12 Oct 2020

October 12, 2020

Written by REBEL Crit
Background: The only well-established treatments for sepsis and septic shock are antibiotic therapy and source control.  Septic shock, the most severe form of sepsis, is characterized by circulatory and cellular metabolism abnormalities.  There have been a host of randomized controlled trials evaluating the use of vitamin C, thiamine, and corticosteroids (i.e. metabolic cocktail) to help mitigate dysregulated host responses in the hopes of improving patient-oriented outcomes. Thus far none of the randomized trials have shown improvements in mortality and shown mixed results with shock reversal (see tables below).
Medical Categories: Infectious Disease
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10 Oct 2020

October 10, 2020

Written by REBEL EM
From Oct 6th – 8th, 2020, Haney Mallemat (@CriticalCareNow) and his team put on an absolutely amazing online critical care conference called ResusX Rewired.  ResusX is a conference designed by resuscitationists to provide clinicians with the most up to date skills and knowledge to help make a difference in your patients' lives.  Haney and his crew made a combination of short-format, high-yield lectures, and completely customizable small group sessions with procedural demos seem easy.  There were so many high-quality speakers and pearls that I learned from this conference that I wanted to archive them here in one post for reference and to share with our readers/followers.
Medical Categories: Cardiovascular, Endocrine, Metabolic, Fluid, and Electrolytes, Infectious Disease, Procedures and Skills, Resuscitation, Thoracic and Respiratory, Toxicology, Trauma
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24 Sep 2020

September 24, 2020

Written by REBEL Covid-19, REBEL EM
Background: Convalescent plasma therapy (CPT) is not a novel treatment modality.  It has been used in other illnesses such as SARS, MERS, and Ebola with variable results. The theory behind CPT is to take antibody rich blood from patients who have recovered from an illness and then administer it to help others recover who currently have the illness.  The US Food and Drug Administration authorized emergency use authorization (EUA) for CPT in patients with COVID-19 (August 2020) based on results from a US Expanded Access Program (EAP) study out of the Mayo Clinic (non-peer reviewed at this time).
Medical Categories: Infectious Disease
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21 Sep 2020

September 21, 2020

Written by REBEL EM
Background: Previous evidence has found that oseltamivir reduces median time to alleviation of influenza symptoms over placebo by about 1 day.  The benefits were greater when treatment was initiated within 24 to 48 hours of symptoms onset. Many previous trials have been criticized for under-recruiting, selective reporting of outcomes, and not including enough children/older patients. Additionally, use of oseltamivir is known to cause side effects such as headaches, nausea/vomiting and, in some cases, neuropsychiatric illness. The CDC currently recommends treatment with oseltamivir in patients with confirmed or suspected influenza who are hospitalized, severely ill, or have higher risk for influenza complications as well as consideration of treatment for symptomatic outpatients if treatment can be initiated within 48 hours.
Medical Categories: Infectious Disease
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17 Sep 2020

September 17, 2020

Written by REBEL Cast

Background: Baloxavir (trade name Xofluza) was approved for the treatment of acute, uncomplicated influenza in patients > 12 years of age in October 2018. However, high-quality data has been underwhelming at best for its efficacy in treatment. Back in November of 2018, REBEL EM concluded:

Clinical Take Home Point: Consistent with every other study on anti-viral medications for influenza, baloxavir appears to decrease duration of symptoms, especially in patients treated within 24 hours of symptoms, BUT a massive exclusion list, cost of the medication, increased resistance after initiation, results only applicable to H3N2 (88% of patients with flu), no comparison to standard care (i.e. symptom based therapy), pharma sponsored study, and no patient oriented outcomes, it is hard to make an argument for the use of baloxivir in patients with confirmed influenza. This trial should be a reminder as to why an industry funded trial, without full release of data, and cherry picked endpoints should not be used to change practice.

Continued research on effective anti-influenza drugs is critically important particularly with the potential for a “double pandemic” in the coming months. While treatment results are modest at best, baloxavir has potential as a prophylactic medication as well.

Medical Categories: Infectious Disease
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