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We review a recent paper by Kilaru et al on pharmacy fills by ED patients for naloxone after an opioid-related ED visit. We also discuss harm reduction and the reasons this is important. For more on harm reduction, including patient education materials, see this.
updated September 23, 2021
We have several podcasts on the vaccine and specifically in pregnancy. Increasing information on safety has become available, but the basic principles in those podcasts still stand. Podcast on vaccine candidates, podcast on vaccines in pregnancy and lactation, update on vaccines in pregnancy. In May 2021, a large CDC registry of the COVID-19 vaccine in pregnancy was published by Shimabukuro et al. The CDC is tracking pregnant patients who receive the COVID-19 vaccine in 2 ways: (1) the V-safe program (enroll at time of immunization using QR code provided in materials you receive and (2) a pregnancy registry (~5,000 individuals enrolled out of initial V-safe pregnancy population. In the pregnancy registry, the CDC is calling pregnant patients each trimester and post-partum and obtaining records from the obstetric provider. These data have demonstrated no increased risk of pregnancy loss, preterm birth, or congenital anomalies. Of note, many of the pregnancies were not complete at that time, as individuals immunized in the first trimester still had ongoing pregnancies. These data are demonstrated in the graphics below.
The American College of Obstetrics and Gynecology (ACOG) released an updated statement on July 30, 2021 that: recommends that pregnant and lactating individuals be vaccinated against COVID-19. Additionally, the document reinforces that the claims linking COVID-19 vaccines to infertility are unfounded and have no scientific evidence supporting them, recommending vaccination for all eligible people who may consider future pregnancy. Further, although women < 50 years old may receive any COVID-19 vaccine, there is an increased but very rare risk of thrombosis with thrombocytopenia syndrome after the Janssen/Johnson & Johnson vaccine and they may opt for an mRNA vaccine instead (Pfizer or Moderna). The Society for Maternal-Fetal Medicine (SMFM) supports these statements.
A multidisciplinary group at the University of Massachusetts Medical School-Baystate has created decision aids to help pregnant people decide if the COVID-19 vaccine is right for them, which can be found here in 10 languages.
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The Society for Academic Emergency Medicine has released new Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE). These guidelines are aimed at de-implementing low-value care to reduce wasteful medical care. The first guidelines, GRACE-1, target recurrent low-risk chest pain and are published in Academic Emergency Medicine (Musey et al). Previously we covered the American College of Emergency Physician’s clinical policy on non-ST elevation acute coronary syndromes, which does not specifically address recurrent chest pain.
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Myocarditis/Pericarditis Cases ACIP Meeting Slides
ACIP Meeting Slides Benefit-Risk Assessment
Myocarditis Data from Israel
Havers et al. Hospitalization of Adolescents Aged 12–17 Years with Laboratory-Confirmed
COVID-19 — COVID-NET, 14 States, March 1, 2020–April 24, 2021 MMWR 2021.
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Ivermectin is among the potential therapies proposed for COVID-19. In this episode, we review the available randomized trials of ivermectin as well as treatment guidelines.
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In this episode we cover the literature on tranexamic acid (TXA) in epistaxis, including a new trial in Annals of Emergency Medicine by Reuben et al, the NoPac trial.
Other references include:
In this episode we review Cannabinoid Hyperemesis Syndrome (CHS / Cannabis Hyperemesis Syndrome) which is characterized by
The nausea and vomiting may be temporarily relieved by hot showers but can be refractory to traditional antiemetics, such as ondansetron and the butyrophenones (haloperidol/droperidol) have been anecdotally used with success, as has capsaicin. We review new articles on the treatment of CHS
High flow oxygen modalities have been restricted in some institutions due to concern for transmission to health care workers. Endotracheal intubation is one of the most aerosol generating procedures, but the exact risk associated with high flow nasal cannula (HFNC) and non-invasive ventilation is unknown. A 2012 meta-analysis reports on a single study that reported on high flow oxygen, but didn’t provide a definition for this.
We review a study (Westafer et al) that describes trends in health care worker infections at an institution before and after implementation of a protocol that increased use of high flow nasal cannula during the COVID-19 pandemic.
Tools to estimate mortality risk in patients with pulmonary embolism exist, including the Pulmonary Embolism Severity Index (PESI), the simplified PESI (sPESI), and the Bova score. We review an article in JAMA Network Open by Barnes et al.
We are bringing you near-daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes. This episode was recorded June 19, 2020
Throughout the COVID-19 pandemic in the United States, personal protective equipment (PPE) shortages have plagued health care workers and institutions, leading the extended use and reuse of N95 respirators and the use of KN95s from China. These studies provide some insight into the effectiveness and potential problems associated with some of these protocols
