Category: Critical Care
Posted: 3/10/2020 by Caleb Chan, MD
(Updated: 12/9/2024)
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(*It is important to note that many of the percentages in these early studies will change as more asymptomatic or minimally symptomatic patients are identified with increased testing)
Epidemiology
Among more than 44,000 confirmed cases of COVID-19 in China as of Feb 11, 2020:
- 30–69 years: ~78%
- severely or critically ill: ~19%
Case-fatality proportion:
-60-69 years: 3.6%
-70-79 years: 8%
-≥80 years: 14.8%.
-With no underlying medical conditions: overall case fatality of 0.9%
-With comorbidities:
-cardiovascular disease (10.5%), diabetes (7%)
-chronic respiratory disease, hypertension, and cancer (6% each)
Presentation
For patients admitted to the hospital, many non-specific signs and symptoms:
- fever (77–98%) and cough (46%–82%) were most common
- of note, gastrointestinal symptoms (~10%) such as diarrhea and nausea present prior to developing fever and lower respiratory tract signs and symptoms.
Diagnosis
No general lab tests have great sensitivity or specificity
A normal CT scan does NOT rule out COVID-19 infection
-In an early study, 20/36 (56%) of patients imaged 0-2 days (‘early’) after symptom onset had a normal CT with complete absence of ground-glass opacities and consolidation
Treatment-
Mainstay of treatment will be management of hypoxemia including early intubation if necessary. However, specifically:
-Steroid therapy is controversial and the WHO is currently recommending against it unless it is being administered for another reason
-has not been associated with any benefit
-associated with possible harm in previous smaller studies with SARS and MERS
-associated with prolonged viremia
-intravenous remdesivir (a nucleotide analogue prodrug with promising in-vitro results against SARS-CoV and MERS-CoV) is available for compassionate use
-lopinavir-ritonavir has been used without any associated benefit
Al-tawfiq JA, Al-homoud AH, Memish ZA. Remdesivir as a possible therapeutic option for the COVID-19. Travel Med Infect Dis. 2020;:101615.
Bernheim A, Mei X, Huang M, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020;:200463.
Holshue ML, Debolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020;
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;
Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395(10223):473-475.
Wu Z, Mcgoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72?314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;
Young BE, Ong SWX, Kalimuddin S, et al. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. 2020;
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
Category: Airway Management
Keywords: Adrenal Crisis (PubMed Search)
Posted: 1/7/2020 by Caleb Chan, MD
(Updated: 12/9/2024)
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Adequate treatment of adrenal crisis (AC) is often delayed, even when a h/o adrenal insufficiency is known.
Besides refractory hypotension, also consider in pts with:
Beware of triggers:
Treatment:
Amrein K, Martucci G, Hahner S. Understanding adrenal crisis. Intensive Care Med. 2018;44(5):652-655.
Rushworth RL, Torpy DJ, Falhammar H. Adrenal Crisis. N Engl J Med. 2019;381(9):852-861.
Category: Critical Care
Posted: 10/1/2019 by Caleb Chan, MD
(Updated: 12/9/2024)
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Blood Transfusion Thresholds in Specific Populations
Sepsis - 7 g/dL
Acute Coronary Syndrome - no current specific recommendations pending further studies
Stable Cardiovascular Disease - 8 g/dL
Gastrointestinal Bleeds
Acute Neurologic Injury - Traumatic Brain Injury - 7 g/dL
Postpartum Hemorrhage - 1:1:1 ratio strategy
Cable CA, Razavi SA, Roback JD, Murphy DJ. RBC Transfusion Strategies in the ICU: A Concise Review. Crit Care Med. 2019; epub ahead of print.
Category: Critical Care
Posted: 8/14/2019 by Caleb Chan, MD
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The Kidney Transplant Patient in Your ED
Darmon M, Canet E, Ostermann M. Ten tips to manage renal transplant recipients. Intensive Care Med. 2019;45(3):380-383.