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COVID-19 Digest: Do NSAIDs Make COVID-19 More Severe? (Recorded 3/30/20, 18:00 MST)

Emergency Medical Minute

Release Date: 03/31/2020

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Emergency Medical Minute

Contributor: John Winkler, MD Educational Pearls: Unstable ventricular tachycardia (VT) typically manifests with syncope, shortness of breath, diaphoresis and/or chest pain with hemodynamic instability Electrical cardioversion of unstable ventricular tachycardia is first line treatment Starting with a higher energy level (or just using the maximum) when performing cardioversion may set you up for better success as many providers feel the first shock has the highest likelihood of success References Dresen, W.F. Ferguson, J.D. Ventricular Arrhythmias. 2018 Feb;36(1):129-139. doi:...

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Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Mechanical CPR (machine assisted compression devices) remains a hot topic of debate in emergency medicine Machine assisted CPR has been advocated to provide more consistent compressions in cardiac arrest and free up staff for other tasks. However, multiple studies have shown mechanical CPR provides no significant survival benefit yet increased rates of injury to the chest and abdomen from the devices. Unless a clear benefit can be found, mechanical CPR devices should not routinely replace traditional CPR in most situations For prolonged...

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"Go unafraid! And also know that you got to reach out to the right people and hold on to those people no matter what they look like, no matter what background they come from...Find people who are positive in your life who can help you. If I'm one of those people, reach out to me."   Russell J. Ledet hails from Lake Charles, Louisiana. After serving in the U.S. Navy, he attended Southern University and A&M College for his undergraduate degrees in biology and chemistry. Afterwards, he went on to complete his Ph.D. in molecular oncology at New York University. He is currently a...

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Emergency Medical Minute

Russell J. Ledet hails from Lake Charles, Louisiana. After serving in the U.S. Navy, he attended Southern University and A&M College for his undergraduate degrees in biology and chemistry. Afterwards, he went on to complete his Ph.D. in molecular oncology at New York University. He is currently a second-year MD-MBA student at Tulane University School of Medicine and A.B. Freeman School of Business. He is the co-founder and president of 'The 15 White Coats', a non profit organization focused on helping people of color get into medical school and improving the cultural literacy of our...

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Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: Cholera has been responsible for 6 previous global pandemics and currently the world is in the seventh pandemic of cholera, ongoing since 1961. Cholera originated in the Ganges Delta of India and spread worldwide but largely is unseen in the US and other developed countries due to water sanitation Cholera is a bacterial illness that is water borne and causes severe diarrhea Estimates say that there are 1.3-4 million cases annually and up to 143,000 people die each year from Cholera. Treatment is largely supportive and can be done with oral...

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Emergency Medical Minute

Contributor: Nick Hatch, MD Educational Pearls: A cesarean scar ectopic pregnancy occurs when the pregnancy implants along the scar tissue deep in the myometrium from a prior cesarean surgery, felt to be precipitated by a small fissure or fistula residual in the scar Diagnosis can be challenging and ultrasound may not clearly show this type of ectopic pregnancy MRI has been successfully used for diagnosis as well Various treatment options exist including medical and surgical management but if left untreated, cesarean ectopic pregnancies are life threatening References Gonzalez N, Tulandi T....

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COVID-19 Digest: The Possible Link Between Severe COVID-19 and Low Vitamin D Levels (Recorded 5/21/20) show art COVID-19 Digest: The Possible Link Between Severe COVID-19 and Low Vitamin D Levels (Recorded 5/21/20)

Emergency Medical Minute

Host: Elizabeth Esty, MD. At this point, with so many of the studies we’ve digested exploring correlations, associations, observational studies and anecdotal reports and speculation, we could subtitle the show: what we don’t know about COVID. And so, today, we’ll look at what we don’t know about Vitamin D and COVID. There have been a number of studies and a fair amount of media coverage in recent weeks that look at a possible link between low Vitamin D levels and severity of COVID.  Vitamin D plays a role in both adaptive and innate immunity, which we discussed at some...

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Emergency Medical Minute

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Emergency Medical Minute

Contributor: Nick Tsipis, MD Educational Pearls: Recent randomized controlled trial compared early intervention (PCI/CABG) to medical management for those diagnosed with moderate to severe cardiac ischemia on stress testing Primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest Secondary outcome was death from cardiovascular causes or myocardial infarction. The study reported that patients who had more aggressive invasive procedures early on in treatment had a 2% increase...

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Contributor: Nick Hatch, MD Educational Pearls: An AC (acromioclavicular joint) separation in the shoulder is a common traumatic injury XRs can help rule out other injuries as well as help with grading the injury There are six different grades for AC separations: Grade I: is stretching of the AC ligament without disruption or displacement of the clavicle and recovers with time. Grade II:  is partial tearing of the AC ligament with some displacement but will also heal with time. Grade III: is a full separation with ligament rupture and may require surgery but is not always indicated....

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More Episodes

In the past two weeks, warnings, questions, and misinformation concerning COVID-19 and NSAID use have been spreading...no pun intended..virally. The pace of this evolving pandemic and the equally quick pace of the news and social media news cycle have meant that information and misinformation travel equally fast. Today we bring to you the story of how a letter in The Lancet led to a world of confusion.

Host: Elizabeth Esty, MD

Research By: Elizabeth Esty & Nathan Novotny

Sound Editing By: Stephen Bahmani

Time Stamps:

0:00 - COVID-19 Statistics

2:55 - The Lancet Letter: What Started the Rumor

4:10 - ACE Inhibitors & ARB's

5:00 - What The Lancet Letter Got Wrong

6:25 - Treatment of HTN and DM in China vs. the U.S.

9:13 - Do ACE Inhibitors Actually Increase ACE-2 Expression?

11:00 - The French Ministry of Health and Their Warning About NSAIDs

14:09 - Misinformation in the Age of COVID-19

15:09 - Potential Harms of Tylenol Use

16:11 - The Need for High-Quality Science to Overcome COVID-19

References:

  1. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? The Lancet Respiratory Medicine. March 2020:S2213260020301168. doi:10.1016/S2213-2600(20)30116-8
  2. Kane S. Ibuprofen - Drug Usage Statistics, ClinCalc DrugStats Database. ClinCalc DrugStats Database. https://clincalc.com/DrugStats/Drugs/Ibuprofen. Published December 23, 2019. Accessed March 30, 2020.
  3. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. March 2020. doi:10.1016/j.cell.2020.02.052
  4. Lu J, Lu Y, Wang X, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). The Lancet. 2017;390(10112):2549-2558. doi:10.1016/S0140-6736(17)32478-9
  5. Wang Zengwu, Chen Zuo, Zhang Linfeng, et al. Status of Hypertension in China. Circulation. 2018;137(22):2344-2356. doi:10.1161/CIRCULATIONAHA.117.032380
  6. Hu C, Jia W. Diabetes in China: Epidemiology and Genetic Risk Factors and Their Clinical Utility in Personalized Medication. Diabetes. 2018;67(1):3-11. doi:10.2337/dbi17-0013
  7. Yuan H, Li X, Wan G, et al. Type 2 diabetes epidemic in East Asia: a 35-year systematic trend analysis. Oncotarget. 2018;9(6). doi:10.18632/oncotarget.22961
  8. Woo KS, Nicholls MG. High prevalence of persistent cough with angiotensin converting enzyme inhibitors in Chinese. Br J Clin Pharmacol. 1995;40(2):141-144.
  9. Chen X, Hu W, Ling J, et al. Hypertension and Diabetes Delay the Viral Clearance in COVID-19 Patients. medRxiv. March 2020:2020.03.22.20040774. doi:10.1101/2020.03.22.20040774
  10. Perico L, Benigni A, Remuzzi G. Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade. NEF. March 2020:1-9. doi:10.1159/000507305
  11. Qiao Y, Shin J-I, Chen TK, et al. Association Between Renin-Angiotensin System Blockade Discontinuation and All-Cause Mortality Among Persons With Low Estimated Glomerular Filtration Rate. JAMA Intern Med. March 2020. doi:10.1001/jamainternmed.2020.0193
  12. The Local. UPDATE - Coronavirus: French health minister and WHO issue warning over taking anti-inflammatories. https://www.thelocal.fr/20200314/coronavirus-french-health-minister-issues-warning-over-anti-flammatories. Published March 14, 2020. Accessed March 30, 2020.
  13. ScienceAlert. Updated: WHO Now Doesn’t Recommend Avoiding Ibuprofen For COVID-19 Symptoms. https://www.sciencealert.com/who-recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms. Accessed March 30, 2020.
  14. European Medicines Agency. Coronavirus disease (COVID-19). https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19#advice-on-using-non-steroidal-anti-inflammatory-medicines-such-as-ibuprofen--section. Published March 18, 2020.
  15. U.S. Food and Drug Administration. FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19. https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19. Published March 19, 2020.
  16. BBC Reality Check team and BBC Monitoring. Coronavirus and ibuprofen: Separating fact from fiction. BBC News. https://www.bbc.com/news/51929628. Published March 17, 2020.
  17. Mosbergen D. Tylenol Overdose Risk Is Staggering; Acetaminophen Safeguards Remain Insufficient: Report. HuffPost. https://www.huffpost.com/entry/tylenol-overdose_n_3976991. Published September 24, 2013.