PODCAST

REBEL EM – Emergency Medicine Blog

Salim R. Rezaie, MD

Rational Evidence-Based Evaluation of Literature

health & fitness medicine

All Episodes

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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Non-Invasive Blood Pressure Monitoring in Critically...

REBEL EM – Emergency Medicine Blog ·

2024/02/08

Background: Patients with shock frequently present with hypotension. Many of these patients are started on vasopressor and inopressor medications to assist in efforts to normalize blood pressure to help improve organ perfusion. In shocky patients, arterial lines are often used to monitor hemodynamic parameters and inform treatment decisions. However, there is limited data on the ... Read more The post Non-Invasive Blood Pressure Monitoring in Critically Ill Adults? appeared first on REBEL EM -

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The Needle Vs. The Knife for Spontaneous...

REBEL EM – Emergency Medicine Blog ·

2024/02/05

Background: The optimal management of primary, spontaneous pneumothorax (sPTX) remains an area of active debate. The British Thoracic Society recommends the least invasive approach possible. In contrast, the American College of Chest Physicians favors first-line chest tube drainage for any sPTX with an estimated volume of over 20%.(3) A Cochrane systematic review comparing simple aspiration ... Read more The post The Needle Vs. The Knife for Spontaneous Pneumothorax: A Closer Look at the EXPRED

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The AcT Trial: Tenecteplase vs Alteplase for Acute...

REBEL EM – Emergency Medicine Blog ·

2024/02/01

Background: Alteplase, a class of medication that converts plasminogen to plasmin leading to fibrin degradation and subsequent clot lysis, has been the standard of care for acute ischemic stroke (AIS) patients that meet eligibility criteria. Tenecteplase, a modified version of alteplase, is being increasingly utilized for AIS due to its favorable pharmacological profile, ease of ... Read more The post The AcT Trial: Tenecteplase vs Alteplase for Acute Ischemic Stroke appeared first on REBEL EM -

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Serial PoCUS for ED Patients with Acute Dyspnea: Is...

REBEL EM – Emergency Medicine Blog ·

2024/01/25

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. It can be used to distinguish between various conditions, including chronic obstructive pulmonary disease (COPD) exacerbation, acute heart failure (AHF), pleural effusion, pulmonary edema, pericardial effusion, pneumothorax, and pneumonia [2,3]. A 2018 systematic review and meta-analysis of 25 studies focusing ... Read more The post Serial PoCUS for ED Patients with Acute Dyspnea: Is More

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Rosh Review MyEMCert Question

REBEL EM – Emergency Medicine Blog ·

2024/01/22

A 46-year-old woman with a history of borderline high cholesterol levels presents with acute-onset chest pain 2 days ago with progressively worsening shortness of breath. Her only medication is an oral contraceptive pill that she has taken for over 20 years. Vital signs show HR of 121 bpm, BP of 124/80 mm Hg, RR of ... Read more The post Rosh Review MyEMCert Question appeared first on REBEL EM - Emergency Medicine Blog.

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Pre-Hospital Antibiotics in Sepsis?

REBEL EM – Emergency Medicine Blog ·

2024/01/18

Background: Sepsis remains one of the leading causes of morbidity and mortality. It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Time to antibiotic therapy (from triage, not from onset of infection) has become a quality metric to improve the time to administration of these medications. In an ... Read more The post Pre-Hospital Antibiotics in Sepsis? appeared first on REBEL EM - Emergency Medicine Blog.

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Clinical Conundrums: Should You Give the First Dose...

REBEL EM – Emergency Medicine Blog ·

2024/01/09

Bottom Line Up Top: In patients with infectious processes that are stable for discharge home, there is no role for giving a first dose of antibiotics IV in the ED. Clinical Scenario: A 45-year-old woman with hypertension presents with a productive cough and fever. Her vitals are: HR 115, BP 120/80, Temp 102.8, O2 Sat ... Read more The post Clinical Conundrums: Should You Give the First Dose of Antibiotics IV Before Discharging Home on Oral Antibiotics? appeared first on REBEL EM - Emergency Medicine

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Rosh Review EM Scholar Monthly Question

REBEL EM – Emergency Medicine Blog ·

2023/12/18

A 55-year-old woman with a history of end-stage kidney disease on peritoneal dialysis presents due to abdominal pain. She has had pain and redness at the site of her catheter exit site. Physical examination is notable for 3 cm of erythema around the catheter exit, located in the lateral left lower quadrant, along with tenderness ... Read more The post Rosh Review EM Scholar Monthly Question appeared first on REBEL EM - Emergency Medicine Blog.

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Don’t Believe the Headline: Ultrasound vs CXR in...

REBEL EM – Emergency Medicine Blog ·

2023/12/10

Background: The use of ultrasound is well established for trauma patients in the emergency department, with almost every patient receiving a FAST (Focused Assessment with Sonography in Trauma) examination as part of the “ABC’s” of trauma. Though the initial focus of the FAST exam was for detection of abdominal free fluid, the eFAST (Extended ... Read more The post Don’t Believe the Headline: Ultrasound vs CXR in Traumatic Pneumothorax Diagnosis appeared first on REBEL EM - Emergency

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Clinical Conundrums: How Long Should We Monitor After...

REBEL EM – Emergency Medicine Blog ·

2023/12/05

How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis? Bottom Line Up Top: After prompt recognition and appropriate treatment with IM epinephrine, the risk of biphasic reactions are exceedingly low. There is no set observation time to monitor patients as long as their symptoms have resolved. At the time of discharge, appropriate patient ... Read more The post Clinical Conundrums: How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis? appeared first on REBEL EM -

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Congestive Heart Failure and Sepsis: A Closer Look at...

REBEL EM – Emergency Medicine Blog ·

2023/11/30

Background: In medicine, guidelines are valuable tools that help guide care. However, they are not rigid rules that must be strictly followed. Clinicians often find themselves grappling with the challenge of balancing the demands of meeting Center for Medicaid & Medicare (CMS) requirements while also addressing the unique needs of each individual patient. For those ... Read more The post Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management appeared first on REBEL EM - Emergency

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REBEL EM – Emergency Medicine Blog

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