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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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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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An Herbal Hope: Is XBJ A Game-Changer in Sepsis...

REBEL EM – Emergency Medicine Blog ·

2023/08/14

Background: Could Xuebijing (XBJ) catalyze a paradigm shift in sepsis management? XBJ is an herbal compound used in China to manage various inflammatory and infectious processes in recent years, including sepsis.2-6 It is an herbal preparation comprising a blend of five herbs: Carthami Flos, Paeoniae Radix Rubra, Angelicae Sinensis Radix, and Salviae Miltiorrhizae.2,5,6 Professor Jinda ... Read more The post An Herbal Hope: Is XBJ A Game-Changer in Sepsis Management? appeared first on REBEL EM -

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