EM Quick Hits 14 – COVID-19 Your Colleagues’ Experiences and Practical Tips

Special edition EM Quick Hits podcast on COVID-19 Drs. Eddy Lang, Salim Rezaie, Anand Swaminathan, Jonathan Sherbino and Reuben Strayer share their experience with the COVID-19 pandemic and offer some practical tips. Podcast production, editing and sound design by Anton Helman Written summary & blog post by Anton Helman, March 2020 Cite this podcast as: Helman, A. Swaminathan, A. Rezaie, S. Sherbino, J. Strayer, R. Lang, E. EM Quick Hits 14 - COVID-19 Your Colleagues Experiences and Practical Tips. Emergency Medicine Cases. March, 2020. https://emergencymedicinecases.com/em-quick-hits-14-covid-19-your-colleagues-experiences-practical-tips/. Accessed [date]. This podcast was recorded in late March, 2020 and the information within is accurate up to this date only, as the COVID pandemic evolves and new data emerges.  COVID weekly updates via the EM Cases Newsletter and on the EM Cases website under 'COVID-19' in the navigation bar. This podcast and blog post are based on Level C evidence - consensus and expert opinion. Examples of protocols, checklists and algorithms are for educational purposes only and require modification for your particular needs as well as approval by your hospital before use in clinical practice. Practical tips on managing yourself, your team and your patients in the COVID-19 pandemic * Address PPE preservation strategies including novel reusable N95 masks, UV light to disinfect masks, collaborating with IPAC, careful attention to protecting ward stock and monitoring for inappropriate use * Match your PPE to your "cold", "warm" and "hot" zones of your ED * Stay well - create a COVID physician wellness hub, go outside, exercise, have virtual coffee or drinks with friends and family, practice mindfulness * Develop a COVID plan for homeless and disadvantaged patients * Communicate professionally and optimistically; monitor your tone and attitude while remaining genuine/authentic, especially with non-ED providers who are looking to us for guidance * Leverage technology to bring a sense of community - virtual rounds, study groups, chat groups * A small subset of patients present with GI symptoms only * Respiratory viral panels that include "coronavirus" is not specific for COVID-19, SARS or MERS - you need specific tests * Ruling in an alternate viral respiratory diagnosis does not rule out COVID-19 - they can co-exist * Indications for various imaging modalities in the ED are controversial, with imaging being most useful to determine extent of disease and to rule out alternative diagnoses, rather than to diagnose COVID-19; some believe that in high prevalence areas we should assume all patients with an acute respiratory illness have COVID-19 and that we should reserve imaging only for those patient with significant vital sign abnormalities * POCUS, in skilled hands,  has been touted as an alternative to CT to save resources and minimize transmission of virus in the hospital * Rather than developing your ED COVID protocols from scratch, borrow from other trusted sources who have already done the work * For anxious patients being discharged home, consider instructing them to purchase a pulse oximeter online, and to return if their oxygen saturation is persistently <90% * IV plaquenil is being used in some jurisdictions for intubated patients * High Flow Nasal Cannula (HFNC) 30L/min, FIO2 30% with a surgical mask applied (even though it aerosolizes virus) may be an option in jurisdictions where ventilators are scarce * “When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.'" - Fred Rogers None of the authors have any conflicts of interest to declare