Evidence-Based Use of Therapeutics for Ambulatory Patients with COVID-19

Currently only a few treatments available help mildly ill patients – people who have COVID-19 who do not require admission to hospital. Drugs like azithromycin, bamlanivimab, colchicine, hydroxychloroquine, ivermectin, lopinavir-ritonavir, and vitamin D do not help patients with COVID-19, and may cause harm. 

Dexamethasone, a steroid that can be given in pill form, may benefit patients who are at home but need supplemental oxygen, but does not help patients who are mildly ill who do not need supplemental oxygen. 

Budesonide, a steroid that can be inhaled (from a “puffer”), has no effect on whether patients with mild COVID-19 get sicker, are hospitalized, or die. But there is weak evidence that inhaled budesonide 800 mcg twice daily for 14 days may make patients feel better a few days earlier, so doctors may consider prescribing it.

Dizziness…the good and the ugly…

The differential diagnosis of vertigo can be broken into peripheral and central causes. It is imperative the Emergency Physician consider central causes of vertigo.

Signs/ Symptoms Differentiating Peripheral and Central Vertigo

 PeripheralCentral
OnsetSudden or InsidiousSudden
Severity of VertigoIntense SpinningIll-defined, may be severe or less intense
Prodromal DizzinessOccurs in up to 25%, often single episodeOccurs in up to 25%, recurrent episodes suggest TIA’s
Intolerant of head movements/Dix-Hallpike ManeuverYesVaries, but often intolerant
Associated Nausea/DiaphoresisFrequentVariable, but often frequent
Auditory SymptomsPoints to peripheral causesMay be present
Proportionality of SymptomsUsually proportionalOften disproportionate
Headache/Neck PainUnusualMore likely
CNS signs/symptomsAbsentUsually present
Head Impulse TestAbnormalOften normal
NystagmusHorizontalVertical/direction-changing
HINTS TestingNegativeAbnormal in at least 1 out of 3 tests