March 31, 2020

I have been thinking a lot about patients with COVID-19 and the pulmonary pattern that they develop.  This disease process has been categorized like ARDS, but the reality is it is not like "typical" ARDS.  Lung compliance is often normal in these patients, and many patients are not in respiratory distress despite low O2 saturations.  Patients can have a bizarre hypoxemia that does not correlate with their symptoms.  I have even read reports of patients looking comfortable and speaking in full sentences with oxygen saturations in the 40 – 80% range.  There are also more traditional patients in respiratory distress with similar oxygen saturations.  This is a situation where we cannot treat a patient based solely on a number - pulse oximetry may not be a reliable marker of respiratory compromise.

Approaches to oxygen supplementation have stressed minimizing aerosolization of viral particles by avoiding HFNC and NIV.  This appears to be a fear-based statement as opposed to an evidence based one.  If we go straight from nasal cannula to intubation, we will simply run out of ventilators.  Then, more challenges present themselves like rationing mechanical ventilation and trying to figure out how to split ventilators due to the lack of resources.

Finally, I have yet to find a study that shows a mortality rate <50% once a patient is intubated.  Maybe a better way to deal with these patients is an intermediary step using HFNC or CPAP while proning patients while they are awake, before considering intubation.  In this post, I want to review some evidence to support my thoughts on this and, just assume that in every scenario we are discussing full PPE (eye protection, N95/PAPR, gown, gloves, and face shield).

March 21, 2020

Background: Since the introduction of SARS-CoV-2 to the world in December 2019, there have been no medications approved or proven effective for the treatment of this pandemic. Lopinavir is an HIV protease inhibitor that is combined with Ritonavir to increase its half-life.  This combination of medications has also been studied in severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) and showed promising results. This makes it a research target for COVID-19.  Many of us are awaiting a treatment that works against SARS-CoV-2 and badly want/need a treatment that is safe and effective. In this publication the authors evaluated the efficacy and safety of oral lopinavir-ritonavir for SARS-CoV-2 infection in adult patients hospitalized with severe COVID-19.

March 20, 2020

On Feb 21st, a patient by the name of Aldo, a 72-year-old male, came to our ED with fever and progressive dyspnea. In addition, his chest x-ray showed an interstitial pattern. It was on this day that COVID19 had arrived in our emergency department… In this post we will describe how we responded to the COVID19 challenge, the impressive number of patients seen in just a few days’ time and some suggestions to prepare your emergency department for the future.

March 1, 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 what is currently known about the basics of COVID-19. 

March 1, 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 cardiovascular considerations in regards to COVID-19. 
0