EM:RAP LIVE: COVID-19 Update | April 7th 2020

Surfactant!

Is there any role for surfactant for the treatment of the alveolar trauma

How can I get the link to the Spanish outreach video you showed?

I believe it was Swami who said something about shifting from an ARDSNET approach of ventilation to Higher FiO2 and Lower PEEPS. Aren't we concerned about the oxygen toxicity of this approach leading to ARDS? I'm a little concerned about the idea of this.

Where can I find the link to the 'remote-area preparedness' paper that was disscussed?

Thanks for this great content!!!
charlie mead

PS. Mentioned by Vanessa Cardy...

Hi, where can we find the document for care in low resource settings that was referenced in the presentation? Thanks.

I’m not at all an expert but listened to the COVID update on April 7 and the discussion about the possibility of Ivermectin being helpful given the recent paper “The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro.” On This Week in Virology podcast 599 they discuss Ivermectin and this paper but point out the extremely high drug concentrations in the in vitro study compared to the drug concentrations used for the approved indications. Apparently the IC50 for inhibiting viral replication in that paper was 2 micro-molar range but the approved dose is in the “sub-nano-molar/kg” range which they note is a 10-20,000 fold increase in dose. They state a paper showing this same in vitro inhibition for dengue virus but when they tried it with usual dosage it had no effect. Way over my head but these virologists seem to suggest it's not likely to be helpful in vivo without much higher probably dangerous doses.

Thanks for all you are doing everyone!

Gregory Guldner, MD, MS, FACEP
Program Director
Riverside Community Hospital / University of California Riverside
Emergency Medicine Residency
Clinical Professor of Emergency Medicine

This may be a dumb question, but who can go home with suspected COVID19? (Aside from the obvious well-appearing patient) After listening and reading to multiple sources, I still have this question. Does anyone have any direction on this? I work in a critical access hospital where all COVID suspected patients must be transferred to various facilities. I'm in the midwest, this is pandemic hasn't landed yet, but it will.

I feel comfortable managing the sick people, but are there any suggested parameters for letting people go home. From what I read the only people going home are those that look good with good cxr, but that seems unfeasible and unnecessary -- though, I could be wrong.

Thanks all

Why are we not seeing widespread convalescent serum use? Is the FDA preventing the use? It looks like they are only giving it right before they close the coffin. If I am hospitalized the first thing I want is convalescent plasma.

what are the neurological symptoms of covid 19
Had a patient in her mid 50 whose only complaint was being confused and with memory problems
no other symptoms and ROS was normal. ct of brain was neg and rest of labs normal
PE was essential normal. she kept repeating *i am confused*
I admitted her to the medical service because of slight elevation of troponin and subtle st depression inferior leads
during the night her troponin elevated to 6 and ekg was consistent with STEM
was taken to cath lab which revealed normal coronaries
this happened about 6 weeks ago. she was eventually dc home
i don't think that she was tested for the virus
i wonder if this was due to covid19
thanks
manuel salazar MD