Take Home Points: Know clinical (cold extremities, oliguria, confusion, dizziness, narrow pulse pressure) and laboratory markers (metabolic acidosis, elevated creatinine, lactic acidosis) of hypoperfusion. An elevated lactate is a danger sign and requires explanation. Norepinephrine is a great first line vasopressor in Cardiogenic shock. Dobutamine is useful for inotropic support in Cardiogenic shock. Use POCUS ... Read more The post REBEL Core Cast 115.0 – Cardiogenic Shock appeared first on RE...
Dec 27, 2023•28 min
Take Home Points: Carbon monoxide is a colorless, odorless, and tasteless gas that results from incomplete combustion of any carbon containing product. Exposure often occur unintentionally from indoor use of gas powered generators, camp stoves, or faulty home heaters. The symptoms of mild, acute exposure are non-specific and can be confused with a variety of ... Read more The post REBEL Core Cast 114.0 – Carbon Monoxide Toxicity appeared first on REBEL EM - Emergency Medicine Blog ....
Dec 13, 2023•12 min
Take Home Points: All STEMIs should be loaded with dual antiplatelet therapy. Prasugrel (Effient) is avoided as there is an increase in bleeding complications if the patient requires a CABG. NSTEMI cases can be challenging to manage. Consult Cardiology early and use all available data. The appropriate medical treatment for ACS patients is as important ... Read more The post REBEL Core Cast 113.0 – ACS Therapies and Management appeared first on REBEL EM - Emergency Medicine Blog ....
Nov 29, 2023•24 min
Take Home Points: Dose your RSI meds correctly. Reach for post-intubation sedation at the same time you are asking for your induction agent and paralytic. Propofol is a great choice for post-intubation sedation, and if your patient becomes hypotensive do not be afraid of adding on a pressor! REBEL Core Cast 112.0 – Awareness During ... Read more The post REBEL Core Cast 112.0 – Awareness During Paralysis appeared first on REBEL EM - Emergency Medicine Blog ....
Nov 15, 2023•18 min
Take Home Points: A CCTA is an anatomic test to determine if a patient has normal coronary arteries, non-obstructive disease, or obstructive disease. The warranty period for a CCTA is anywhere from 3-10 years depending on the characteristics of the plaque. A nuclear stress test is a functional study that allows for ischemia-driven management. The ... Read more The post REBEL Core Cast 111.0 – Cardiac Testing appeared first on REBEL EM - Emergency Medicine Blog ....
Oct 25, 2023•24 min
Take Home Points: Patients with recent onset atrial fibrillation can safely be cardioverted if they are 1) on anticoagulation 2) Low risk based on CHADS-VASC with onset < 48 hours or 3) High risk based on CHADS-VASC with onset < 12 hours. In anaphylaxis, think, “If A, B or C, give E.” If the patient ... Read more The post REBEL Core Cast 110.0 – On Shift Learning Pearls appeared first on REBEL EM - Emergency Medicine Blog ....
Oct 11, 2023•12 min
Take Home Points: In the context of poisoning, a “wide QRS” is anything greater than 100 milliseconds. A newly “wide QRS”, especially with hemodynamic instability, should prompt consideration of sodium channel blockade and not ventricular tachycardia. Treatment is guided by administration of sodium-bicarbonate. Recall that the resultant alkalemia driven by sodium-bicarbonate will shift potassium intracellularly. ... Read more The post REBEL Core Cast 109.0 – Na Channel Blocker Poisoning appeared...
Sep 27, 2023•11 min
Take Home Points: Airway management is paramount; expect a challenging intubation and consider controlling the airway early if there is apparent airway compromise. Understanding the cause of angioedema (mast cell vs. bradykinin mediated) helps dictate directed management. Urticaria and pruritus = MAST CELL mediated, which is treated like a standard allergic reaction. REBEL Core Cast ... Read more The post REBEL Core Cast 108.0 – Angioedema appeared first on REBEL EM - Emergency Medicine Blog ....
Sep 13, 2023•10 min
Take Home Points Clinical presentation is very nonspecific; evaluate all patients presenting with back pain for infectious risk factors. Baseline labs should not guide diagnosis, but may assist in later management. MRI is key to diagnosis, obtain this imaging in all patients who raise clinical suspicion Patients with hemodynamic instability and neurologic compromise warrant empiric ... Read more The post REBEL Core Cast 107.0 – Vertebral Osteomyelitis appeared first on REBEL EM - Emergency Medic...
Aug 30, 2023•8 min
Take Home Points REBEL Core Cast 106.0 – Nerve Block Basics Click here for Direct Download of the Podcast Resources REBEL EM: Local Anesthetic Systemic Toxicity Sono in Staten Blog: https://www.statenislandem.com/sono-in-staten Core Ultrasound: https://www.coreultrasound.com/ POCUS Atlas: https://www.thepocusatlas.com/ Highland Ultrasound: http://highlandultrasound.com/ Post Created By: Billy Caputo MD Post Peer Reviewed By: Anand Swaminathan MD, MPH (Twitter ... Read more The post REBEL Core Ca...
Aug 16, 2023•26 min
Background: Getting a definitive airway in a critically ill trauma patient can be a stressful situation. The potential for soiled airways, cervical spine injuries, maxillofacial injuries and head injuries combined with agitation/delirium, altered mental status and hypoxemia can make securing a definitive airway both an anatomic and physiologic challenge. Traditional RSI entails preoxygenation followed by ... Read more The post REBEL Cast Ep122 – Delayed vs Rapid Sequence Intubation in Agitated T...
Aug 07, 2023•19 min
Background: The ongoing debate between video laryngoscopy (VL) and direct laryngoscopy (DL) has ignited intense debate within the emergency medicine and critical care communities. A recent pragmatic, randomized, multicenter trial (The DEVICE Trial) compared the two techniques to determine if VL outperformed DL in first-pass success (FPS). In this blog post, we explore the study’s ... Read more The post REBEL Cast Ep121: The Battle of the Blades – Video Laryngoscopy vs. Direct Laryngoscopy appear...
Jul 31, 2023•27 min
Take Home Points Methylxanthines are a drug class that includes caffeine, theophylline, and theobromine. The three main mechanisms that account for the clinical presentation of methylxanthine toxicity are: catecholamine release, adenosine antagonism, and phosphodiesterase inhibition. Beta agonism will lead to hyperlactatemia, hypokalemia, hyperglycemia, and tachycardia. Adenosine antagonism may lead to seizures and/or supraventricular tachycardia that ... Read more The post REBEL Core Cast 105.0...
Jul 26, 2023•10 min
Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases. It is possible that the induction agent used could play an important ... Read more The post REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? appeared first on REBEL EM - Emergency ...
Jul 17, 2023•18 min
Take Home Points Provider assessment of how the patient looks is extremely important. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately. POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations. Isolated elevation in aVR ... Read more The post REBEL Core Cast 104.0 – Subtle ECGs in Acute Coronary Occlusion appeared first on REBEL EM - Emergency Medicine Blog ....
Jul 05, 2023•34 min
Back on June 1st, 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC?. This stemmed a lot of discussion in the background between Swami, myself, and Scott. We felt it was worthwhile to record this as a podcast to better flush out some nuanced points. ... Read more The post REBEL Cast Ep119: A Discussion with Scott Weingart on the CT FIRST Trial appeared first on REBEL EM - Emergency Medicine Blog ....
Jun 29, 2023•33 min
Background: Hemorrhage is the leading cause of mortality in trauma patients. Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Some clinicians have advocated for early administration of 4-factor ... Read more The post REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC fo...
Jun 26, 2023•17 min
Take Home Points Caustics are substances that injure tissue upon physical contact. Caustic potential is not purely a function of pH. The decision to admit is dependent on the history and physical. Vomiting, drooling, and stridor are concerning. Stridor alone or 2/3 symptoms should warrant admission and gastroenterology consultation for potential endoscopy. The lack of ... Read more The post REBEL Core Cast 103.0 – Caustic Ingestions appeared first on REBEL EM - Emergency Medicine Blog ....
Jun 07, 2023•12 min
Background Information: Opioid overdose deaths have been increasing in the past twenty years. The national number of overdose deaths from any opioid has increased 62.5% from 2019 to 2021 (from 48,000 to 81,400 annual deaths), which includes prescription opioids (natural and semi-synthetic opioids and methadone), heroin, and synthetic opioids other than methadone including fentanyl (1). Opioid ... Read more The post REBEL Cast Ep117: Low Dose vs Standard Dose Take-Home Buprenorphine From the ED a...
Jun 05, 2023•22 min
Take Home Points The Parkland formula can be used to be a guide for initial fluid resuscitation. This is based on second- and third-degree burns (not first-degree). Utilize response to treatment as a guide to continue fluid resuscitation. Patients in fires in closed spaces for a prolonged time are at risk for airway edema and ... Read more The post REBEL Core Cast 102.0 – Burn Management appeared first on REBEL EM - Emergency Medicine Blog ....
May 24, 2023•27 min
