, H1N1, Ebola, etc…) with mixed results. The theory behind CPT is it can supplement the patient’s immune response by administering plasma rich in antibodies from someone previously infected who has recovered.  Thus far the US Expanded Access Program, showed that giving convalescent plasma earlier (i.e. ≤3 days) and with higher titers (>18.45 S/Co) was associated with improved mortality in COVID-19 (This data cannot show causality as there was no randomization and no control arm) [3].

December 4, 2020

Background: Throughout the COVID19 pandemic, massive efforts have been invested on the research of effective therapeutics.  Much of the research looks at repurposing older treatments (i.e. antimalarial drugs, antiviral agents, interleukin blockers and convalescent plasma therapy).  There have been no large randomized, controlled trials of targeted treatments specific to SARS-CoV-2. LY-CoV555 is an anti-spike protein neutralizing monoclonal antibody that binds with high affinity to the receptor-binding domain of SARS-CoV-2. Its role in treatment of COVID19 is unclear.

December 3, 2020

Background Information:

Nausea and/or vomiting are chief complaints that account over 4 million emergency department (ED) visits each year.1 Multiple studies have shown aromatherapy in the form of isopropyl alcohol “prep” pads to be effective in postoperative nausea and vomiting.2,3 More specifically in the ED, a single randomized controlled trial showed nausea relief with inhaled isopropyl alcohol when compared to placebo.4 The authors of this study decided to take it one step further in this placebo-controlled randomized control trial by comparing aromatherapy to oral ondansetron in ED patients with nausea and vomiting