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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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The RSI Trial: Ketamine vs Etomidate in Rapid...

REBEL EM – Emergency Medicine Blog ·

2026/01/08

Etomidate or ketamine? The debate over the ideal agent for emergency rapid sequence intubation (RSI) has raged for years with no clear winner. Etomidate has been touted in the past for its rapid onset and minimal intrinsic effects on hemodynamics. However, the drug is well known as a transient adrenal suppressant though the impact of this suppression isn’t clear. Ketamine has risen in recent years as an alternative, due to its perceived hemodynamic stability, analgesic properties and absence of

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POCUS Use in Shock Resuscitation: Evidence for...

REBEL EM – Emergency Medicine Blog ·

2026/01/05

Shock is a life threatening condition that requires rapid resuscitation, and targeted treatment. Due to its complex nature, shock management poses many challenges for physicians in the acute care setting, more specifically, in the emergency department (ED). Point-of-care-ultrasound (POCUS) has emerged as a promising diagnostic and therapeutic clinical tool in this context, allowing ED physicians to assess hemodynamics and guide treatment interventions in real-time at the bedside.The post POCUS Use

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Rib Fracture Risk: Using RibScore + SCARF to Predict...

REBEL EM – Emergency Medicine Blog ·

2025/12/29

Rib fractures are among the most common injuries in older trauma patients and can look deceptively “benign” early—until pain-limited ventilation, atelectasis, pneumonia, and respiratory failure develop hours to days later. Disposition decisions based on fracture count alone often miss the interaction between anatomic injury burden and physiologic reserve, especially in frail patients with limited pulmonary “margin.” RibScore offers an anatomy/CT-based estimate of pulmonary complication risk, while

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Clinical Conundrum: How Effective is Oseltamivir in...

REBEL EM – Emergency Medicine Blog ·

2025/12/24

Annual influenza cases exceed one billion worldwide, with the vast majority of patients experiencing mild to moderate severity of illness. This massive health burden explains the extensive research into antivirals, including oseltamivir (Tamiflu). Initial studies supported the utility of oseltamivir for preventing complications, hospitalization and shortening disease course in patients with mild to moderate influenza. However, subsequent analysis determined that Roche (the manufacturer of

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Is Abelacimab the Next Step in AF Anticoagulation?...

REBEL EM – Emergency Medicine Blog ·

2025/12/15

Antithrombotic therapy is a cornerstone in the treatment of atrial fibrillation (AFib), though it carries a significant risk of bleeding. While Vitamin K antagonists (VKAs), the oldest anticoagulants, were largely supplanted by direct oral anticoagulants (DOACs) following trials like ARISTOTLE and ROCKET AF, the risk of bleeding with these newer agents still exists.Enter Abelacimab, a novel drug designed to provide thrombosis protection while minimizing the impact on hemostasis. Abelacimab is a

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Clinical Conundrum: Pregnant and Puking: What’s Safe...

REBEL EM – Emergency Medicine Blog ·

2025/12/10

Nausea with or without vomiting is very common in early pregnancy, affecting approximately 70% of pregnancies (Maisal 2012). Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy that can lead to significant maternal dehydration, electrolyte abnormalities, and weight loss if not properly managed. Pharmacologic treatment is crucial to break the cycle of vomiting, restore oral intake, and prevent complications such as Wernicke’s encephalopathy or hospitalization. Timely and

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19:06

REBEL Core Cast 146.0–Ventilators Part 4: Setting up...

REBEL EM – Emergency Medicine Blog ·

2025/12/08

Ventilator management can feel overwhelming—there are so many knobs to turn, numbers to watch, and changes to make. But before adjusting any settings, it’s crucial to understand why the patient is in distress in the first place, because the right strategy depends on the underlying cause. In this episode, we’ll walk through three different cases to see how the approach changes depending on the problem at hand.The post REBEL Core Cast 146.0–Ventilators Part 4: Setting up the Ventilator appeared first

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The Dilt Drop: Can Calcium Break the Fall?

REBEL EM – Emergency Medicine Blog ·

2025/12/01

Atrial fibrillation with rapid ventricular response (AF with RVR) is one of the most common dysrhythmias encountered in the emergency department and often requires prompt rate control. Diltiazem remains a go-to agent due to its rapid onset, AV nodal selectivity, and reliable heart rate reduction. However, hypotension occurs in up to 13% of patients, occasionally symptomatic in 4% of patients, and particularly concerning in those with limited reserve (Ellenbogen 1995). The post The Dilt Drop: Can

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Winter is Coming: Are You Using the Right Pneumonia...

REBEL EM – Emergency Medicine Blog ·

2025/11/24

Pneumonia season doesn’t just fill your waiting room – it fills your brain with decisions: Admit or discharge? Floor or ICU? CURB-65, PSI/PORT, and SMART-COP all promise to help, but they’re not built to answer the same question. This quick comparison walks you through how each score thinks, where each one shines, and when a “low-risk” patient might actually be one bad hour away from crashing.Don’t just diagnose pneumonia — predict who might acutely decompensate. The post Winter is Coming: Are You

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Midazolam vs Ketamine as Second Line in Status...

REBEL EM – Emergency Medicine Blog ·

2025/11/10

Status epilepticus is traditionally defined as a seizure lasting ≥5 minutes or recurrent seizures without return to baseline in between. It is a neurologic emergency associated with increased morbidity and mortality the longer it persists. Some complications include cardiac arrhythmias, respiratory failure, aspiration pneumonia, and recurrent status epilepticus. The established treatment paradigm includes first line treatment with benzodiazepines (midazolam IM, lorazepam IV, diazepam IV). Second

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REBEL Core Cast 144.0: Tourniquet Tips

REBEL EM – Emergency Medicine Blog ·

2025/11/03

In this episode of the Rebel Core Content podcast, Swami provides crucial tips on using tourniquets. Highlighting the significance of these life and limb-saving devices, the discussion focuses on the optimal placement of tourniquets, emphasizing placing them 2-3 inches (5-6 cm) above the bleeding source and avoiding joints. Swami also advises on the correct way to tighten the tourniquet using the Velcro strap first, followed by minimal use of the windless. The importance of noting the application

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MDCalc Wars – The Rise of BISAP: Is Ranson Retiring?

REBEL EM – Emergency Medicine Blog ·

2025/10/27

Predicting severity in acute pancreatitis matters — it guides where patients go, how closely we watch them, and how aggressively we manage fluids and complications. Two of the most commonly used tools are Ranson’s Criteria and the BISAP Score.Ranson’s offers a comprehensive, data-rich assessment once labs and time points are available, while BISAP gives a fast, bedside estimate of mortality risk that’s perfect for the early phase of care. The post MDCalc Wars – The Rise of BISAP: Is Ranson

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17:53

REBEL CAST – IncrEMentuM26 Speaker Spotlight : George...

REBEL EM – Emergency Medicine Blog ·

2025/10/23

🧭 REBEL Rundown 📝Introduction In this exciting episode of REBEL Cast, host Dr. Mark Ramzy joins forces with renowned educator and speaker, Dr. George Willis. Broadcasting straight from the ACEP 25 in Salt Lake City, the duo talk about bringing together the international emergency medicine community, as they reflect on their experiences at the Increment ... Read moreThe post REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy appeared first on REBEL EM -

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The TRAUMOX2 Trial: Early Restrictive vs Liberal...

REBEL EM – Emergency Medicine Blog ·

2025/10/20

The TRAUMOX2 trial was an open-label pragmatic, international randomized controlled trial designed to evaluate whether a restrictive oxygen strategy targeting lower oxygen saturation reduces death and/or major respiratory complications compared with a liberal oxygen strategy in adult trauma patients. The post The TRAUMOX2 Trial: Early Restrictive vs Liberal Oxygen Strategies in Adult Trauma Patients appeared first on REBEL EM - Emergency Medicine Blog.

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Treatment for Alcohol Use Disorder

REBEL EM – Emergency Medicine Blog ·

2025/10/16

Emergency medicine physicians were trailblazers during the opioid epidemic, and now we have the same opportunity with alcohol use disorder (AUD). Treating AUD deserves the same attention we give to opioid overdose, diabetic ketoacidosis, or hypertensive emergencies. Even when alcohol use doesn’t present as an immediate crisis, each ED encounter is a chance to intervene—one that could help prevent future withdrawal, traumatic injury, or upper gastrointestinal bleed. Naltrexone and other Medications

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Screening for Alcohol Use Disorder

REBEL EM – Emergency Medicine Blog ·

2025/10/13

Each year, about 1 in 7 men and 1 in 11 women in the United States meet criteria for alcohol use disorder (AUD)—affecting nearly 29 million people, roughly the entire population of Texas. Patients with AUD face staggering health risks: they are 3.5 times more likely to die than the general population, and their life expectancy is up to 25 years shorter. Over the past decade, alcohol-related emergency department (ED) visits have climbed by nearly 50%. Between 2021 and 2023 alone, alcohol accounted

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15:29

REBEL Core Cast – DKA: Beyond the Basics Part 2 –...

REBEL EM – Emergency Medicine Blog ·

2025/10/09

Mechanical ventilation can feel overwhelming, especially when faced with a sea of ventilator modes and unfamiliar terminology. In Part 2 of the series, we go beyond breath types and delivery mechanics to explore the most used modes in the ICU. We will break down each one; explaining how it works, when to use it, and why the goal isn’t the “best mode” but the most comfortable one for the patient.The post REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial appeared first on

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12:56

REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation...

REBEL EM – Emergency Medicine Blog ·

2025/10/02

When you take the airway, you take the wheel and you now control the patient’s oxygenation and ventilation. In this REBEL Crit episode, Dr. Lodeserto and Dr. Acker walk through the physiology, ventilator strategies, and clinical curveballs that separate calm control from chaos at the bedside.The post REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator appeared first on REBEL EM - Emergency Medicine Blog.

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MDCalc Wars – Tiny Patient, Big Decision: Head CT or...

REBEL EM – Emergency Medicine Blog ·

2025/09/29

PECARN has been THE decision rule for guidance on management of kids with head injuries, but the Infant Scalp Score dives even deeper—built just for babies with scalp hematomas. Which rule is best in this situation? The post MDCalc Wars – Tiny Patient, Big Decision: Head CT or no Head CT? appeared first on REBEL EM - Emergency Medicine Blog.

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Clinical Conundrum: What is the Utility of...

REBEL EM – Emergency Medicine Blog ·

2025/09/25

Procalcitonin is a protein that is upregulated during inflammatory states. An elevation in procalcitonin should be specific to bacterial infections. Viral infections should result in decreased procalcitonin levels thus allowing us to differentiate bacterial from viral and help guide antibiotic prescription. However, this differentiation isn’t what we see in real life data.The post Clinical Conundrum: What is the Utility of Procalcitonin in the ED? appeared first on REBEL EM - Emergency Medicine

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REBEL EM – Emergency Medicine Blog

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