January 11, 2021

Background: Current trauma resuscitation prioritizes control of bleeding and uses massive transfusion protocols to prevent and treat coagulopathy. This is typically done in the form of massive transfusion protocols delivered in proportions that approach the composition of whole blood. Two strategies to help guide this replacement of blood products are conventional coagulation tests and viscoelastic hemostatic assays.

January 7, 2021

Background/Introduction: Emergency department visits related to cannabis use appear to be increasing nationally secondary to continued trends of legalization, decriminalization, or less restrictive medical cannabis use laws in many states. The number of individuals with daily cannabis use in the United States increased from 5.1 million in 2005 to 8.1 million in 2013 (Bollom 2018). With an increase in the accessibility and consumption of cannabis, there has also been an increase in the utilization of emergency departments for potential adverse effects of cannabis use, particularly gastrointestinal adverse effects. For example, in Colorado, the emergency department visits for cyclic vomiting nearly doubled after liberalization of medical marijuana (Kim 2015). Studies attempting to look at nationwide sampling have noted that the number of persistent vomiting related hospitalization related to cannabis use had a significantly increased trend, with a 286% increase over a 5-year period (Patel 2019). This has led to a renewed interest in the understanding of cannabis hyperemesis syndrome, first well-described in 2004, and recently defined by the Rome IV criteria (Allen 2004). The effective management of cannabis hyperemesis syndrome is still being elucidated as commonly used antiemetics are often ineffective for acute exacerbations. The role of haloperidol as an off-label treatment is being explored but anecdotal evidence suggests it may be an effective adjunct in the treatment of cannabis hyperemesis syndrome.

January 5, 2021

“A little starvation can really do more for the average sick man than can the best medicines and the best doctors.” -Mark Twain- Let me start off by saying, this is not a typical blog post for REBEL EM.  This is a post about a personal journey for me.  Anyone who follows me on my personal Facebook page knows I have been on a journey toward a healthier life over the past 4 years or so.  I used to weigh 240lbs (109kg) and was able to get my weight down to 205lbs (93kg) with carefully changing my diet and being more cognizant of my daily exercise.  I however hit a plateau. As my journey has continued, I began to read a lot more about intermittent fasting. I figured let’s give it a shot. Well, the rest as they say is history.  The transformation has been amazing with a further drop in my weight to 180lbs (82kg). As I have been sharing this with others, I have received lots of questions about this and wanted to share what I have learned about it in the hopes of helping others realize their own health journey. First let me start off by saying if you want to learn more consider reading The Complete Guide to Fasting (Heal Your Body Through Intermittent, Alternate-Day, and Extended Fasting [Link is HERE]. This is a phenomenal book on all the ins and outs of intermittent fasting and I highly recommend it for anyone interested in this topic.

January 4, 2021

"We continually find more ways to use our time while trying to find more ways to save it. You see, you can't actually save time. You can find just different ways to spend it. So when you say you don't have time to do something, you're really saying that you're using your time for other things." — Unknown Author Since medical school, I often wished there were one or two extra hours in the day that only I was aware of. The strain of balancing school, family, friends, and hobbies was challenging and barely manageable. That strain increased exponentially when my family grew, and my professional desires and responsibilities grew as well.

January 2, 2021

Background: Antibodies targeted at the SARS-CoV2 spike protein are an essential part of the body’s immune response to COVID19 infection. The recent emergency use authorization (EUA) Pfizer and Moderna vaccines act by introducing mRNA into the body that instructs cells to create a polyclonal spike protein antibody response. These antibodies bind to numerous locations on the SARS-CoV2 spike protein limiting the virus’s ability to enter and infect host cells. However, the vaccine is yet to be available in adequate numbers to immunize the general population and the pandemic continues.

Since the start of the COVID19 pandemic, extensive efforts have been made by pharmaceutical companies to create monoclonal antibodies that can be administered to people during the viremic phase of illness. The goal of these drugs is to give patients antibodies prior to their body mounting a response in an effort to prevent progression of disease. We have previously reviewed the EUA drug bamlanivimab (LY-CoV555) - a monoclonal antibody. In that review, we note the absence of any difference in patient centered outcome as well as serious methodological flaws. Here we review a monoclonal antibody cocktail - REGN-COV2 (casirivimab/imdevimab).