The Journal of Emergency Medicine
Objectives: To describe the implementation of an ED-based
program to offer monoclonal antibody therapy to patients with
mild-moderate COVID-19 disease.
Background: Monoclonal antibody therapy (MOAB) has re-
cently emerged as a treatment for mild to moderate COVID-19,
potentially preventing those with underlying conditions from
progressing to severe illness and hospitalization. Further, as EDs
are the primary point of health care access for many at-risk in-
dividuals, offering MOAB in the ED may increase availability
of treatment options for patients from traditionally underserved
communities.
Methods: A retrospective chart review was conducted of pa-
tients 12 years and above who received treatment in our urban,
academic, community hospital. Patients 12 years and older
were screened for eligibility during ED visits or during follow-
up calls providing positive test results. Staff was trained on
specific consent, infusion, monitoring, and documentation pro-
cedures adherent to MOAB administration under the Emergency
Use Authorization. Patients were contacted following MOAB
and queried regarding symptom resolution and healthcare uti-
lization. Data regarding patient demographics, ED course, and
7-day unscheduled visits were collected.
Results: In this ongoing quality improvement initiative, from
December 2020 to March 2021, there were 26,229 patient en-
counters at the pilot ED site. 84 patients were provided MOAB,
87% Bamlanivimab and 13% Bamlanivimab/Etesevimab. Pa-
tients had a mean age of 52.3 years (SD 24.4); 21% were 12-17
years of age and 37% were >65 years old. 52% were male.
33% self-reported as Caucasian, 19% Black, 18% Asian/Pacific
Islander, 21% as other, and 9% were unknown. 17% identi-
fied as Latinx. 19% of patients were insured by Medicaid, 36%
Medicare, 39% commercially insured, and 6% were uninsured.
Patients had symptoms a median of 3 days prior to MOAB. After
age (46%), the most commonly reported eligibility criteria was
obesity (20%), followed by hypertension (11%) and immuno-
compromised state (11%). 74% of infusions were administered
during nights and weekends. No infusion reactions occurred. 8%
returned to an ED within 7 days of MOAB, 5% were hospital-
ized. No patients required ICU admission or died.
Conclusion: ED-based MOAB has been safely implemented
and may be an effective treatment for patients with mild to mod-
erate COVID-19. Health-system wide expansion of this program
may provide opportunities to offer this life-saving therapy to un-
derserved populations with poor access to care.
 ADJUSTED D-DIMER TO EXCLUDE
CONCURRENT PULMONARY EMBOLISM IN
PATIENTS WITH COVID-19
Isenberg Derek, md faaem, Zandrow Gregory, md,
Schreyer Kraftin E., md mba faaem, Satz Wayne A., md
faaem
Objectives: To determine if elevated D-dimers in Severe Acute
Respiratory Syndrome Coronavirus-2 (COVID-19) positive pa-
tients were predictive of concurrent pulmonary embolism (PE),
and what, if any, adjusted D-dimer cutoff would be predictive of
PE in COVID-19 patients.
413
Background: COVID-19 has led to over 500,000 death the
United States. COVID-19 has been linked to a prothrombotic
state, increasing the affected individual’s propensity to form
blood clots which is reflected in elevated D-dimers levels. While
elevated D-dimers have been associated with 28-day mortality
(making them useful in tracking the disease), it is difficult, in
the acute setting, to determine if an elevated D-dimer is due to
COVID-19, a pulmonary embolism (PE), or both conditions si-
multaneously.
Methods: This was a retrospective chart review of emergency
department patients who underwent a computed tomography
pulmonary angiogram (CTPA) who had documented COVID-19
infections between March and December of 2020. Charts were
abstracted for COVID-19 polymerase chain reaction (PCR) re-
sults, D-dimers levels, and CTPA results. Kruskal-Wallis rank
sum one-way analysis of variance and sensitivity analyses were
completed via the software R.
Results: Of 346 COVID-19 positive patients by nasal swab
PCR, 24 (6.9%) had a PE on CTPA. The average D-dimer in the
subset was 22,768 ng/dL vs 3,620 ng/dL in COVID-19 positive
but PE negative patients (p=.034). As a screening test for con-
current PE, a D-dimer cut off of 1,000ng/dL or, for those over
50, [age in years]∗ 20 ng/dL, had a sensitivity of 96%, specificity
of 48% and negative predictive value (NPV) of 99.4%. A cut off
of 1,000ng/dL had a sensitivity of 100%, specificity of 44% and
NPV of 100%.
Conclusion: Emergency department patients with COVID-19
and a PE have a significantly higher elevation in their D-dimer
when compared to COVID-19 positive patients without a PE. A
flat cut off of 1000ng/dL or a two tiered cut off of 1,000ng/dL for
those <50 years old and [age in years]∗ 20 ng/dL for those >50
years old proved to be reasonable screening tests for concurrent
PE in COVID-19 positive patients.
414
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 RETHINKING ONDANSETRON AS A
FIRST LINE AGENT FOR NAUSEA AND
VOMITING IN THE EMERGENCY
DEPARTMENT
Camejo Melanie, md, Gaddis Monica L., phd, Dinh Phi
Objectives: Ondansetron is commonly used as a first-line agent
to treat nausea and vomiting in the Emergency Department. The
purpose of this study was to test the hypothesis that Odansetron
is not superior to other antiemetics, when used to treat nau-
sea and vomiting due to headache or abdominal pain in an
emergency department. The medications that were compared
in the study include: ondansetron, metoclopramide, haloperidol,
prochlorperazine and promethazine.
Background: Ondansetron has been used for many years to treat
nausea and vomiting. Oftentimes, it does have to be redosed and
patients are eventually sent home with a prescription. There are
many other medications that can be used for nausea and vomit-
ing that may be superior to ondansetron that need to be explored.
Methods: This study was performed at a tertiary care cen-
ter/safety net hospital located in Kansas City, Missouri. This
was a descriptive study using a retrospective chart review. RED-
Cap was used to document information and there were no
patient identifiers retained. Subjects included were >18 years
of age with nausea and vomiting with abdominal pain (R10.9)
or Headache (R51). Excluded were minors <18 years of age
and pregnant patients. Charts from January 2019-January 2020
were reviewed. All antiemetics used, route of administration and
need for subsequent dosing of an antiemetic up to 3 doses were
recorded.
Results: Charts reviewed totaled 3003 after exclusions; first
line medications were: 1,802 (59.99%) patients received
ondansetron, 609 (20.27%) received prochlorperazine, 502
(16.71%) received metoclopramide, 91 (3.03%) patients re-
ceived haloperidol and 0 received promethazine. 78% of the
ondansetron group, 96% of the prochlorperazine group, 81.6%
of the metoclopramide group, and 53% of the haloperidol group
did not need a second dose of anti-emetics. Of the percent-
age of patients that required a second dose; if ondansetron was
given, 78% of patients did not need a third dose of anti-emetics,