The Blog

Thanks for dropping by! We have curated an incredible collection of the best articles from the leading Emergency Medicine, Tactical Medicine, Prehospitial Medicine, Austere & Remote Medicine authors, as well as Survival Medicine gurus and many others!

We hope you find something of interested to you, please use the search bar on top to narrow down what you are looking for.

As always, all credit is given to the original author and origin publication.

Blogs

The DisCoVeRy Trial: Remdesivir in COVID-19 – An Expensive Version of Tamiflu?

Marco Torres | Oct 18, 21

Background: Since the beginning of the pandemic, hundreds of trials have been  performed looking at medications with the potential to be repurposed for use against COVID19. To date, no antiviral medications directed at SARS-CoV-2 have shown any convincing evidence of improvement.  Treatments directed against the virus itself including ivermectin, hydroxychloroquine, and convalescent plasma have all fell well short of meaningful outcomes. Multiple previous trials (See discussion) have shown that remdesivir is associated with a shorter time to clinical improvement when the medication is started within 10 days of symptom onset. The largest trial on the topic [2] showed no benefit in mortality, initiation of ventilation or hospital length of stay.  Due to the mixed previous results, there is no consensus on the use of remdesivir in COVID-19.

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Marco Torres | Sep 27, 21
The TOGETHER Trial: COVID-19 and Fluvoxamine Take Two

Background: Despite having a safe and effective set of vaccines for COVID-19, there have been some low resource countries in which it has been very challenging in getting the vaccine allocated.  Therefore, identifying an inexpensive, widely available, and effective therapy against COVID-19 is still an important topic of research.

We have written before on fluvoxamine on REBEL EM. It is a selective serotonin reuptake inhibitor (SSRI) and a sigma-1 receptor (S1R) agonist.  This makes this medication interesting as it has several potential favorable mechanisms in the treatment of COVID-19, including anti-inflammatory and antiviral effects.

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Marco Torres | Sep 23, 21
Awake Proning for COVID-19 Acute Hypoxemic Respiratory Failure

Background: Awake prone positioning was an intervention adopted early in the COVID-19 pandemic for patients with hypoxemic respiratory failure.  Unfortunately, many early trials were not powered to show improvements in oxygenation, escalation of respiratory support, or mortality. The one meta-analysis (Link is HERE) including 50 trials with ≈3000 patients suffered from methodological flaws of the included studies. Most of the trials were small, observational, with very wide confidence intervals which made interpreting these trials of limited utility and really an interpretation of the absence of evidence, rather than an absence of benefit.  Despite the lack of high-quality evidence,  many clinicians continue to apply awake prone positioning and the approach has even incorporated into some clinical guidelines. Better evidence to guide this practice is clearly needed.

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Marco Torres | Sep 20, 21
It’s All About Risk: BNT162b2 mRNA COVID-19 Vaccination vs Natural Infection

Background: The world has been involved in mass vaccination efforts for the last nine months. Since the vaccines were approved, billions of doses have been administered.  Initial trials showed the COVID-19 vaccines to be efficacious and safe.   However, assessing vaccine safety based on phase 3 trials has some limitations;  limited numbers of participants, healthier than average sample population etc. This makes these trials underpowered to identify less common adverse events. Post-study, real life data has revealed the increased occurrence of some adverse events after vaccination including myocarditis, thrombosis, lymphadenopathy, idiopathic facial nerve palsy, etc.  These adverse events may have decreased confidence in getting vaccinated for some groups.   Vaccine surveillance is required to monitor the safety of the new vaccines in real world settings. Although active surveillance can help highlight suspicious trends, the lack of a control group limits the ability to identify causal effects of vaccination. Ultimately, the effectiveness of mRNA vaccination against SARS-CoV-2 is well established but we are lacking high-quality real-world safety data.

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Marco Torres | Sep 13, 21
RECOVERY RS: CPAP vs HFNO vs Conventional Oxygen Therapy in COVID-19

Background: Much of the last two years has been both a complete blur and indelibly memorable. This dichotomy is encapsulated by the rapid changes and updates in medical management and hospital algorithms coupled with the memories of frightened faces of patients and families. 

Early in the pandemic, controversy and anecdote predicated non-invasive strategies to support acute hypoxemic respiratory failure from COVID-19. The debate revolved around the fear of delaying tracheal intubation thus exacerbating lung injury through the generation of large tidal volumes (P-SILI), the risks of nosocomial infection of staff through aerosol generation, or oxygen shortages due to the amount of oxygen required for these non-invasive oxygen systems. 

The lack of high-quality evidence led to variability in guidelines and local clinical practice. However, we rely on the highest quality of literature to drive patient management. As such, this is the largest randomized clinical trial to investigate different modes of non-invasive ventilation in COVID-19 patients with respiratory failure.

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Marco Torres | Sep 11, 21
Rebellion21: Good Vibrations with Corona – Using POCUS in the COVID Era via Eric Chin, MD

In this 18-minute presentation from Rebellion in EM 2021, Dr. Eric Chin, MD describes the role of point-of-care ultrasound in the evaluation of a COVID patient. Much of this talk focuses on thoracic and lung ultrasound.

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Marco Torres | Sep 02, 21
The PRIEST Score: Predicting Adverse Outcomes in COVID-19
PRIEST Score rebel em

Background: The limited availability of rapid tests with sufficient sensitivity has been an issue since the beginning of the pandemic.  Therefore, multiple clinical decision scores have been studied to overcome this issue. The addition of laboratory and radiological information can improve predictions scores but run the risks of increased ED length of stay and potential infection risk related to repeated patient contact. What is really needed is a score based on clinical assessment alone with high discrimination.

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