PODCAST

REBEL EM – Emergency Medicine Blog

Salim R. Rezaie, MD

Rational Evidence-Based Evaluation of Literature

health & fitness medicine

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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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REBEL Reflections Episode 5: Thinking in Bets –...

REBEL EM – Emergency Medicine Blog ·

2024/03/13

How sure are you? Think back to the last time someone asked you a difficult question regarding a patient on shift. How sure were you about your decision? Was there a clear-cut right or wrong answer? And after making your decision, how sure were you that the answer you made was the correct one? ... Read moreThe post REBEL Reflections Episode 5: Thinking in Bets – Making Better Decisions When You Don’t Have All the Facts appeared first on REBEL EM - Emergency Medicine Blog.

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Clinical Conundrums: Should I Pretreat Patients with...

REBEL EM – Emergency Medicine Blog ·

2024/03/12

Bottom Line Up Top: Pretreatment is ineffective and unnecessary as it does not significantly reduce the risk of serious adverse reactions to contrast. Pretreatment should not delay imaging required for definitive diagnosis. Clinical Scenario: A 65 year-old woman presents with shortness of breath. Her vitals are notable for tachycardia and mild hypoxia, but she is ... Read more The post Clinical Conundrums: Should I Pretreat Patients with Contrast Allergy Prior to IV Contrast Administration

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Rosh Review MyEMCert Question

REBEL EM – Emergency Medicine Blog ·

2024/03/11

A 42-year-old man presents to the emergency department after a motor vehicle collision. He has no medical problems. He sustained a crush injury to his left leg and a prolonged extraction time. He is agitated and reporting significant pain. His left leg is mottled with significant ecchymoses and gross deformity below the left knee. Pulses ... Read moreThe post Rosh Review MyEMCert Question appeared first on REBEL EM - Emergency Medicine Blog.

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REBEL Core Cast 119.0 – Sleep Hygiene

REBEL EM – Emergency Medicine Blog ·

2024/03/06

REBEL Core Cast 119.0 – Sleep Hygiene Click here for Direct Download of the Podcast Employ sleep strategies: Anchor sleep: a period of sleep that overlaps each day regardless of your night shift schedule to provide a guidepost for your body clock. Ideally would overlap with when you would normally be asleep if you were ... Read moreThe post REBEL Core Cast 119.0 – Sleep Hygiene appeared first on REBEL EM - Emergency Medicine Blog.

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The PROPHY-VAP Trial: Ceftriaxone to Prevent VAP in...

REBEL EM – Emergency Medicine Blog ·

2024/02/29

Background: Ventilator-associated pneumonia (VAP), or what the CDC recently renamed infection-related ventilator-associated complication (IVAC), is defined as a nosocomial pneumonia occurring on day 3 of mechanical ventilation that was preceded by 2 days of stable or decreasing ventilator requirements.1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already ... Read moreThe post The PROPHY-VAP Trial: Ceftriaxone to Prevent VAP in

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Restrictive or Liberal Transfusion Strategy in...

REBEL EM – Emergency Medicine Blog ·

2024/02/22

Background: Concurrent anemia worsens outcomes in patients that present with acute myocardial infarctions. Transfusions increase the oxygen carrying capacity of blood which can improve the perfusion of at-risk cardiac tissue. However, transfusions are also associated with immunosuppression, thrombotic phenomena, volume overload, and inflammatory reactions. An optimal transfusion hemoglobin cutoff has not yet been established in ... Read moreThe post Restrictive or Liberal Transfusion Strategy in

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Another Study on Peripheral Vasopressors

REBEL EM – Emergency Medicine Blog ·

2024/02/19

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. Historically the administration of vasopressors was restricted to central venous catheters (CVC) due to concerns for local tissue injury resulting from vasoconstriction if extravasation occurred from a peripheral IV. The placement of CVCs, however, ... Read more The post Another Study on Peripheral Vasopressors appeared first on REBEL EM - Emergency

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The NICO Trial: NIV in Comatose Patients with Acute...

REBEL EM – Emergency Medicine Blog ·

2024/02/15

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. It is unclear, though, if the risks of intubation (including ventilator associated ... Read more The post The NICO Trial: NIV in Comatose Patients with Acute Poisoning appeared first on REBEL EM - Emergency

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Clinical Conundrums: Do We Need to Order a CT for...

REBEL EM – Emergency Medicine Blog ·

2024/02/12

Bottom Line Up Top: In selective patients presenting with flank pain, we can diagnose renal colic without a CT scan. There is also a subset of patients that would benefit from IV contrast enhanced CT scanning. Clinical Scenario: A 35-year-old man with no PMH presents with left flank pain, hematuria and history of kidney stones. ... Read more The post Clinical Conundrums: Do We Need to Order a CT for Every Patient with Renal Colic? appeared first on REBEL EM - Emergency Medicine Blog.

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REBEL EM – Emergency Medicine Blog

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