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COVID-19 Digest: Hydroxychloroquine Update (Recorded 4/3/20)

Emergency Medical Minute

Release Date: 04/04/2020

Podcast 568: Shock ‘em!  show art Podcast 568: Shock ‘em! 

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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Podcast 567:  Mechanical CPR….Not So Fast show art Podcast 567: Mechanical CPR….Not So Fast

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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Selected Audio from 'UnfilterED #7: Russell J. Ledet, Ph.D.' show art Selected Audio from 'UnfilterED #7: Russell J. Ledet, Ph.D.'

Emergency Medical Minute

"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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UnfilterED #7: Russell J. Ledet, Ph.D. show art UnfilterED #7: Russell J. Ledet, Ph.D.

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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Podcast 566:  The Cholera Pandemic show art Podcast 566:  The Cholera Pandemic

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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Podcast 565: Cesarean Scar Pregnancies show art Podcast 565: Cesarean Scar Pregnancies

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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On the Streets #5: Trauma during COVID-19 show art On the Streets #5: Trauma during COVID-19

Emergency Medical Minute

Jordan sits down to discuss trauma with Dr. Kaysie Banton, the Trauma Services Medical Director at Level 1 Trauma Center Swedish Medical Center in Englewood, Colorado. In this laid back interview, Dr. Banton discusses how the COVID-19 has affected trauma volumes at Swedish. While trauma as an aggregate hasn’t decreased, the types of trauma for the time of year have shifted as well as the acuity of injuries that present. This episode focuses on how public opinion surrounding the pandemic has shifted the way patients seek care, how delays to seeking care changes her role as a trauma surgeon...

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Podcast 564:  Cardiac Ischemia Management Update show art Podcast 564:  Cardiac Ischemia Management Update

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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Podcast 563:  DC ACs show art Podcast 563:  DC ACs

Emergency Medical Minute

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 our coverage of COVID-19 this week, we’ve investigated the shakey evidence for NSAID use making COVID worse, heard first-hand accounts from ED clinicians with COVID, and looked at the status of testing in the United States. Before capping our week of coverage off, we wanted to analyze some of the most recent literature on clinical interventions for COVID, particularly the recently FDA approved hydroxychloroquine. 

Host: Elizabeth Esty, MD

Research By: Elizabeth Esty and Nathan Novotny

Sound Editing By: Stephen Bahmani

References

  1. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research. 2020;30(3):269-271. doi:10.1038/s41422-020-0282-0
  2. Gautret P, Lagier J-C, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. March 2020:105949. doi:10.1016/j.ijantimicag.2020.105949
  3. Molina JM, Delaugerre C, Goff JL, et al. No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection. Médecine et Maladies Infectieuses. March 2020. doi:10.1016/j.medmal.2020.03.006
  4. Chen Z, Hu J, Zhang Z, et al. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. medRxiv. March 2020:2020.03.22.20040758. doi:10.1101/2020.03.22.20040758