PODCAST

REBEL EM – Emergency Medicine Blog

Salim R. Rezaie, MD

Rational Evidence-Based Evaluation of Literature

health & fitness medicine

All Episodes

7:56

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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14:41

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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DanGer Shock Trial: Microaxial Flow Pump or Standard...

REBEL EM – Emergency Medicine Blog ·

2024/05/02

Background: STEMI can be complicated by cardiogenic shock and this complication is associated with a high morbidity and mortality rate. Decreased cardiac output results in inadequate perfusion and subsequent end-organ damage. Mechanical circulatory support can improve perfusion and, in theory, result in better outcomes. The ECLS-Shock trial did not demonstrate improved mortality with ECMO compared ... Read moreThe post DanGer Shock Trial: Microaxial Flow Pump or Standard Care in Infarct-Related

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Don’t Forget About the IO in the Critically Ill Patient

REBEL EM – Emergency Medicine Blog ·

2024/04/29

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line. If you are not familiar with this ... Read more The post Don’t Forget About the IO in the Critically Ill Patient appeared first on REBEL EM - Emergency Medicine

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The ACORN Trial: Battle of the Gorilla-Cillins...

REBEL EM – Emergency Medicine Blog ·

2024/04/25

Background: Acutely ill adults presenting to the hospital with suspected infection commonly receive empiric, broad-spectrum antibiotics as part of their initial management including coverage of both MRSA and pseudomonas species. MRSA coverage includes the use of vancomycin while anti-pseudomonal coverage is often with cefepime or piperacillin-tazobactam. Both cefepime and piperacillin-tazobactam have similar gram-negative bacterial coverage ... Read more The post The ACORN Trial: Battle of the

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Clinical Conundrums: Should I Provide Patients with...

REBEL EM – Emergency Medicine Blog ·

2024/04/24

Bottom Line Up Top: Steroids provide modest improvement in time to resolution and degree of resolution of symptoms in pharyngitis. They should be considered in patients presenting to the ED after weighing potential benefits and risks. Clinical Scenario: A 22-year-old man with a history of poorly controlled diabetes presents with 3 days of sore throat. ... Read more The post Clinical Conundrums: Should I Provide Patients with Pharyngitis a Dose of Corticosteroids appeared first on REBEL EM -

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How Much O2 Is Right in COVID?

REBEL EM – Emergency Medicine Blog ·

2024/04/22

Background: Hypoxemic respiratory failure is a frequent complicating feature of severe COVID-19 infection. Early in the pandemic, extensive efforts were made to identify the best approach to oxygenation in this group of patients. Best practices settled on aggressive use of non-invasive ventilation (NIV) and delaying invasive mechanical ventilation (IMV) where feasible. Advanced interventions include proning ... Read more The post How Much O2 Is Right in COVID? appeared first on REBEL EM - Emergency

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From Debate to Data: Emerging Insights into RSI...

REBEL EM – Emergency Medicine Blog ·

2024/04/18

Introduction: Resuscitationists continue to debate the choice of induction agents in rapid sequence intubation (RSI). Critics of etomidate highlight its link to adrenal suppression in critically ill patients (Albert 2011), while critics of ketamine highlight the higher incidence of post-intubation hypotension (Mohr 2020). Amidst the debate, the Ketased Trial (Jabre 2009), a large multicenter prospective, ... Read moreThe post From Debate to Data: Emerging Insights into RSI Induction with Ketamine

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Intubation in Surgical Patients: VL vs DL

REBEL EM – Emergency Medicine Blog ·

2024/04/15

Background: Although most intubations are typically successful there is still a portion of patients that may require multiple intubation attempts. Repeated intubation attempts could lead to respiratory and hemodynamic complications. We recently covered the DEVICE trial on REBEL EM which compared a standard geometry video laryngoscopy approach vs a standard geometry direct laryngoscopy approach in ... Read moreThe post Intubation in Surgical Patients: VL vs DL appeared first on REBEL EM - Emergency

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Hematologic Emergencies in the Critical Care Setting...

REBEL EM – Emergency Medicine Blog ·

2024/04/11

Background: Hematologic emergencies in the critical care setting are rare but deadly complications that can often be managed appropriately if identified early on and received prompt intervention. In this 2-part review, we will discuss several hematologic emergencies and discuss the literature on current guidelines and principles of management. Shoon Oo MD1 , Vinh Dao MD1, ... Read moreThe post Hematologic Emergencies in the Critical Care Setting Part 2 appeared first on REBEL EM - Emergency

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Hematologic Emergencies in the Critical Care Setting...

REBEL EM – Emergency Medicine Blog ·

2024/04/08

Background: Hematologic emergencies in the critical care setting are rare but deadly complications that can often be managed appropriately if identified early on and received prompt intervention. In this 2 part review, we will discuss several hematologic emergencies and discuss the literature on current guidelines and principles of management. Vinh Dao MD1, Shoon Oo MD1, ... Read more The post Hematologic Emergencies in the Critical Care Setting Part 1 appeared first on REBEL EM - Emergency Medicine

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REBEL Core Cast 120.0 – Salicylate Toxicity

REBEL EM – Emergency Medicine Blog ·

2024/03/20

Take Home Points Salicylates are a commonly used and widely prescribed xenobiotic due to their analgesic, anti-inflammatory, and anti-pyretic properties. Common preparations include aspirin, methyl-salicylate (Oil of Wintergreen), and bismuth-subsalicylate (Pepto-Bismol). Salicylate toxicity should be considered in the patient with tachypnea, clear lungs, and some degree of acid-base disturbance. Mainstays of management include: GI decontamination, ... Read moreThe post REBEL Core Cast 120.0

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Let’s Get Salty: Hypertonic 3% Saline Through...

REBEL EM – Emergency Medicine Blog ·

2024/03/14

Background: Elevated intracranial pressure in patients with acute brain injury is a neurologic emergency requiring early recognition and early aggressive treatment to prevent progression to cerebral ischemia, brain herniation, and ultimately death. There are two primary options for treatment in terms of hyperosmolar agents: mannitol and hypertonic saline (HTS). Both agents have pros and cons, ... Read moreThe post Let’s Get Salty: Hypertonic 3% Saline Through Peripheral IVs in Adult Patients with

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