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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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Panscans, or a combination of head to pelvis CT scans, have been used in patients following significant trauma. Recent attention has shifted to the utility of routine CT scans following cardiac arrest. This is based on (1) identification of potential causes of cardiac arrest (2) identification of complications of resuscitation. In this episode, we cover an article by Branch et al in Academic Emergency Medicine.
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In this episode, we discuss thrombotic thrombocytopenia associated with the viral vector COVID-19 vaccines (VITT: Vaccine-Induced Thrombotic Thrombocytopenia) – a very very rare, but real entity. Information is still emerging so numbers will likely change in the coming days. For more on cerebral vein thrombosis in general, check out this podcast.
International Society of Thrombosis and Hemostasis Statement
United Kingdom Guidance On Thrombosis Following Vaccinations
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If you’re looking for vaccine-induced thrombotic thrombocytopenia (CVT/CVST with thrombocytopenia following AstraZeneca or J&J COVID-19 vaccine), check out this podcast.
Multicenter Cohort Study: Ferro JM et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004 Mar;35(3):664-70. Epub 2004 Feb 19. PMID: 14976332.
Utility of D-dimer:
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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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The Advisory Committee on Immunization Practices (ACIP) released preliminary data from the CDC v-safe registry on mRNA COVID-19 vaccines and pregnancy. In this podcast episode, we discuss the mechanisms of the vaccines, what we know, and this new data. If you’re looking for the pregnancy decision aids, they’re available here.
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This viral vector is currently going before the FDA, and more data was released in this briefing document here (a summary of all vaccines in the US can be found here).
