April 22, 2020

Take Home Points
  • N95 masks ideally should be single use but in COVID19 times, safe reuse practices are critical.
  • The best approach to reuse is vaporized H2O2 and UV light decontamination with a total of 3 decon cycles prior to losing mask integrity.
  • A backup method of cycling between 4 masks is likely effective as SARS-CoV-2 cannot survive > 72 hours outside a human host in sufficient numbers to cause infection.
  • Ethanol soaks are effective in decontamination but destroy mask integrity and should not be use.

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 8, 2020

Take Home Points
  1. Hyperthyroidism can present along a spectrum from the minimally symptomatic to severely decompensated and presentation can vary with age
  2. If there are a lot of interconnecting systems complaints consider obtaibning a TSH, t3 and t4 
  3. Once you’ve diagnosed hyperthyroidism, dont anchor on it. Look for what might have caused it especially in those with comorbidities
  4. If the patient is stable and reliable you can discharge them home with Atenolol. Make sure to have the patient follow up with their PCP or Endocrinologist. If, however, you feel uncomfortable doing that or the patient needs more social support, call your endocrinologist on call and get their recommendations.

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.

April 2, 2020

Background: Peripheral intravenous (PIV) access is one of the most commonly performed invasive procedures in unwell patients.  Although, most patients can have PIVs placed by palpation, there is a subset of patients with difficult vascular access that will require ultrasound-guided peripheral IVs. We have covered this topic before with Jacob Avila (The Ultrasound Podcast, 5 Minute Sono) in REBEL Cast Ep 62. One thing we did not cover was catheter dwell rates.  Catheter dwell rate is an important endpoint as it takes time to perform the procedure, but more importantly for the patient, premature IV failure can include complications such as infiltration, phlebitis, ischemia, necrosis, as well as delays in receiving medications. Therefore, an important concept worth covering is the length of the catheter that is in the vein.

Midline catheters, which we have also covered on REBEL EM are catheters with lengths of 6 to 20cm and represent a potential solution.  These catheters have high success rates and longevity, but insertion requires institutional protocols and specialized training.  A nice go between is the peripheral ultralong catheter (ULC), which is 6.35cm. As with anything new in medicine, it is important to review the evidence to ensure we are performing best practices for our patients.