October 28, 2020

Take Home Points
  • Measles is highly infective: One infected person can infect approximately 10-20 unvaccinated people
  • 2 doses of MMR is 97% protective
  • Unvaccinated people can acquire measles from travel to endemic areas with low vaccination rates
  • There is a large amount of misinformation on the internet
  • Misinformation uses fear based messaging and the power of story
  • The evidence is overwhelming > 23,000,000 patients showing no evidence of any link between autism and MMR
  • Anecdotes are not evidence but vulnerable patients may be more susceptible to story then statistics
  • We should add anecdote as a tool to counsel patients

October 14, 2020

Take Home Points
  • Trauma resulting in a retrobulbar hemorrhage can lead to orbital compartment syndrome which is a vision threatening injury
  • Diagnosis is made clinically based on the presence of an afferent pupillary defect, vision loss and an intraocular pressure > 40 mm Hg
  • Treatment is with a lateral canthotomy - a simple but mentally daunting procedure

October 1, 2020

Background information: There are two popular blade shapes for video laryngoscopy, a standard-geometry blade comparable to a Macintosh blade and a hyperangulated blade. The standard-geometry blade permits both direct and indirect visualization during intubation, whereas the hyperangulated blade permits only indirect visualization. The hyperangulated blade is used with a rigid stylet, whereas the standard-geometry blade allows the use of a bougie if indicated. Proposed benefits of the hyperangulated blade include decreasing the need for head and neck manipulation. Previous research includes an observational study using emergency department data that compared the two blade shapes found no association between blade geometry and first-attempt success rates (Moiser et al.), but this was a single-center study with only 463 patients. Previous unadjusted data from the registry used in the current study by Driver et al. found that standard-geometry video laryngoscopy had a higher first-attempt success rate than video laryngoscopy using the hyperangulated blade (91 percent versus 80 percent, n=1,644) based on data from 2002 through 2012 (Brown et al.).

September 30, 2020

Take Home Points
  • 100k people in US have sickle cell, the majority will at some point develop acute chest syndrome (ACS)
  • The mortality rate per episode is 3-9%, similar to those of STEMI
  • ACS is a syndrome - CXR infiltrate + respiratory symptoms
  • Treat it aggressively and early (antibiotics, respiratory support)
  • If you’re considering exchange transfusion - get hematology onboard quickly

September 17, 2020

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.