April 27, 2020

Background: In patients with stable coronary artery disease the goals of treatment are to reduce the risk of death, ischemic events, and to improve quality of life. In order to achieve those objectives all patients with coronary artery disease should be treated with guideline based medical therapy. Currently, many of them undergo elective angiography and placement of stents if needed when they have abnormal stress tests. Before the widespread use of drug-eluting stents, trials evaluating incremental effects of revascularization added to medical therapy did not show a reduction in the rates of death or MI. However, those trials did not include sufficient numbers of participants, and only included those with known coronary anatomy prior to randomization.

April 26, 2020

Background: Awake proning, or having patients lie on their stomachs, can help oxygenation by helping to recruit posterior portions of the lungs and by helping with perfusion to oxygenated lung segments. The literature around proning centers on intubated patients with adult respiratory distress syndrome in the ICU. However, there are increasing recommendations from front line clinicians and experts about the benefits of proning hypoxemic COVID19 patients who are awake in an effort to improve oxygenation and stave off intubation. While there may be physiologic reasoning, anecdotal experience and application of data from intubated patients, there is an absence of data specifically on COVID19 patients and proning. Fortunately, we now have some literature to look at:

REBEL Review 100: Canadian Syncope Risk Score

Created April 25, 2020 | Cardiovascular | DOWNLOAD

April 24, 2020

In this episode of REBEL Cast,I sit down with Richard Levitan and talk about some ideas from his experience in New York, where he spent 10 days during the surge of the COVID-19 pandemic. And the lessons he took away were, I think, invaluable for how we’re going to manage these patients going forward.

April 23, 2020

Background: Electronic cigarette use, or vaping, has been rising in popularity in the United States. Electronic cigarette use has been associated with respiratory symptoms that have collectively been labeled e-cigarette or vaping product use-associated lung injury (EVALI). In a recent study of mass spectrometry of bronchoalveolar lavage samples, Vitamin E acetate was found in 94% of cases in the EVALI group and was not present in the comparison group [2]. Per the CDC data, the number of hospitalized cases peaked in August and September of 2019. Due to identifying the likely etiology of the lung injury, vitamin E acetate, there has been increased regulation and a subsequent decrease in cases; however, vaping-associated lung injury remains in the potential differential diagnosis for patients presenting to the emergency department with unexplained respiratory symptoms.