Academic EM blog (2)

As I didn’t get any bottles thrown at me for my first academic update, I thought I might try a second. Do let me know if you have any suggestions for improvement or other topics that you think should be covered.
 
COVID-19 research
 
The papers are coming thick and fast, but still the quality of evidence is limited. I promised to keep an eye out for certain things; one of these is the coagulopathy and risk of thromboembolic disease associated with COVID-19, and specifically whether we should be targeting this with therapeutic rather than prophylactic anticoagulation. The short answer is that no-one yet knows – but there is a comprehensive 66-page review written by the international great and good in JACC if you want the long version:
http://www.onlinejacc.org/content/early/2020/04/15/j.jacc.2020.04.031
The clinical bottom line is that if you are admitting someone to hospital with any significant illness, including COVID-19, they should be risk assessed and considered for weight-based prophylaxis to avoid the complications of thromboembolism. But then we knew that already..
 
What about potential treatment options for our patients with COVID-19? Self-proningis not a term I’d come across before this pandemic, but I have come across the concept while lying on a sun lounger beside a pool reading a book. I think the emergency medicine term for this is ‘lying on your front’. However, the idea really appeals to me because it’s free, almost anyone can do it, and if it helps our patients with COVID-19, then we are potentially onto a winner. 
The majority of previous evidence related to proning is in intubated patients with ARDS in the ICU. This article, published a few days ago, is one of the first descriptions of proning in awake patients in the ED:
https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.13994
The rationale is clear, and in this series from New York a convenience sample of 50 hypoxic patients with suspected COVID-19 were recruited in the ED and underwent proning – which almost universally improved their oxygenation (the primary outcome). These were sick patients, 13 of whom ended up being intubated, but if there is a potential to avoid escalation in a group of our COVID-19 patients then we should be exploring this. Hopefully there will be more evidence to come on this topic, and in particular the potential risks associated with the technique, which haven’t been fully explored. 
 
Exciting times for the research community involved in COVID-19 trials. The latest one that caught my eye is the proposed convalescent plasma study being coordinated by NHSBT – you may remember that in the dark days of the Ebola crisis a similar treatment was proposed and investigated. Further details can be found at:
https://www.nhsbt.nhs.uk/how-you-can-help/convalescent-plasma-clinical-trial/
Bottom line – if you have had COVID-19, we need your plasma to run this clinical trial. 
 
Non-COVID evidence
 
If you are interested in academic emergency medicine and what the future holds, you might want to take a look at this editorial in the EMJ, which I hope persuades you that the future is bright, but we all have a part to play.
http://emj.bmj.com/cgi/content/full/emermed-2020-209429 
 
Another article that caught my eye in the EMJ was this paper encompassing a review and exploratory trial of methods of removing glue from the eyelids. It’s embarrassing when it happens but if you have an idea of how to manage it, then hopefully the angst around the situation can be reduced. 
https://emj.bmj.com/content/37/4/212
 
Non-clinical 
 
An interesting take on whether we as healthcare workers are more at risk of contracting COVID-19 than our neighbours is included in this episode of ‘More or Less’ from BBC Radio 4. It also includes an explanation of the infographic used to explain social isolation
https://www.bbc.co.uk/programmes/m000hfqq
 
Finally, given my academic role, I will always encourage you to read high quality research articles, and apply the principles of critical appraisal to what you read. In these strange times, however, I would urge you all to read a non-evidence based book, “The Boy, the Mole, the Fox and the Horse” by Charlie Mackesy; a fable for our times, equally relevant to young and old. In the words of the horse, “Everyone is a bit scared”, “But we are less scared together.” 
 
Stay safe and sane,
Jason Smith on behalf of the academic team