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R.E.B.E.L. EM | Emergency Medicine Blog - Health
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Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain - REBEL EM - Emergency Medicine Blog
Discover how the Incrementum Conference is transforming emergency medicine in Spain. Join Rebel Cast with Dr. Francisco 'Paco' Campillo Palma and Dr. Carmen Maria Cano to explore the specialty's recognition, top sessions, and why you should attend in April 2026.
TXA for Hemoptysis: We Put That $#!t on Everything (That Bleeds) - REBEL EM - Emergency Medicine Blog
Discover results from the first RCT comparing nebulized vs IV tranexamic acid (TXA) for hemoptysis in the emergency department. Nebulized TXA showed faster bleeding control and fewer interventions. Learn more.
MDCalc Wars: Sorting Out Syncope - Which Rule Should You Trust? - REBEL EM - Emergency Medicine Blog
Compare the San Francisco Syncope Rule (SFSR) and Canadian Syncope Risk Score (CSRS) for ED syncope management. Learn which decision rule is more reliable, their strengths, pitfalls, and how to apply them in practice.
REBEL Core Cast 139.0: Pneumothorax Decompression - REBEL EM - Emergency Medicine Blog
Learn practical, evidence-based strategies for pneumothorax decompression in the ED. This REBEL Core Cast episode covers ultrasound confirmation, limitations of needle decompression, and why finger thoracostomy is the preferred approach for tension pneumothorax.
ICARUS ED Trial: Concentrated Albumin for Undifferentiated Sepsis in the Emergency Department - REBEL EM - Emergency Medicine Blog
The ICARUS-ED trial tested 20% albumin for septic emergency department patients. Results show small physiologic changes, but no meaningful benefit over crystalloids—despite the high cost.
REBEL Core Cast 138.0: A Simple Bedside Approach to Shock - REBEL EM - Emergency Medicine Blog
Learn a simple, systematic bedside approach to diagnosing shock using the 4 L’s and pulse pressure. REBEL Core Cast 138.0 breaks down shock types, clinical signs, and rapid decision-making for critically ill patients
REBEL Core Cast 137.0: A Simple Approach to Sinus Tachycardia - REBEL EM - Emergency Medicine Blog
Learn a systematic approach to evaluating sinus tachycardia—the most common cardiac dysrhythmia in critically ill patients. Explore 8 key causes and why identifying the underlying issue matters more than treating the heart rate alone.
Combination Inhalers in Asthma: Time to Switch? - REBEL EM - Emergency Medicine Blog
A SABA/ICS combo inhaler reduces asthma exacerbations when compared to a SABA inhaler alone. Comparison against an inferior treatment modality reduces the utility of this data makes demonstration of superiority significantly easier
REBEL Core Cast 134.0 - Acetaminophen Toxicity - REBEL EM - Emergency Medicine Blog
Acetaminophen (APAP) overdose remains one of the most common causes of acute liver failure in the United States. While its therapeutic use is widespread and generally safe, unintentional overdoses and delayed presentations can lead to devastating outcomes. In this episode of REBEL Cast, we break down the pathophysiology, clinical course, diagnostic approach, and evidence-based management ... Read more
TNK vs tPA — The ORIGINAL Trial - REBEL EM - Emergency Medicine Blog
The American Heart Association and the European Stroke Organization have updated their guidelines to recommend TNK as an alternative to tPA in patients eligible for thrombolysis. TNK, a bioengineered variant of tPA, has some advantages, including its single-dose administration, fibrin specificity, and longer half-life. Several studies have demonstrated the safety and efficacy of TNK as an alternative to tPA
How Accurate are Blood Gas Electrolyte Measurements? - REBEL EM - Emergency Medicine Blog
Bottom Line Up Top: Blood gas electrolytes closely correlate with serum measurements and can be used under most circumstances to guide clinical care. Clinical Scenario: A 62 year old woman with a history of HTN, ESRD on MWF dialysis presents to the Emergency Department with generalized weakness. Her vital signs are HR = 82, BP ... Read more
Size Matters: The Impact of Cuff Size on Blood Pressure - REBEL EM - Emergency Medicine Blog
Background: Accurate blood pressure (BP) measurement is essential in the emergency department (ED), where it serves as a key marker of hemodynamic stability and informs critical management decisions. Improper technique and incorrect cuff sizing can lead to falsely high or low readings, impacting patient care. The issue of BP cuff size has been studied in ... Read more
Street Medicine: Compassionate Care for the Unhoused - REBEL EM - Emergency Medicine Blog
Introduction: In this episode of Rebel Cast, host Marco Propersi, along with co-hosts Steve Hockman and Kim Baldino, delve into the practice and importance of street medicine—the direct delivery of healthcare to homeless and unsheltered individuals. Special guests Dr. Jim O’Connell, a pioneer of street medicine, and Dr. Ed Egan, a recent street medicine fellowship ... Read more
Is the D-Dimer Useful in High-Probabilty Pulmonary Embolism? - REBEL EM - Emergency Medicine Blog
Bottom Line Up Top: A negative D-Dimer likely excludes significant pulmonary embolism (PE) in all patients but the low chance of getting a negative result makes a D-Dimer first approach of low clinical utility in the high pre-test probability group. Clinical Scenario: A 45-year-old man with malignant melanoma presents with right-sided pleuritic chest pain for ... Read more
Clinical Conundrum: Do I Have to Replace the Nail After an Avulsion? - REBEL EM - Emergency Medicine Blog
Bottom Line Up Top: Replacing the nail into the eponychial fold doesn’t appear to be critical to nail regrowth and cosmetic outcomes of finger injuries with nail avulsion. Clinical Scenario: A 6-year-old boy presents to the Peds ED with an injury to their left 2nd digit. The finger was caught in a car door, injuring ... Read more
IVC Distensibility Index vs Collapsibility Index: Using the Correct Index - REBEL EM - Emergency Medicine Blog
The use of point-of-care ultrasonography (POCUS) to evaluate the IVC as a marker for fluid responsiveness has spread from cardiology and nephrology into critical care and emergency medicine, transforming medical practice.
Balancing Innovation and Reality: Evaluating AI's Role in STEMI Diagnosis - REBEL EM - Emergency Medicine Blog
Background: ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring rapid diagnosis and intervention. While ECGs play a central role in detecting STEMI, misinterpretations often occur, leading to unnecessary catheterization or missed diagnoses. With advancements in artificial intelligence (AI), there is potential for machine learning models to assist in more accurate detection of STEMI. ... Read more
D-Dimer in High-Risk PE: A Gamble Worth Taking? - REBEL EM - Emergency Medicine Blog
Background: The current standard care for evaluating pulmonary embolism (PE) advises against D-dimer testing in patients with a high clinical probability. European and American guidelines emphasize a sequential diagnostic approach based on pretest probability assessment using either a formal clinical decision instrument (e.g., Wells’, Revised Geneva) or clinical gestalt. D-dimer testing is commonly used to ... Read more
Clinical Conundrum: Should Acute Asthma Exacerbations Be Discharged From the ED With Combination Beta Agonist/Corticosteroid Inhalers? - REBEL EM - Emergency Medicine Blog
Author: Steven Orellana DO Bottom Line Up Top: In patients with mild to moderate asthma exacerbations that are stable for discharge home, there is evidence to support discharging patients from the ED with combination Inhaled Corticosteroid/Long-Acting Beta Agonist (ICS-LABA) maintenance therapy. Clinical Scenario: A 21-year-old man with a history of asthma presents with difficulty breathing ... Read more
Rethinking Fluid Resuscitation in Vaso-Occlusive Crisis: Is Lactated Ringer’s the Superior Choice? - REBEL EM - Emergency Medicine Blog
Background: Sickle cell disease (SCD) affects an estimated 300,000 infants born worldwide each year and has a total estimated prevalence of 100,000 in the United States alone (Piel 2017). Within this population, over 90% of healthcare encounters are due to painful vaso-occlusive episodes (VOE) (Kidwell 2021). VOE is often complicated by hypovolemia, making fluid administration ... Read more
REBEL Core Cast 133.0 - TMJ Dislocation - REBEL EM - Emergency Medicine Blog
Take Home points: Atraumatic TMJ dislocations are typically anterior in nature and can be reduced by a variety of techniques in the ED Traumatic TMJ dislocations often involve mandible fractures and typically require open reduction and fixation in the operating room Consider using the syringe, gag and extraoral reduction techniques first line as they frequently ... Read more
Clinical Conundrum: Should We Always Treat Fever in Patients with Sepsis? - REBEL EM - Emergency Medicine Blog
Bottom Line Up Top: There doesn’t appear to be a morbidity or mortality benefit to treating fever in sepsis and fever may have a protective effect. Only treat fever if it causes the patient distress. Clinical Scenario: A 45-year-old woman presents with cough and shortness of breath. Vitals are BP 114/42, HR 138, T 102.1, ... Read more
REBEL Core Cast 132.0 - Recent-Onset AFib - REBEL EM - Emergency Medicine Blog
Take Home points: If the patient is low risk with CHA2DS2-VASc (men < 2, women < 3), cardioversion is safe up to 48 hours from onset. In higher risk patients, we should reserve cardioversion unless there is clear onset less than 12 hours or the patient has been anticoagulated for 3 weeks. Consider anticoagulation in ... Read more
Threading the Needle: Bougie-First Intubation - REBEL EM - Emergency Medicine Blog
Background: In 2018, the BEAM Trial, a small single-center randomized clinical trial, conducted in the emergency department at Hennepin County Medical Center, demonstrated that bougie use significantly increased the first-attempt intubation success rate compared to the endotracheal tube with stylet (98% vs 87% (absolute difference, 11% [95% CI, 7% to 14%]).1 Conversely, the 2021 BOUGIE ... Read more