April 17, 2020

There are lots of mixed messages flying around social media about COVID-19 lung injury.  Although social media is a very powerful way to get information across, it can also amplify messages that are incorrect or not based in quality research and data.  Two pervasive messages have been that COVID19 lung injury is the same as high altitude pulmonary edema (HAPE) and that COVID19 pneumonia is simply typical acute respiratory distress syndrome (ARDS).

April 17, 2020

The SARS-CoV-2 pandemic has strained our available healthcare resources and caused unprecedented stress in the lives of our healthcare workers.  With the advent of COVID-19 and the resultant deaths of our colleagues, it has become painfully clear that our profession has become inherently dangerous.  It is ethically sound to expect the provision of appropriate personal protective equipment (PPE) before treating patients with infectious diseases.1  To borrow from our pre-hospital counterparts, when responding in dangerous situations the utmost priority is your personal safety and the safety of your teammates, and only once these have been assured are we able to attend to the needs of the victim/patient.  However, we cannot be frozen by fear and through the proper and appropriate use of PPE, clinicians can safely uphold the sacred duty to care for the ill.  Following the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, a study analyzed the nosocomial infections in Hong Kong healthcare workers.  Standardized PPE contact and droplet precautions included a mask, gloves, gowns, and handwashing.  Notably, none of the personnel who utilized all four measures were infected with SARS.  Contrastingly, all of the healthcare workers with nosocomial infection had failed to implement at least one of the PPE methods.2  We have confidently and effectively employed PPE against airborne, droplet, and contact pathogens for years (e.g. Mycobacterium tuberculosis, H1N1 influenza A, Clostridium difficile).  Now, as we battle COVID-19, similar to lessons learned on the battlefield and taught in Tactical Combat Casualty Care, we must first engage in suppression of the threat prior to initiating patient care.3

REBEL Review 98: Non-Invasive Positive Pressure Ventilation Management

Created April 11, 2020 | Thoracic and Respiratory | DOWNLOAD

April 10, 2020

Airway Pressure Release Ventilation (APRV) is a mode of ventilation that allows spontaneous breathing throughout the ventilation cycle.  It is a time-cycled mode of ventilation between two levels of positive airway pressure with the main time on the high level and a shorter period of time during the expiratory release to facilitate ventilation. This may not be a mode of ventilation many ED physicians are comfortable and have experience with and in this podcast Frank Lodeserto, MD reviews how to setup, titrate, and wean patients on this mode of ventilation.

April 5, 2020

Hey there REBEL Cast listeners, Salim Rezaie here.  For me and I am sure many COVID-19 has been quite the whirlwind.  So much information, so little time to process all of it.  Meanwhile, many of us are on the frontlines having to take care of these patients.  Personally, I have never been so wrong, so many times about a single disease process.  What I say today, may be different tomorrow.  This podcast was recorded on April 3rd, 2020 so any information that comes out after this, might change the viewpoints that are expressed today.

0