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REBEL EM – Emergency Medicine Blog

Salim R. Rezaie, MD

Rational Evidence-Based Evaluation of Literature

health & fitness medicine

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Non-Invasive Blood Pressure Monitoring in Critically...

REBEL EM – Emergency Medicine Blog ·

2024/02/08

Background: Patients with shock frequently present with hypotension. Many of these patients are started on vasopressor and inopressor medications to assist in efforts to normalize blood pressure to help improve organ perfusion. In shocky patients, arterial lines are often used to monitor hemodynamic parameters and inform treatment decisions. However, there is limited data on the ... Read more The post Non-Invasive Blood Pressure Monitoring in Critically Ill Adults? appeared first on REBEL EM -

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The Needle Vs. The Knife for Spontaneous...

REBEL EM – Emergency Medicine Blog ·

2024/02/05

Background: The optimal management of primary, spontaneous pneumothorax (sPTX) remains an area of active debate. The British Thoracic Society recommends the least invasive approach possible. In contrast, the American College of Chest Physicians favors first-line chest tube drainage for any sPTX with an estimated volume of over 20%.(3) A Cochrane systematic review comparing simple aspiration ... Read more The post The Needle Vs. The Knife for Spontaneous Pneumothorax: A Closer Look at the EXPRED

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The AcT Trial: Tenecteplase vs Alteplase for Acute...

REBEL EM – Emergency Medicine Blog ·

2024/02/01

Background: Alteplase, a class of medication that converts plasminogen to plasmin leading to fibrin degradation and subsequent clot lysis, has been the standard of care for acute ischemic stroke (AIS) patients that meet eligibility criteria. Tenecteplase, a modified version of alteplase, is being increasingly utilized for AIS due to its favorable pharmacological profile, ease of ... Read more The post The AcT Trial: Tenecteplase vs Alteplase for Acute Ischemic Stroke appeared first on REBEL EM -

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Serial PoCUS for ED Patients with Acute Dyspnea: Is...

REBEL EM – Emergency Medicine Blog ·

2024/01/25

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. It can be used to distinguish between various conditions, including chronic obstructive pulmonary disease (COPD) exacerbation, acute heart failure (AHF), pleural effusion, pulmonary edema, pericardial effusion, pneumothorax, and pneumonia [2,3]. A 2018 systematic review and meta-analysis of 25 studies focusing ... Read more The post Serial PoCUS for ED Patients with Acute Dyspnea: Is More

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Rosh Review MyEMCert Question

REBEL EM – Emergency Medicine Blog ·

2024/01/22

A 46-year-old woman with a history of borderline high cholesterol levels presents with acute-onset chest pain 2 days ago with progressively worsening shortness of breath. Her only medication is an oral contraceptive pill that she has taken for over 20 years. Vital signs show HR of 121 bpm, BP of 124/80 mm Hg, RR of ... Read more The post Rosh Review MyEMCert Question appeared first on REBEL EM - Emergency Medicine Blog.

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Pre-Hospital Antibiotics in Sepsis?

REBEL EM – Emergency Medicine Blog ·

2024/01/18

Background: Sepsis remains one of the leading causes of morbidity and mortality. It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Time to antibiotic therapy (from triage, not from onset of infection) has become a quality metric to improve the time to administration of these medications. In an ... Read more The post Pre-Hospital Antibiotics in Sepsis? appeared first on REBEL EM - Emergency Medicine Blog.

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Clinical Conundrums: Should You Give the First Dose...

REBEL EM – Emergency Medicine Blog ·

2024/01/09

Bottom Line Up Top: In patients with infectious processes that are stable for discharge home, there is no role for giving a first dose of antibiotics IV in the ED. Clinical Scenario: A 45-year-old woman with hypertension presents with a productive cough and fever. Her vitals are: HR 115, BP 120/80, Temp 102.8, O2 Sat ... Read more The post Clinical Conundrums: Should You Give the First Dose of Antibiotics IV Before Discharging Home on Oral Antibiotics? appeared first on REBEL EM - Emergency Medicine

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Rosh Review EM Scholar Monthly Question

REBEL EM – Emergency Medicine Blog ·

2023/12/18

A 55-year-old woman with a history of end-stage kidney disease on peritoneal dialysis presents due to abdominal pain. She has had pain and redness at the site of her catheter exit site. Physical examination is notable for 3 cm of erythema around the catheter exit, located in the lateral left lower quadrant, along with tenderness ... Read more The post Rosh Review EM Scholar Monthly Question appeared first on REBEL EM - Emergency Medicine Blog.

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Don’t Believe the Headline: Ultrasound vs CXR in...

REBEL EM – Emergency Medicine Blog ·

2023/12/10

Background: The use of ultrasound is well established for trauma patients in the emergency department, with almost every patient receiving a FAST (Focused Assessment with Sonography in Trauma) examination as part of the “ABC’s” of trauma. Though the initial focus of the FAST exam was for detection of abdominal free fluid, the eFAST (Extended ... Read more The post Don’t Believe the Headline: Ultrasound vs CXR in Traumatic Pneumothorax Diagnosis appeared first on REBEL EM - Emergency

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Clinical Conundrums: How Long Should We Monitor After...

REBEL EM – Emergency Medicine Blog ·

2023/12/05

How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis? Bottom Line Up Top: After prompt recognition and appropriate treatment with IM epinephrine, the risk of biphasic reactions are exceedingly low. There is no set observation time to monitor patients as long as their symptoms have resolved. At the time of discharge, appropriate patient ... Read more The post Clinical Conundrums: How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis? appeared first on REBEL EM -

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Congestive Heart Failure and Sepsis: A Closer Look at...

REBEL EM – Emergency Medicine Blog ·

2023/11/30

Background: In medicine, guidelines are valuable tools that help guide care. However, they are not rigid rules that must be strictly followed. Clinicians often find themselves grappling with the challenge of balancing the demands of meeting Center for Medicaid & Medicare (CMS) requirements while also addressing the unique needs of each individual patient. For those ... Read more The post Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management appeared first on REBEL EM - Emergency

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Rosh Review EM Scholar Monthly Question

REBEL EM – Emergency Medicine Blog ·

2023/11/20

A 35-year-old woman presents with 4 days of headache, nasal congestion, ear pain, and mild sore throat. She has been taking an over-the-counter medication for her symptoms, but it doesn’t do anything for her. According to recent FDA news, which medication has she likely been taking? Diphenhydramine Oxymetazoline Phenylephrine Pseudoephedrine FOR THE RIGHT ANSWER CLICK ... Read more The post Rosh Review EM Scholar Monthly Question appeared first on REBEL EM - Emergency Medicine Blog.

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UK-REBOA on Trial: Innovative or Over-Inflated?

REBEL EM – Emergency Medicine Blog ·

2023/11/20

Background: Hemmorhage is a major cause of preventable death in trauma patients. Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. Theoretically, the use of REBOA with aortic occlusion should help ... Read more The post UK-REBOA on Trial: Innovative or Over-Inflated? appeared first on REBEL EM - Emergency

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Hydroxycobalamin vs Methylene Blue for Vasoplegic...

REBEL EM – Emergency Medicine Blog ·

2023/11/06

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. This dysregulation of vasodilation is associated with a mortality of close to 25%. After catecholamine vasopressors, treatment options include angiotensin II, corticosteroids, methylene blue and hydroxocobalamin. The latter two ... Read more The post Hydroxycobalamin vs Methylene Blue for Vasoplegic

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REBEL Cast Book Club Episode 4 — The Rise of...

REBEL EM – Emergency Medicine Blog ·

2023/11/01

What is Flow? Simply put, flow is the peak of human performance, maximum focus with maximum responsiveness, an optimal state of consciousness. This state of mind is accessible to anyone under the right circumstances and has huge implications to how we live, work and train. REBEL Cast Book Club Episode 4 — The Rise ... Read more The post REBEL Cast Book Club Episode 4 — The Rise of Superman: Decoding the Science of Ultimate Human Performance appeared first on REBEL EM - Emergency Medicine

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CRYOSTAT-2: Early Empiric Cryoprecipitate in Major...

REBEL EM – Emergency Medicine Blog ·

2023/10/30

Background: Hemorrhage is the leading cause of trauma related mortality. The initial injury is often complicated by multifactorial coagulopathy that can exacerbate bleeding. Fibrinogen is the precursor to fibrin and a major component of stable clot formation. Fibrinogen and fibrin are often depleted during major trauma as a result of consumption, breakdown, and dilution. Most ... Read more The post CRYOSTAT-2: Early Empiric Cryoprecipitate in Major Trauma appeared first on REBEL EM - Emergency

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Pediatric UTIs: Short-Course vs. Standard-Course...

REBEL EM – Emergency Medicine Blog ·

2023/10/26

Background: There is a shifting paradigm towards shorter durations of antibiotics in pediatric infections. Conflicting international guidelines recommend treatment of urinary tract infection (UTI) with antibiotic courses ranging from just 3 days to 7–14 days.1–4 Antimicrobial resistance is a global health crisis, underscoring the importance of antibiotic stewardship. Investigators in the SCOUT Trial examine the ... Read more The post Pediatric UTIs: Short-Course vs. Standard-Course Antibiotics — Is

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Rosh Review EM Scholar Monthly Question

REBEL EM – Emergency Medicine Blog ·

2023/10/23

A 5-year-old boy is brought in by his parent for a dental injury. The patient was walking his dog when it ran after a squirrel. The patient was pulled forward, causing him to hit his tooth on the asphalt. His parent noticed a dental problem and immediately brought the patient to the ED. The physical ... Read more The post Rosh Review EM Scholar Monthly Question appeared first on REBEL EM - Emergency Medicine Blog.

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Corticosteroids in Severe Community Acquired...

REBEL EM – Emergency Medicine Blog ·

2023/10/05

Background: Community-acquired pneumonia (CAP) can lead to pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and an increased risk of death. Corticosteroids have excellent anti-inflammatory and immunomodulatory effects that could mitigate some of the inflammation caused by pneumonia. There have been several randomized trials that have shown glucocorticoids have positive effects ... Read more The post Corticosteroids in Severe Community Acquired

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The SQuID Protocol: SQ Insulin in DKA?

REBEL EM – Emergency Medicine Blog ·

2023/10/02

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment. Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin ... Read more The post The SQuID Protocol: SQ Insulin in DKA? appeared first on REBEL EM - Emergency Medicine Blog.

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