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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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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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STREAM-2: Half-Dose Tenecteplase vs Primary PCI in...

REBEL EM – Emergency Medicine Blog ·

2023/09/28

Background: Primary PCI is the recommended reperfusion strategy in patients with STEMI and should be initiated within 2 hours after first medical contact. In non-PCI-capable hospitals this goal is not always achievable due to delays in transfer. In these cases, thrombolysis is recommended to improve morbidity and mortality. The STREAM-1 trial found that for [2] ... Read more The post STREAM-2: Half-Dose Tenecteplase vs Primary PCI in Older Patients with STEMI? appeared first on REBEL EM -

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Clinical Conundrum: Should a Troponin Routinely be...

REBEL EM – Emergency Medicine Blog ·

2023/09/21

Bottom Line Up Top: Troponins should not be routinely sent in patients presenting with SVT. Rarely, they may be necessary if the patient has concerning ischemic symptoms that persist after conversion to sinus rhythm. Clinical Scenario: A 44-year-old man presents with palpitations that started 45 minutes ago. He has no medical problems and denies any ... Read more The post Clinical Conundrum: Should a Troponin Routinely be Ordered in Patients with SVT? appeared first on REBEL EM - Emergency Medicine

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Rosh Review EM Scholar Monthly Question

REBEL EM – Emergency Medicine Blog ·

2023/09/18

An 85-year-old man presents for evaluation of left wrist pain. Last night, he missed the last step while descending the stairs at his house. He fell and landed on his hands and did not have other injuries. Acetaminophen and ibuprofen have not alleviated his pain. X-ray imaging is shown below. His physical exam reveals limited ... Read more The post Rosh Review EM Scholar Monthly Question appeared first on REBEL EM - Emergency Medicine Blog.

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The ECLS-SHOCK Trial: ECPR in Infarct-Related...

REBEL EM – Emergency Medicine Blog ·

2023/09/14

Background: Cardiogenic shock develops in up to 10% of patients with acute myocardial infarction (AMI) and carries a 30 day mortality rate around 50%. Revascularization of the culprit lesion remains one of the few established treatments though there are numerous other unproven modalities including extracorporeal life support (ECLS). Many centers have attempted ECLS to achieve ... Read more The post The ECLS-SHOCK Trial: ECPR in Infarct-Related Cardiogenic Shock appeared first on REBEL EM - Emergency

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POCUS in the ED: Is Confirmatory RUQ US Still Necessary?

REBEL EM – Emergency Medicine Blog ·

2023/09/11

Background: Point of care ultrasound (POCUS) has a demonstrated sensitivity of 89.8% and specificity of 88.0% for identification of cholelithiasis and has a proven negative predictive value for ruling out other acute biliary pathology such as acute cholecystitis.1 It is a quickly deployable and easily interpreted study that can be done in real time to ... Read more The post POCUS in the ED: Is Confirmatory RUQ US Still Necessary? appeared first on REBEL EM - Emergency Medicine Blog.

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Unpacking the PEACH Trial: What is Levetiracetam’s...

REBEL EM – Emergency Medicine Blog ·

2023/09/07

BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality (Hostettler 2019). Levetiracetam is frequently used to prevent seizures in patients with conditions such as ICH, traumatic brain injury (TBI), supratentorial neurosurgery, and subarachnoid hemorrhage (SAH). However, guidelines offer no strong recommendations for its use, specifically ... Read more The post Unpacking the PEACH Trial: What is

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The PACER Trial: Platelet Transfusion before CVC...

REBEL EM – Emergency Medicine Blog ·

2023/08/31

Background: Bleeding complications are an uncommon but potentially a significant risk during central venous catheter (CVC) placement. Thrombocytopenia is associated with increased bleeding complications but there is no good-quality evidence showing that prophylactic platelet transfusions decrease that risk. Previous studies were retrospective and current society guidelines have differing thresholds (20,000 – 50,000 per cubic millimeter) ... Read more The post The PACER Trial: Platelet Transfusion

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Clinical Conundrum: Does IM Ketorolac Provide...

REBEL EM – Emergency Medicine Blog ·

2023/08/28

Clinical Scenario: A 34-year-old woman presents to the ED with back pain. After your history and physical, you conclude that the patient’s pain is muscular in origin and likely secondary to heavy lifting while moving apartments. You contemplate analgesic options and decide that a NSAID makes sense. Should you give her PO ibuprofen or IM ... Read more The post Clinical Conundrum: Does IM Ketorolac Provide Superior Pain Relief to PO Ibuprofen? appeared first on REBEL EM - Emergency Medicine

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Back in the Game: The Effects of Activity on Youth...

REBEL EM – Emergency Medicine Blog ·

2023/08/24

Background: Sports-related concussions are among the most common injuries in children and adolescents, affecting millions of youth athletes annually.1 Given their prevalence in this population, providers must be up to date on diagnosis and management. Historical practice recommends rest to prevent adverse outcomes; however, evidence suggests strict rest is harmful. Relative rest (activities of daily ... Read more The post Back in the Game: The Effects of Activity on Youth Concussion Recovery

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TAME Trial: Mild Hypercapnia vs Normocapnia in...

REBEL EM – Emergency Medicine Blog ·

2023/08/21

Background Information: Cardiac arrest is a devastating event that imposes considerable human and financial burdens. While it is widely recognized that cardiac arrest leads to brain injury, what is often overlooked is the persistent cerebral hypoperfusion that continues even after circulation is restored. The sustained cerebral hypoperfusion can be attributed to impaired cerebrovascular auto-regulation, which ... Read more The post TAME Trial: Mild Hypercapnia vs Normocapnia in Out-of-Hospital

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Rosh Review EM Scholar Monthly Question

REBEL EM – Emergency Medicine Blog ·

2023/08/17

A 24-year-old woman presents to the emergency department with persistent severe pain in her right thigh following a direct blow during a soccer match 2 weeks ago. She is participating in an important tournament, so she has been attempting to continue playing. However, she reports difficulty and pain with walking and feels a hard lump ... Read more The post Rosh Review EM Scholar Monthly Question appeared first on REBEL EM - Emergency Medicine Blog.

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