PODCAST

REBEL EM – Emergency Medicine Blog

Salim R. Rezaie, MD

Rational Evidence-Based Evaluation of Literature

health & fitness medicine

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MDCalc Wars – Tiny Patient, Big Decision: Head CT or...

REBEL EM – Emergency Medicine Blog ·

2025/09/29

PECARN has been THE decision rule for guidance on management of kids with head injuries, but the Infant Scalp Score dives even deeper—built just for babies with scalp hematomas. Which rule is best in this situation? The post MDCalc Wars – Tiny Patient, Big Decision: Head CT or no Head CT? appeared first on REBEL EM - Emergency Medicine Blog.

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Clinical Conundrum: What is the Utility of...

REBEL EM – Emergency Medicine Blog ·

2025/09/25

Procalcitonin is a protein that is upregulated during inflammatory states. An elevation in procalcitonin should be specific to bacterial infections. Viral infections should result in decreased procalcitonin levels thus allowing us to differentiate bacterial from viral and help guide antibiotic prescription. However, this differentiation isn’t what we see in real life data.The post Clinical Conundrum: What is the Utility of Procalcitonin in the ED? appeared first on REBEL EM - Emergency Medicine

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TXA for Hemoptysis: We Put That $#!t on Everything...

REBEL EM – Emergency Medicine Blog ·

2025/09/08

Hemoptysis is a potentially life-threatening emergency that can lead to airway compromise and hemorrhagic shock. While definitive treatments like bronchoscopy, bronchial artery embolization (BAE), and surgery can be effective, they often require significant time and specialized resources—capabilities not universally available in all hospitals or emergency departments.Tranexamic acid (TXA), an antifibrinolytic agent, has emerged as both an adjunctive and potentially definitive therapy in the acute

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REBEL Core Cast 140.0: The Power and Limitations of...

REBEL EM – Emergency Medicine Blog ·

2025/09/01

The sicker the patient, the more likely an IO line is the right choice. In emergencies such as cardiac arrest or hemorrhagic shock, the speed and reliability of IO access outshine traditional intravenous (IV) or central line placements. There's virtually no resuscitation medication or blood product that cannot be administered through an IO, making it indispensable in life-threatening scenarios. The post REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine

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MDCalc Wars: Sorting Out Syncope – Which Rule Should...

REBEL EM – Emergency Medicine Blog ·

2025/08/25

Syncope is one of the most common complaints we face in the ED. Most patients do well, yet a small subset are harboring serious cardiac or neurologic disease. Admit everyone, and we waste beds and resources; discharge everyone, and we risk missing life-threatening disease. As always in emergency medicine, we’re searching for the needle in the haystack—the one patient out of hundreds who’s truly at risk.You may have heard of the San Francisco Syncope Rule, but have you met its worthy opponent, the

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ICARUS ED Trial: Concentrated Albumin for...

REBEL EM – Emergency Medicine Blog ·

2025/08/11

Sepsis is one of the most common emergencies we encounter, yet despite decades of research, it still carries a high burden of morbidity and mortality. Over the years, our attempts to improve outcomes have spanned the spectrum—from clearly lifesaving (like timely antibiotics) to largely discredited (like high-dose vitamin C).On paper, treatment with albumin makes sense: it’s a large protein that can boost oncotic pressure and theoretically counteract sepsis-induced capillary leak. But when tested in

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MDCalc Wars: Stop Before the CT! — Are You Using PERC...

REBEL EM – Emergency Medicine Blog ·

2025/07/28

Diagnosing PE in the emergency department is tricky. The symptoms—chest pain, shortness of breath, tachycardia—are nonspecific and overlap with many other conditions. But missing a PE can have devastating consequences, so there’s often a low threshold to order a CTA. Resulting in over-testing, radiation exposure, contrast risk, increased length of stay, and unnecessary healthcare costs. Wells Criteria and PERC help clinicians safely and systematically identify which patients actually need further

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Casting Doubt: The SUSPECT Trial — Bandaging Vs....

REBEL EM – Emergency Medicine Blog ·

2025/07/14

Managing patients with suspected occult scaphoid fractures and normal X-rays presents a common clinical dilemma. About 1 in 10 of these patients will have an occult fracture, and roughly 10% of all scaphoid fractures result in nonunion. However, the risk of nonunion among patients with MRI-confirmed occult fractures is much lower—around 3.5%.Guidelines recommend immobilization with a thumb spica cast or splint when clinical suspicion is high. But that threshold is subjective, and snuffbox

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MDCalc Wars: HEART Score Vs. EDACS

REBEL EM – Emergency Medicine Blog ·

2025/06/30

Chest pain is one of the most common—and anxiety-inducing—presentations in the Emergency Department. With millions of visits each year, clinicians face the constant challenge of identifying who is having a major cardiac event and who can safely go home. While most of these patients won’t have acute coronary syndrome, the stakes for missing it are high. That’s where clinical decision rules like the HEART Score and EDACS can help.The post MDCalc Wars: HEART Score Vs. EDACS appeared first on REBEL EM

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Combination Inhalers in Asthma: Time to Switch?

REBEL EM – Emergency Medicine Blog ·

2025/06/23

🧭 REBEL Rundown 📌 Key Points 💨 Most asthma patients still leave the ED with a SABA alone—time for an upgrade. 📉 SABA/ICS combo inhalers cut severe exacerbations compared to SABA alone. 🏥 Study excluded typical ED patients—few had recent exacerbations. 💰 New combo inhaler costs ~$500 and was compared to a weaker treatment. 💡 ... Read moreThe post Combination Inhalers in Asthma: Time to Switch? appeared first on REBEL EM - Emergency Medicine Blog.

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REBEL Core Cast 135.0: A Simple Approach to Hypoxemia...

REBEL EM – Emergency Medicine Blog ·

2025/06/16

In this episode, we break down a practical bedside approach to hypoxemia. We clarify the difference between hypoxemia (low oxygen in the blood) and hypoxia (low oxygen at the tissue level), and walk through the major causes of hypoxemia that you need to recognize quickly at the bedside.The post REBEL Core Cast 135.0: A Simple Approach to Hypoxemia (vs. Hypoxia) appeared first on REBEL EM - Emergency Medicine Blog.

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The ADAPT-Sepsis Trial: Biomarker-Guided Antibiotic...

REBEL EM – Emergency Medicine Blog ·

2025/06/09

Antibiotic stewardship entails delivering the most appropriate antimicrobial therapy for the most appropriate duration of time to help provide the best outcome for patients with sepsis. An unnecessarily extended course of antibiotics leads to adverse effects, greater cost, medication utilization and most importantly antimicrobial resistance. However, too short of a course could lead to failure to treat and clinical deterioration. The optimal duration of antibiotics in sepsis remains uncertain and

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REBEL Core Cast 134.0 – Acetaminophen Toxicity

REBEL EM – Emergency Medicine Blog ·

2025/06/02

Acetaminophen (APAP) overdose remains one of the most common causes of acute liver failure in the United States. While its therapeutic use is widespread and generally safe, unintentional overdoses and delayed presentations can lead to devastating outcomes. In this episode of REBEL Cast, we break down the pathophysiology, clinical course, diagnostic approach, and evidence-based management ... Read moreThe post REBEL Core Cast 134.0 – Acetaminophen Toxicity appeared first on REBEL EM -

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MDCalc Wars: NEXUS Criteria Vs Canadian C-Spine Rules

REBEL EM – Emergency Medicine Blog ·

2025/05/27

Over 1 million blunt trauma patients visit US emergency departments each year for possible c-spine injuries. Yet, 98% of c-spine imaging shows no fracture. Using clinical decision tools can safely and significantly reduce unnecessary imaging.The post MDCalc Wars: NEXUS Criteria Vs Canadian C-Spine Rules appeared first on REBEL EM - Emergency Medicine Blog.

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Is 7 Days Enough? Rethinking Antibiotic Duration in...

REBEL EM – Emergency Medicine Blog ·

2025/05/19

Current IDSA guidelines for sepsis recommend individualized durations of antibiotic therapy based on source control and clinical response, but definitive guidance remains limited. Three small noninferiority RCTs suggested that 7 days of antibiotics may be sufficient for patients with gram-negative bacteremia—but these trials had notable limitations: they excluded ICU patients, included only clinically improving individuals, and did not assess gram-positive infections. The BALANCE trial, a large

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TNK vs tPA — The ORIGINAL Trial

REBEL EM – Emergency Medicine Blog ·

2025/05/05

The American Heart Association and the European Stroke Organization have updated their guidelines to recommend TNK as an alternative to tPA in patients eligible for thrombolysis. TNK, a bioengineered variant of tPA, has some advantages, including its single-dose administration, fibrin specificity, and longer half-life. Several studies have demonstrated the safety and efficacy of TNK as an alternative to tPAThe post TNK vs tPA — The ORIGINAL Trial appeared first on REBEL EM - Emergency Medicine

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How Accurate are Blood Gas Electrolyte Measurements?

REBEL EM – Emergency Medicine Blog ·

2025/04/28

Bottom Line Up Top: Blood gas electrolytes closely correlate with serum measurements and can be used under most circumstances to guide clinical care. Clinical Scenario: A 62 year old woman with a history of HTN, ESRD on MWF dialysis presents to the Emergency Department with generalized weakness. Her vital signs are HR = 82, BP ... Read moreThe post How Accurate are Blood Gas Electrolyte Measurements? appeared first on REBEL EM - Emergency Medicine Blog.

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Size Matters: The Impact of Cuff Size on Blood Pressure

REBEL EM – Emergency Medicine Blog ·

2025/04/14

Background: Accurate blood pressure (BP) measurement is essential in the emergency department (ED), where it serves as a key marker of hemodynamic stability and informs critical management decisions. Improper technique and incorrect cuff sizing can lead to falsely high or low readings, impacting patient care. The issue of BP cuff size has been studied in ... Read moreThe post Size Matters: The Impact of Cuff Size on Blood Pressure appeared first on REBEL EM - Emergency Medicine Blog.

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Street Medicine: Compassionate Care for the Unhoused

REBEL EM – Emergency Medicine Blog ·

2025/04/02

Introduction: In this episode of Rebel Cast, host Marco Propersi, along with co-hosts Steve Hochman and Kim Baldino, delve into the practice and importance of street medicine—the direct delivery of healthcare to homeless and unsheltered individuals. Special guests Dr. Jim O’Connell, a pioneer of street medicine, and Dr. Ed Egan, a recent street medicine fellowship ... Read moreThe post Street Medicine: Compassionate Care for the Unhoused appeared first on REBEL EM - Emergency Medicine

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Is the D-Dimer Useful in High-Probabilty Pulmonary...

REBEL EM – Emergency Medicine Blog ·

2025/03/31

Bottom Line Up Top: A negative D-Dimer likely excludes significant pulmonary embolism (PE) in all patients but the low chance of getting a negative result makes a D-Dimer first approach of low clinical utility in the high pre-test probability group. Clinical Scenario: A 45-year-old man with malignant melanoma presents with right-sided pleuritic chest pain for ... Read more The post Is the D-Dimer Useful in High-Probabilty Pulmonary Embolism? appeared first on REBEL EM - Emergency Medicine Blog.

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REBEL EM – Emergency Medicine Blog

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