April 5, 2021

Background Information:

The use of corticosteroids in patients with pneumonia secondary to COVID-19 has been a controversially hot topic, particularly early on in the pandemic. Prior evidence seen in Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome have led some to argue against their use due to delayed viral clearance.1 More recent evidence related to SARS-Cov-2 has specifically shown reduced mortality and reduced need for mechanical ventilation with corticosteroids.2-4 More recently, the RECOVERY Trial showed an improvement in 28-day mortality among patients on oxygen therapy who received Dexamethasone.5 Little information exists in the literature about patients with moderate to severe disease who do not warrant ICU level of care but require hospital admission due to the extent of their illness. The authors of this study designed and conducted a pragmatic, partially randomized control trial to evaluate the possible benefit of methylprednisolone in hospitalized patients with moderate to severe COVID-19 pneumonia.

December 26, 2020

Background Information: With rising cases, an increasing death toll, and a significant strain on hospital systems globally, the COVID-19 pandemic seemed to have no end in sight. The aggressive pursuit of a vaccine has led to multiple clinical trials starting before the end of this year. In fact, there are 48 vaccines under clinical evaluation and 11 of these are currently being evaluated in phase 3 clinical efficacy trials.1 Among those includes, the replication-deficient chimpanzee adenoviral vector developed at Oxford University (ChAdOx1). Following the initiation of a phase 1 clinical trial in the UK (COV001), three additional randomized controlled trials were initiated across the UK (COV002), Brazil (COV003) and South Africa (COV005). Upon completion of enrollment, the authors of the following paper sought to perform a combined interim analysis of the four trials to assess ChAdOx1’s efficacy and safety

August 6, 2020

Background: As the COVID-19 pandemic continues a number of challenges have arisen. Amongst these is the ability of clinicians to predict which patients will suffer from early decompensation. It is well established that there are patients that will rapidly decline while others, who initially present similarly, will continue without disease progression. A clinical decision instrument (CDI) to guide clinicians can be useful placing patients requiring hospital admission at the correct level of care without over-utilizing ICUs or, putting patients on the floors who will suffer from early decompensation.

May 4, 2020

Introduction: Emergency physicians rarely are involved in tube exchanges; I can’t remember the last time I had to do one. However, during the COVID19 surge, we found ourselves boarding intubated patients for days and even weeks as our ICUs were filled to the brim. With our ICU teams so busy, it became increasingly important for us to aid in critical care management where we could. Initially this was simply with lines and hemodynamic monitoring but, tube exchange became important. A number of our boarding patients developed considerable mucous plugging and tube obstruction that could not be cleared by suction. Reintubation with a fresh tube, while well within our scope, creates unnecessary risks - aerosol generation, increased provider exposure and possible harm to patient if intubation proves challenging. Tube exchange over a bougie seems to make a lot of sense.

Note: Due to the lack of experience most EM clinicians have with this procedure and the fact that it is a high-risk one, it may be best to consult anesthesia to help with the procedure if they are available. We acknowledge that this may not be possible if that service is stretched thin due to circumstances.

May 3, 2020

The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019.  The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic. The spread of this virus is now global with lots of media attention.  The virus has been named SARS-CoV-2 and the disease it causes has become known as coronavirus disease 2019 (COVID-19).  This post will serve as a summary of emerging available evidence in regard to neurologic manifestations associated with COVID-19.