February 22, 2021

Background: Emergency Medicine clinicians must be adept in the management of the agitated patient. While verbal de-escalation techniques should be attempted, they are often inadequate. The next option after attempts at verbal de-escalation is chemical restraint with medications to help with a more rapid decline in agitation. Although it is agreed that IM antipsychotics or benzodiazepines are first line medications to treat agitation, there is no consensus on any one single agent. The big question therefore, still remains however of what medications should we use and at what dose? There are numerous papers investigating the utility of various medications. Today, we look at a comparison of droperidol, ziprasidone and lorazepam.

February 20, 2021

Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness.  Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and resource intensive. [BLAZE-1] [REGN-COV2]Easily accessible effective treatments are badly needed for patients with mild COVID-19 not requiring hospitalization. Many reports have shown an under representation of patients with asthma and chronic obstruct pulmonary disease in patients hospitalized with COVID-19. One hypothesis is this may be due to the use of inhaled glucocorticoids in these patients.  Inhaled glucocorticoids have been shown to reduce exacerbations of both asthma and COPD.

February 19, 2021

Update: This article was removed from the Lancet server on February 19th, 2021 (Link)

Background: Vitamin D deficiency is common amongst critically ill patients and there has been ample speculation about a possible role for supplementation (with calcifediol) in the treatment of patients with COVID19. Calcifediol is cheap, readily available and, has minimal side effects making it an ideal therapeutic - if it works. To date, there is limited high-quality evidence on efficacy.

February 18, 2021

Background:  Headache was the 5th most common reason for patients to present to the emergency department in the US in 2016.  Often ED providers include IV fluid boluses in their headache treatment cocktail, with prior research demonstrating IV fluids are included approximately 40% of the time (Jones).  While dehydration may precipitate some headaches, there is little evidence to support the use of IV fluids for their treatment.

February 15, 2021

Background: Alteplase has been the accepted thrombolytic for acute ischemic stroke (AIS) for 25 years. However, recent data has emerged regarding tenectaplase as an alternative.  Tenecteplase is a modified form of alteplase, with a lower cost and more favorable pharmacokinetic profile allowing for bolus injection.  Specifically, it has a higher fibrin specificity and lower affinity to plasminogen activator inhibitor (PAI-1) with a slightly longer half-life.