COVID Therapeutics Update

John Misdary, MD, Florida ACEP Pediatric Emergency Committee Co-Chair

COVID-19 cases among children spiked dramatically during the delta and omicron variant surges.  Since the pandemic began children represented 18.9% of cumulated cases and make up 22.2% of the US population.  This fortunately has not equated to hospitalizations. Among reporting states children ranged from 1.5%-4.6% of their cumulated hospitalizations and 0.1%-1.5% of all child COVID-19 cases resulted in hospitalizations.  In all states reporting 0.01% of pediatric cases resulted in death.  MISC has been a concern with the total number of patients meeting criteria have totaled 6851 and with 59 deaths which equates to 0.05% of all pediatric COVID-19 cases.  MISC has remained a high concern in which vaccine effectiveness data has remained uncharacterized according to Pfizer’s data and there is no data that shows treatment of COVID-19 of any type of prevention. read more

CO Poisoning – Pearls and Management

Anthony Del Zotto, DO, Charleston Area Medical Center and Jaryd Zummer, MD , University of Kentucky

Better late than never. It is still winter, and we are all trying to stay warm inside while awaiting warmer days to arrive! We thought this would be a fitting time to review CO toxicity, with some pearls and management tips.

Carbon monoxide (CO) is the true “silent” killer. A major contributor to indoor fire-related incidents, it is responsible for up to 500 deaths per year in the US and has both significant short and long-term morbidity. This colorless, tasteless, and odorless gas is formed via the incomplete combustion of carbon-containing fuels. Most common implicated devices include furnaces, fireplaces, space heaters, stoves, and automobile or boats, especially in poorly ventilated areas or with faulty or blocked exhaust systems. Hemoglobin’s affinity for CO is approximately 200-250 times stronger than that of oxygen. When hemoglobin binds CO to form carboxyhemoglobin, it effectively reduces hemoglobin’s O2 carrying capacity (leftward shift of the oxyhemoglobin dissociation curve) and delivery of O2 to vital tissues. This tissue hypoxia not only causes a shift to anaerobic metabolism and consequently lactate production, but also increases cerebral blood flow and capillary permeability to cause cerebral edema in the most severe cases. read more