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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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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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REBEL Core Cast 125.0 – Hyperkalemia

REBEL EM – Emergency Medicine Blog ·

2024/06/26

Take Home Points Always obtain an EKG in patients with ESRD upon presentation Always obtain an EKG in patients with hyperkalemia as pseudohyperkalemia is the number one cause If the patient with hyperkalemia is unstable or has significant EKG changes (wide QRS, sine wave) rapidly administer calcium salts In patients who are anuric, early mobilization ... Read more The post REBEL Core Cast 125.0 – Hyperkalemia appeared first on REBEL EM - Emergency Medicine Blog.

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Sympathetic Crashing Acute Pulmonary Edema: High-Dose...

REBEL EM – Emergency Medicine Blog ·

2024/06/20

Background: Sympathetic Crashing Acute Pulmonary Edema (SCAPE) results from an increased systemic vascular resistance and activation of the Renin-Angiotensin-Aldosterone System (RAAS), which causes increased sodium/water reabsorption and worsening cardiac function. Additionally, sympathetic activation shifts fluid from splanchnic beds into the systemic circulation. The fluid build-up in the lungs causes hypoxia, dyspnea, and further sympathetic surge. ... Read more The post Sympathetic Crashing

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REBEL Core Cast 124.0 – Hyperinsulinemia Euglycemia...

REBEL EM – Emergency Medicine Blog ·

2024/06/12

Take Home Points Management of severe beta-blocker and calcium-channel blocker toxicity should occur in a stepwise fashion: potential gastric decontamination, multiple lines of access, judicious fluids, calcium, glucagon, and vasopressors as needed. Initiation of high dose insulin therapy requires a tremendous amount of logistical and cognitive resources as it requires cross-disciplinary collaboration and is prone ... Read moreThe post REBEL Core Cast 124.0 – Hyperinsulinemia Euglycemia

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Should We Be Switching to Whole Blood Instead of...

REBEL EM – Emergency Medicine Blog ·

2024/06/06

Background: Hemorrhage remains as one of the biggest causes of death in trauma patients. Strategies such as permissive hypotension, massive transfusion protocols, avoidance of crystalloids, TXA, and definitive hemorrhage control help decrease mortality in these patients. Empiric component blood transfusion (RBCs, plasma, & platelets) in a 1:1:1 ratio is considered the gold standard of resuscitation ... Read more The post Should We Be Switching to Whole Blood Instead of Component Therapy in

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The Modified Valsalva Maneuver: Practical Treatment...

REBEL EM – Emergency Medicine Blog ·

2024/05/27

Background: The REVERT Randomized Controlled Trial demonstrated the superiority of the modified valsalva maneuver (MVM) over the standard valsalva maneuver (VM) in re-establishing normal sinus rhythm (NSR) in patients with PSVT (Appelboam 2015). MVM exaggerates venous return to the heart and increases vagal outflow by elevating the patient’s legs. However, the success rate of the ... Read more The post The Modified Valsalva Maneuver: Practical Treatment or Pointless Trick? appeared first on

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ANNEXA-1: Andexanet Alfa Associated with Harm in DOAC...

REBEL EM – Emergency Medicine Blog ·

2024/05/23

Background: In May of 2018, Andexanet alfa gained accelerated approval by the FDA for the reversal direct oral anticoagulants (DOACs) despite a lack of robust evidence for use. The 2022 AHA/ASA guidelines give the drug a level 2A recommendation and recommend it over the use of 4F-PCC (Greenberg 2022). FDA approval alongside guideline endorsement has ... Read moreThe post ANNEXA-1: Andexanet Alfa Associated with Harm in DOAC Reversal appeared first on REBEL EM - Emergency Medicine Blog.

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Automated vs Manual Chest Compressions in...

REBEL EM – Emergency Medicine Blog ·

2024/05/20

Background Information: Out of hospital cardiac arrest (OHCA) is a medical emergency that requires immediate intervention to increase the chance of survival. The global survival rate of OHCA patients who received CPR has increased in the past 40 years [1]. However, CPR related rib and sternal injuries are observed more frequently in OHCA and are ... Read more The post Automated vs Manual Chest Compressions in Out-of-Hospital Cardiac Arrest appeared first on REBEL EM - Emergency Medicine Blog.

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Rosh Review My EMCert Monthly Question

REBEL EM – Emergency Medicine Blog ·

2024/05/20

A 67-year-old woman with a history of atrial fibrillation on apixaban presents to the ED for epistaxis that began 30 minutes ago. Her bleeding is difficult to control with direct nasal pressure and topical agents but resolves with silver nitrate cauterization. Her vital signs are within normal limits. How should this patient’s apixaban be managed? ... Read more The post Rosh Review My EMCert Monthly Question appeared first on REBEL EM - Emergency Medicine Blog.

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Sub-Dissociative IV vs Nebulized Ketamine to Treat Pain

REBEL EM – Emergency Medicine Blog ·

2024/05/16

Background: IV subdissociative ketamine at a dose of 0.1 to 0.3mg/kg is increasingly being used as an opioid sparing option for short-term acute pain relief. Alternatively, nebulized ketamine can be used for this indication and may have a benefit as it does not require IV access. In the KetaBAN trial, authors randomized 120 patients to ... Read more The post Sub-Dissociative IV vs Nebulized Ketamine to Treat Pain appeared first on REBEL EM - Emergency Medicine Blog.

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REBEL EM – Emergency Medicine Blog

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