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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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Levitan/Rezaie Practical Airway Course

REBEL EM – Emergency Medicine Blog ·

2024/11/19

View Course Dates This 2-day course provides an in-depth look at effective surgical airway management techniques that you will actually use in your next emergency airway. There is a unique focus on airway anatomy and imaging combined with one-of-a-kind opportunity to practice the techniques on a large variety of non-embalmed, specially prepared cadavers. This is ... Read more The post Levitan/Rezaie Practical Airway Course appeared first on REBEL EM - Emergency Medicine Blog.

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REBEL Core Cast 131.0 – Traumatic Arthrotomy

REBEL EM – Emergency Medicine Blog ·

2024/11/13

Take Home points: Always suspect an open joint if there is a laceration, regardless of size, the lies over joint CT scan of the affected joint is widely considered to be the standard approach to evaluation but the saline load test may be useful in certain circumstances. Obtain emergency orthopedics consultation for all open joints ... Read more The post REBEL Core Cast 131.0 – Traumatic Arthrotomy appeared first on REBEL EM - Emergency Medicine Blog.

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Is Pip-Tazo Harming Sepsis Patients?

REBEL EM – Emergency Medicine Blog ·

2024/11/11

Background: Patients with sepsis are routinely treated with empiric broad-spectrum antibiotics while awaiting source identification, as recommended by the surviving sepsis campaign.2 Vancomycin, in combination with either piperacillin-tazobactam or cefepime, is commonly used for empiric treatment in these cases. Literature comparing the two regimens has largely focused on the adverse effects of each medication, rather ... Read more The post Is Pip-Tazo Harming Sepsis Patients? appeared first on

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Elbow Dislocations

REBEL EM – Emergency Medicine Blog ·

2024/11/06

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow (Cohen 1998) Posterolateral is the most common type of dislocation (80%) Demographics Most commonly affects ... Read more The post Elbow Dislocations appeared first on REBEL EM - Emergency Medicine

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REBEL Core Cast 129.0 – Gastric Lavage

REBEL EM – Emergency Medicine Blog ·

2024/10/16

Take Home Points Orogastric lavage may still play an important role in treatment of the overdose patient. Do not perform lavage if the ingestion has limited toxicity at any dose or the ingested dose is unlikely to cause significant toxicity. Strongly consider orogastric lavage in a patient who has taken an overdose of drugs that ... Read moreThe post REBEL Core Cast 129.0 – Gastric Lavage appeared first on REBEL EM - Emergency Medicine Blog.

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Clinical Conundrums: Should Ketamine be Preferred...

REBEL EM – Emergency Medicine Blog ·

2024/09/23

Bottom Line Up Top: Based on the available evidence, we should strongly consider ketamine over etomidate as our default induction agent in critically ill patients. Clinical Scenario: A 48 year old man presents with fever, hypotension, hypoperfusion and hypoxemia. Workup reveals multifocal pneumonia and oxygenation only marginally improves with non-invasive ventilation. You decide to intubate ... Read more The post Clinical Conundrums: Should Ketamine be Preferred Over Etomidate in RSI? appeared

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Rosh Review My EMCert Monthly Question

REBEL EM – Emergency Medicine Blog ·

2024/09/09

A newborn boy presents to the emergency department shortly after a home delivery. The mother had routine prenatal care and reports that he was due in 2 days. The patient appears term and vigorous but is in respiratory distress and gasping for air. His heart rate is 80 bpm. What percent of oxygen should you ... Read more The post Rosh Review My EMCert Monthly Question appeared first on REBEL EM - Emergency Medicine Blog.

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The Ducanto Catheter—It Sucks!

REBEL EM – Emergency Medicine Blog ·

2024/09/02

Background: Emergency intubations present a unique set of challenges, particularly when dealing with heavily contaminated airways. Anesthesiologist, Dr. James DuCanto, developed the DuCanto catheter to enhance airway management in these high-stakes situations. The commonly used 14 Fr Yankauer catheter, with its smaller bore, may struggle to clear heavily contaminated airways effectively. In contrast, the 28 ... Read moreThe post The Ducanto Catheter—It Sucks! appeared first on REBEL EM - Emergency

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Nirmatrelvir for Vaccinated or Unvaccinated Adult...

REBEL EM – Emergency Medicine Blog ·

2024/08/28

Background: The clinical burden of severe COVID-19 triggered a pharmaceutical race to find effective, easily accessible, oral treatments that could decrease the morbidity and mortality associated with the disease. Nirmatrelvir is an oral antiviral agent that inhibits the SARS-CoV2 main protease involved in viral replication. It is administered with ritonavir, which inhibits the cytochrome P450-3A4 ... Read moreThe post Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with COVID-19

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Remote Consult Protocols for Retinal Artery...

REBEL EM – Emergency Medicine Blog ·

2024/08/22

Background: Retinal artery occlusion (RAO) is a time-sensitive ophthalmic emergency that demands rapid diagnosis and intervention. Administration of intravenous tissue plasminogen activator (IVtPA) within 4.5 hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses.1,2 Intra-arterial (IA) tPA has also shown benefit but is less ... Read moreThe post Remote Consult Protocols for Retinal Artery Occlusion: A

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The PROTECTION Trial – A Randomized Trial of...

REBEL EM – Emergency Medicine Blog ·

2024/08/12

Background Information: Acute kidney injury (AKI) is one of the most frequent complications of cardiac surgery and the cause is complex. Renal hypoperfusion from decreased glomerular filtration rate after cardiopulmonary bypass is a major contributor.1 This in combination with exogenous toxins, endogenous metabolites, oxidative stress, bleeding and reperfusion injury can all lead to the patient ... Read more The post The PROTECTION Trial – A Randomized Trial of Intravenous Amino Acids for

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The REBEL Lit Distillery at ResusX

REBEL EM – Emergency Medicine Blog ·

2024/07/24

Do you know the latest evidence in critical care/resuscitation? If this question makes you uncomfortable or you just don’t have time to keep up with the literature, you should sign up for the REBEL Lit Distillery at the ResusX Conference in Philly. Let us help you keep up to date. -Workshop: Sept 17th, 2024 -Location: ... Read moreThe post The REBEL Lit Distillery at ResusX appeared first on REBEL EM - Emergency Medicine Blog.

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A Winning Hand in Cardiology: Queen of Hearts AI...

REBEL EM – Emergency Medicine Blog ·

2024/07/22

Background: Cath lab activation based on ST-elevation myocardial infarction (STEMI) criteria is founded on aging data and requires evolution. In the “Occlusive Myocardial Infarction (OMI) Manifesto,” emergency physicians Dr. Steve Smith, Dr. Pendell Meyers, and Dr. Scott Weingart introduced a new paradigm —OMI vs. non-occlusive myocardial infarction (NOMI). The OMI/NOMI paradigm focuses on the presence ... Read more The post A Winning Hand in Cardiology: Queen of Hearts AI Model Enhances OMI

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Navigating Nerve Blocks: US-Guided Nerve Blocks Vs....

REBEL EM – Emergency Medicine Blog ·

2024/07/15

Background: Ultrasound-guided nerve blocks have become appealing for pain management in the emergency department (ED). The adoption and expansion of ultrasound, coupled with the precise delivery route and low complication rates, facilitated the transition of nerve blocks from the operating room to the ED. However, some blocks, like the brachial plexus blocks, can cause significant complications, ... Read moreThe post Navigating Nerve Blocks: US-Guided Nerve Blocks Vs. Sub-Dissociative Ketamine

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Clinical Conundrums: Is an Arterial Lactate Necessary?

REBEL EM – Emergency Medicine Blog ·

2024/07/11

Bottom Line Up Top: A peripheral venous blood lactate can reliably be used instead of an arterial blood lactate as a marker of systemic tissue hypoperfusion and to measure response to treatment. Clinical Scenario: A 63 year old woman with diabetes, hypertension and rheumatoid arthritis presents with fever, back pain and dysuria. Vitals are HR ... Read moreThe post Clinical Conundrums: Is an Arterial Lactate Necessary? appeared first on REBEL EM - Emergency Medicine Blog.

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REBEL Core Cast 126.0 – Peds Hem Onc Emergencies

REBEL EM – Emergency Medicine Blog ·

2024/07/10

Take Home Points Early administration of antibiotics (within 60 min) in patients with fever and neutropenia is life saving. Fever in sickle cell is an emergency and always requires cultures and antibiotics even if the child appears well. Avoid sedation and lying supine and steroids in patients with mediastinal masses. Red flags in patients with ... Read more The post REBEL Core Cast 126.0 – Peds Hem Onc Emergencies appeared first on REBEL EM - Emergency Medicine Blog.

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Rosh Review My EMCert Monthly Question

REBEL EM – Emergency Medicine Blog ·

2024/07/08

A 45-year-old man presents to the ED with shortness of breath that began 4 hours ago. He reports 2 days of cough, fever, and pleuritic chest pain. He is speaking in 3–4 word phrases, breathing at 33 breaths/minute, and appears in mild to moderate respiratory distress. He has right middle lobe crackles on auscultation. An ... Read more The post Rosh Review My EMCert Monthly Question appeared first on REBEL EM - Emergency Medicine Blog.

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BPAP vs AVAPS for Hypercapnic Respiratory Failure in...

REBEL EM – Emergency Medicine Blog ·

2024/07/01

Background: Non-invasive positive pressure ventilation (NIPPV) is an effective treatment modality for patients with both hypoxemic or hypercapnic respiratory failure and has been shown to decrease the need for intubation [2]. Continuous positive airway pressure (CPAP) provides a constant positive pressure support throughout the breathing cycle, while bilevel positive airway pressure (BPAP) provides different levels ... Read moreThe post BPAP vs AVAPS for Hypercapnic Respiratory Failure in the ED

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The PREOXI Trial: Pre-Oxygenation with NIV vs Facemask

REBEL EM – Emergency Medicine Blog ·

2024/06/28

Background: Tracheal intubation is frequently performed in critically ill patients. Hypoxemia is one of the major adverse events that can occur during intubation and it increases the risk of morbidity and mortality. Preoxygenation before induction of anesthesia increases the amount of oxygen in the lungs and decreases the risk of hypoxemia by prolonging the safe ... Read moreThe post The PREOXI Trial: Pre-Oxygenation with NIV vs Facemask appeared first on REBEL EM - Emergency Medicine Blog.

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Should End-Tidal Capnometry (ETC) During ED...

REBEL EM – Emergency Medicine Blog ·

2024/06/27

Background: Procedural sedation and analgesia (PSA) is a frequently employed in the emergency department (ED) to facilitate painful procedures. Some of the potential untoward effects of PSA include cardio-respiratory depression and/or airway compromise. Standard practice in many parts of the world includes non-invasive pulse oximetry as well as end-tidal capnometry (ETC) for patient monitoring. ETC ... Read more The post Should End-Tidal Capnometry (ETC) During ED Procedural Sedation/Analgesia

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