Category: Infectious Disease

REBEL Core Cast – Basics of EM – Introduction

Written by EJ Wright, MD
This post first appeared on REBEL Cast

Welcome to the EMRA Basics of Emergency Medicine Podcast. I am your host EJ Wright, and the following series is an all encompassing approach to the most common chief complaints in the ED based on the well known EMRA Basics of Emergency Medicine, A Chief Complaint-Based Guide. Each cast will highlight myself and a guest attending physician as we take new learners through the differentials, red flags, physical exam findings, and a sample presentation that you need to know to treat patients in the ED.

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The INSPIRATION Trial: Intermediate Dose Anticoagulation in Critically Ill Patients with COVID-19

Written by Jessica DiPeri, MD
This post first appeared on REBEL EM

Background: COVID-19 infection increases the risk of thrombosis due to multiple factors. (Rico-Mesa, 2020). Over the last 2 years, researchers have published 12 RCTs investigating various anticoagulation strategies among patients diagnosed with COVID-19 in multiple clinical settings. To date, only a multiplatform trial in noncritically ill patients, the HEP-COVID trial, and the MICHELLE trial have shown a benefit.

Severely ill patients with COVID-19 in the intensive care setting have an increased risk of thromboembolism, with an incidence reported as high as 31% (Klok, 2020). It remains unclear what the optimal prophylactic anticoagulation strategy is in critically ill patients.

Does intermediate-dose anticoagulation improve clinical outcomes compared to standard prophylactic anticoagulation in patients with COVID-19 treated in the intensive care unit?

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The MICHELLE Trial: Anticoagulation Post-Discharge in Patients Hospitalized Secondary to COVID-19

Background:Patients diagnosed with COVID-19 have an increased risk of thromboembolic events, including pulmonary embolism and deep vein thrombosis (DVT). In addition, COVID-19 patients with increased coagulation parameters such as D-dimer, fibrin degradation products, prothrombin time, and activated partial thromboplastin time are at higher risk of morbidity and mortality.
Several RCTs have investigated the benefit of anticoagulation in patients with COVID-19 in various clinical settings. The INSPIRATION Trial investigated outcomes with an intermediate vs. standard prophylactic dose of anticoagulation in ICU patients. A multiplatform trial and HEP-COVID Trial investigated therapeutic anticoagulation in critically ill and non-critically ill hospitalized patients. The ACTIV-4B Trial investigated anticoagulation in symptomatic COVID-19 patients who did not require hospitalization. Currently, there is some evidence in support of therapeutic anticoagulation in non-critically ill hospitalized patients. However, there is no evidence to support the use of full dose anticoagulation in either the ICU or outpatient setting.

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Mycoplasma Pneumonia-Associated Mucositis

A 15-year-old female, with no past medical history, presented to the pediatric emergency department with cough and fever after being discharge with a diagnosis pneumonia two days prior. A chest x-ray on her first visit showed a single left lower lobe infiltrate and she was subsequently prescribed amoxicillin for suspected community acquired pneumonia (Figure 1). Upon return to emergency department, the patient complained of worsening symptoms, including dysphagia, secondary to sores in her mouth that developed after being discharge.

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