April 19, 2020

Many facilities are using COVID-19 screening protocols to determine how to cohort patients in the ED. Although this sounded like a good idea initially, this strategy is destined to fail.  Early on in the pandemic, we thought we could identify potential COVID-19 patients based on the presence of fever and cough. However, multiple studies are coming out showing a high prevalence of asymptomatic patients with positive tests for SARS-CoV-2.  Identifying asymptomatic patients is important to improve outpatient quarantine (i.e. maximize physical distancing) and to improve staff safety (i.e. incorrectly admitting patients to the wrong area of the hospital). In most regions, there are simply not enough tests to test everyone, but a universal testing strategy needs to be implemented, especially for admitted patients as this can have major ramifications to staff and patient safety.

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

April 9, 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 new outbreak has been producing lots of hysteria and false truths being spread, however the data surrounding the biology, epidemiology, and clinical characteristics are growing daily, making this a moving target.  This post will serve as a summary of thrombosis and hemoglobin in regard to COVID-19.

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.

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