general description Hydroxychloroquine is typically used for treatment of malaria, SLE, or rheumatoid arthritis. It has anti-viral activity in vitro, as well as anti-inflammatory activities. mechanism of action appears similar Multiple mechanisms of anti-viral activity, including: Interference with the cellular receptor ACE2 (potentially making it particularly effective against SARS and COVID-19). Impairment of acidification of […]
Search Results for: COVID-19
Lopinavir in COVID-19
This is some old material on lopinavir for COVID-19. I’ve removed it from the main chapter because it doesn’t appear to work. For the sake of interest, here it is: general description This is a combination of antiviral agents used in treatment of HIV (including post-exposure prophylaxis following needle-stick injury). Compared to remdesivir, lopinavir/ritonavir has […]
COVID 19 Complete Chapter
CONTENTS Basic biology Infection control Transmission Personal protective equipment (PPE) Diagnosis Signs & symptoms Labs Imaging CXR & CT scan Lung ultrasonography General approach to imaging Bronchoscopy Diagnostic approach for admitted patients Treatment: General protocols ED patients getting admitted to the hospital Inpatient management of hypoxemic, non-intubated patients Intubated patients Treatment: Specific anti-viral & immunosuppressive […]
IBCC: COVID-19
Friends, As COVID-19 has exploded, so has the amount of information about COVID-19. There are currently over 700 publications regarding coronavirus listed in PubMed within the past few months. More are being released daily. Many haven’t been catalogued on PubMed yet. This chapter will attempt to synthesize the latest and most important information on COVID-19. […]
COVID19 Pulm Fellows Seminar
ESICM Seminar on COVID Ventilation Subtypes of COVID Mild Silent Hypoxemia (can cause iatrogenic injury) Indolent Fine then Not (Intubated or Not-Inflammatory Markers) Hyperacute Cytokine Storm / Hemophagocytic Lymphohistiocytosis (HLH) / DIC PathoPhys Loss of hypoxic vasoconstriction Micro-thrombotic disease Avoidance of Intubation tachypnea, hypoxemia, do not seem to be indication Mental […]
COVID 19 ICU/stepdown management
CONTENTS: Management of COVID-19 patients admitted to stepdown or ICU Link to full chapter here (more complete – but longer). Preamble & caveats Initial tests to guide management Organ support Cardiovascular Respiratory Noninvasive respiratory support Invasive mechanical ventilation Infectious disease – antibiotics Renal Hematology Neurology Immunomodulation Steroid Tocilizumab Baricitinib Things that don’t work Remdesivir Convalescent […]
PulmCrit – Awake Proning for COVID-19
Recently, many on twitter have been engaged in a furious debate about how to ventilate patients with COVID-19. Is it ARDS or not? High PEEP or low PEEP?… As an intensivist, these issues are near and dear to my heart. However, the truth is that humble methods to keep patients off invasive ventilation altogether are […]
IBCC chapter: Guide to APRV for COVID-19
COVID appears to cause a form of pseudoARDS (rather than true ARDS). This responds especially well to APRV, often avoiding many forms of iatrogenesis (e.g., proning, paralysis, myopathy, deep sedation, and delirium). Embracing APRV requires a zentensivist perspective on tidal volumes and minute ventilation (they will vary a bit! you won’t have total control of […]
PulmCrit – Baricitinib for COVID-19: The rise of the jakinibs
Background: JAK-inhibitors (jakinibs) in the greater context Much of the harm from infections is mediated by hyperactive inflammatory reactions. To date, most research has focused on two classes of medications to treat this: Corticosteroids have the advantage of being cheap, widely available, and often effective. The disadvantage is that corticosteroids modulate innumerable molecular pathways, thereby […]
PulmCrit – Lupus Anticoagulant in COVID-19: Culprit or correlate?
An emerging body of evidence relates lupus anticoagulant to COVID-19. Both of these topics are enormously confusing on their own, so let’s try to ease into this… background on lupus anticoagulant what is lupus anticoagulant? Lupus anticoagulant isn’t any single thing, but instead it refers to a variety of different antibodies which may behave […]
PulmCrit- Timed & titrated use of steroid in COVID-19?
Guideline recommendations on steroid use in COVID are contradictory. For example, the Surviving Sepsis Campaign recommends steroid for intubated patients with COVID and ARDS,1 whereas the IDSA guidelines recommend that steroid should be restricted to randomized controlled trials. Reviewing these documents shows that they often lean on data from influenza and MERS, which may not […]
Invictus: Survival, Sustainment, and Service in the Era of COVID-19
Invictus – William Ernest Henley These are difficult and challenging times. The current situation with the pandemic is unprecedented. The impact it has imposed in terms of economic cost, human suffering, and strain on our healthcare teams around the globe is unbelievable. Furthermore, while there is a glimmer of hope on the horizon, the […]
PulmCrit – Preview of Lopinavir/Ritonavir efficacy in COVID-19?
background Lopinavir/Ritonavir (tradename KALETRA) is a combination of protease inhibitors typically used in HIV, including post-exposure prophylaxis (lopinavir is the actual antiviral agent, with ritonavir functioning to inhibit metabolism of lopinavir, thereby boosting levels of lopinavir). In vitro, Lopinavir/Ritonavir has activity against SARS-CoV-1 and functions synergistically with ribavirin (the addition of ribavirin increases Lopinavir’s potency […]
EMCrit – Mental practice in the COVID19 era: Mastering PPE
How do you learn high priority, low practice-iteration skills?
EMCrit – Critical Care for Non-Intensivists during COVID19 Pandemic
Crit Care during COVID19
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