EM Quick Hits 16 COVID-19 Oxygenation Strategies, Trauma Care, Addictions Considerations, Cardiovascular Complications and Compassionate Care

Topics in this EM Quick Hits podcast Anand Swaminathan on oxygenation strategies for COVID-19 learned from the New York experience (1:10) Andrew Petrosoniak on trauma care considerations in the COVID-19 era (9:26) Michelle Klaiman on addiction medicine considerations in the COVID-19 era (15:38) Brit Long & Michael Gottlieb on cardiac complications of COVID-19 (21:19) Leeor Sommer on physician compassion and preserving patients' humanity in the COVID-19 era (28:52) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Andrew Petrosoniak, Brit Long and Anton Helman Cite this podcast as: Helman, A. Swaminathan, A. Klaiman, M. Sommer, L. Long, B. Gottlieb, M. Petrosoniak, A. EM Quick Hits 16 - COVID-19 - Oxygenation Strategies, Trauma Care, Addictions Considerations, Cardiovascular Complications & Compassionate Care. Emergency Medicine Cases. April, 2020. https://emergencymedicinecases.com/em-quick-hits-covid-19-oxygenation-trauma-addictions-cardiovascular-complications/. Accessed [date]. This blog post and podcast are based on Level C evidence - consensus and expert opinion. Examples of protocols, checklists and algorithms are for educational purposes and require modification for your particular needs as well as approval by your hospital before use in clinical practice. This podcast was recorded in early April, 2020 and the information within is accurate up to this date only, as the COVID pandemic evolves and new data emerges. The blog post will be updated regularly and we are working on a weekly update via the EM Cases Newsletter which will be replicated on the EM Cases website under 'COVID-19' in the navigation bar. Oxygenation strategies for COVID-19: New York City experience There appears to be three phenotypes of COVID-19 patients: * The well COVID-19 patient - URI/flu-like illness +/- abnormal CXR, but normal/near normal vital signs * "Happy hypoxic" - relatively asymptomatic and appearing comfortable but oxygen saturation <90% despite 5-6L NP and 15L NRB, consider HFNC with covering surgical mask or CPAP in negative pressure room, both of which may prevent the need for intubation * Respiratory failure - severe hypoxia and tachypnea who appear to be tiring; consider early intubation and preoxygenation with CPAP or gentle controlled BVM 2 person (6-10 breaths/min) Awake proning in the ED for "Happy Hypoxic" COVID-19 patients For patients requiring NP and/or NRB oxygenation simply instruct patient to roll over into the prone position taking care not to disturb their IV or NP/NRB, wait a few minutes and assess their oxygenation and subjective symptoms; if either improve, remain prone - if not, return to supine position. Proning may be beneficial to those COVID-19 patients on HFNC, CPAP or intubated, however this requires trained providers and is better suited for the ICU where they have experience proning patients. Awake pronation on EMcrit Could the best mode of noninvasive ventilation for COVID-19 by CPAP?  Update 2021: Randomized, open-label clinical trial assessing high-flow oxygen nasal cannula versus conventional supplemental oxygen in ED’s and ICU’s across 3 hospitals in Colombia, including 220 patients with respiratory distress due to severe COVID-19 (PaO2/FiO2 <200). At the end of 28 days,