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R.E.B.E.L. EM | Emergency Medicine Blog - Health
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Rosh Review My EMCert Monthly Question - REBEL EM - Emergency Medicine Blog
A parent presents to the ED with their 6-week-old infant for evaluation of a fever. The infant was born full term and has no other symptoms. Physical exam is normal and vital signs are HR is 150 bpm, SpO2 is 99%, and a rectal T is 101.4°F (38.6°C). Blood cultures are sent and lab results ... Read more
Levitan/Rezaie Practical Airway Course - REBEL EM - Emergency Medicine Blog
View Course Dates This 2-day course provides an in-depth look at effective surgical airway management techniques that you will actually use in your next emergency airway. There is a unique focus on airway anatomy and imaging combined with one-of-a-kind opportunity to practice the techniques on a large variety of non-embalmed, specially prepared cadavers. This is ... Read more
REBEL Core Cast 131.0 - Traumatic Arthrotomy - REBEL EM - Emergency Medicine Blog
Take Home points: Always suspect an open joint if there is a laceration, regardless of size, the lies over joint CT scan of the affected joint is widely considered to be the standard approach to evaluation but the saline load test may be useful in certain circumstances. Obtain emergency orthopedics consultation for all open joints ... Read more
Is Pip-Tazo Harming Sepsis Patients? - REBEL EM - Emergency Medicine Blog
Background: Patients with sepsis are routinely treated with empiric broad-spectrum antibiotics while awaiting source identification, as recommended by the surviving sepsis campaign.2 Vancomycin, in combination with either piperacillin-tazobactam or cefepime, is commonly used for empiric treatment in these cases. Literature comparing the two regimens has largely focused on the adverse effects of each medication, rather ... Read more
Elbow Dislocations - REBEL EM - Emergency Medicine Blog
Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow (Cohen 1998) Posterolateral is the most common type of dislocation (80%) Demographics Most commonly affects ... Read more
REBEL Core Cast 130.0 - Omphalitis - REBEL EM - Emergency Medicine Blog
Take Home Points Early diagnosis: erythema and warmth of the skin surrounding the umbilicus isn’t normal. Get labs, start abx and get the patient admitted Consult peds surgery on all of these patients as progression to nec fast, while uncommon, is devastating If the patient appears toxic or has systemic symptoms, the simply omphalitis has ... Read more
REBEL Core Cast 129.0 - Gastric Lavage - REBEL EM - Emergency Medicine Blog
Take Home Points Orogastric lavage may still play an important role in treatment of the overdose patient. Do not perform lavage if the ingestion has limited toxicity at any dose or the ingested dose is unlikely to cause significant toxicity. Strongly consider orogastric lavage in a patient who has taken an overdose of drugs that ... Read more
REBEL Core Cast 128.0 - Toxic Alcohols - REBEL EM - Emergency Medicine Blog
Take Home Points Toxic alcohols generally refer to methanol and ethylene glycol as these substances pose significant metabolic derangement and end-organ damage. Patient who present shortly after ingestion will simply look inebriated – no different than ethanol intoxication. At this point, patients will have an elevated osmolar gap and little to no anion gap. Patient ... Read more
REBEL Core Cast 127.0 - Penetrating Neck Injuries - REBEL EM - Emergency Medicine Blog
Take Home Points Anticipate anatomically challenging airways and consider early intubation prior to loss of airway anatomy. Skip the zones of the neck and focus on hard signs of vascular (Shock w/o another source, Pulsatile bleeding, Expanding hematoma, Audible bruit, Signs of stroke) or aerodigestive (Airway compromise, Bubbling wound, Extensive SubQ air, Stridor, Significant hemoptysis/hematemesis). ... Read more
Rosh Review My EMCert Monthly Question - REBEL EM - Emergency Medicine Blog
A newborn boy presents to the emergency department shortly after a home delivery. The mother had routine prenatal care and reports that he was due in 2 days. The patient appears term and vigorous but is in respiratory distress and gasping for air. His heart rate is 80 bpm. What percent of oxygen should you ... Read more
The Ducanto Catheter—It Sucks! - REBEL EM - Emergency Medicine Blog
Background: Emergency intubations present a unique set of challenges, particularly when dealing with heavily contaminated airways. Anesthesiologist, Dr. James DuCanto, developed the DuCanto catheter to enhance airway management in these high-stakes situations. The commonly used 14 Fr Yankauer catheter, with its smaller bore, may struggle to clear heavily contaminated airways effectively. In contrast, the 28 ... Read more
Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with COVID-19 - REBEL EM - Emergency Medicine Blog
Background: The clinical burden of severe COVID-19 triggered a pharmaceutical race to find effective, easily accessible, oral treatments that could decrease the morbidity and mortality associated with the disease. Nirmatrelvir is an oral antiviral agent that inhibits the SARS-CoV2 main protease involved in viral replication. It is administered with ritonavir, which inhibits the cytochrome P450-3A4 ... Read more
Remote Consult Protocols for Retinal Artery Occlusion: A Visionary Approach in Emergency Care? - REBEL EM - Emergency Medicine Blog
Can a remote consult protocol using point-of-care OCT improve the time to diagnosis and treatment of retinal artery occlusions in patients presenting with painless monocular vision loss?
The PROTECTION Trial - A Randomized Trial of Intravenous Amino Acids for Kidney Protection - REBEL EM - Emergency Medicine Blog
PROTECTION Trial: In patients undergoing cardiac surgery with cardiopulmonary bypass, does the administration of intravenous amino acid therapy lead to lower occurrence of postoperative AKI when compared to placebo?
A Winning Hand in Cardiology: Queen of Hearts AI Model Enhances OMI Detection - REBEL EM - Emergency Medicine Blog
Background: Cath lab activation based on ST-elevation myocardial infarction (STEMI) criteria is founded on aging data and requires evolution. In the “Occlusive Myocardial Infarction (OMI) Manifesto,” emergency physicians Dr. Steve Smith, Dr. Pendell Meyers, and Dr. Scott Weingart introduced a new paradigm —OMI vs. non-occlusive myocardial infarction (NOMI). The OMI/NOMI paradigm focuses on the presence ... Read more
Navigating Nerve Blocks: US-Guided Nerve Blocks Vs. Sub-Dissociative Ketamine - REBEL EM - Emergency Medicine Blog
In adult trauma patients with isolated extremity injuries, do peripheral nerve blocks, compared to sub-dissociative ketamine, result in a reduction of pain by the numerical scale rating of at least 3 points?
REBEL Core Cast 126.0 - Peds Hem Onc Emergencies - REBEL EM - Emergency Medicine Blog
Take Home Points Early administration of antibiotics (within 60 min) in patients with fever and neutropenia is life saving. Fever in sickle cell is an emergency and always requires cultures and antibiotics even if the child appears well. Avoid sedation and lying supine and steroids in patients with mediastinal masses. Red flags in patients with ... Read more
Should End-Tidal Capnometry (ETC) During ED Procedural Sedation/Analgesia (PSA) Not Be Standard Care? - REBEL EM - Emergency Medicine Blog
Does end-tidal capnometry (ETC) plus usual care in patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED) decrease respiratory adverse events compared to usual care alone?
REBEL Core Cast 125.0 - Hyperkalemia - REBEL EM - Emergency Medicine Blog
Take Home Points Always obtain an EKG in patients with ESRD upon presentation Always obtain an EKG in patients with hyperkalemia as pseudohyperkalemia is the number one cause If the patient with hyperkalemia is unstable or has significant EKG changes (wide QRS, sine wave) rapidly administer calcium salts In patients who are anuric, early mobilization ... Read more
REBEL Core Cast 124.0 - Hyperinsulinemia Euglycemia Therapy - REBEL EM - Emergency Medicine Blog
Take Home Points Management of severe beta-blocker and calcium-channel blocker toxicity should occur in a stepwise fashion: potential gastric decontamination, multiple lines of access, judicious fluids, calcium, glucagon, and vasopressors as needed. Initiation of high dose insulin therapy requires a tremendous amount of logistical and cognitive resources as it requires cross-disciplinary collaboration and is prone ... Read more
Should We Be Switching to Whole Blood Instead of Component Therapy in Hemorrhagic Shock? - REBEL EM - Emergency Medicine Blog
In adult patients experiencing hemorrhagic shock, is whole blood transfusion associated with improved survival and/or decreased overall blood utilization compared to component therapy (RBCs, Plasma, Platelets)?
The Modified Valsalva Maneuver: Practical Treatment or Pointless Trick? - REBEL EM - Emergency Medicine Blog
Does simultaneously performing the modified valsalva maneuver and administering intravenous adenosine, compared to either treatment alone, have greater success in achieving normal sinus rhythm in patients presenting to the ED with PSVT?
Automated vs Manual Chest Compressions in Out-of-Hospital Cardiac Arrest - REBEL EM - Emergency Medicine Blog
What is the impact of automated chest compression devices (ACCD) vs manual chest compressions (mCC) on the rate of ROSC, frequency of CPR related chest injuries and duration of in-hospital cardiopulmonary resuscitation (IHCPR)?
Rosh Review My EMCert Monthly Question - REBEL EM - Emergency Medicine Blog
A 67-year-old woman with a history of atrial fibrillation on apixaban presents to the ED for epistaxis that began 30 minutes ago. Her bleeding is difficult to control with direct nasal pressure and topical agents but resolves with silver nitrate cauterization. Her vital signs are within normal limits. How should this patient’s apixaban be managed? ... Read more
DanGer Shock Trial: Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock - REBEL EM - Emergency Medicine Blog
DanGer Shock Trial: In adult patients with STEMI complicated by cardiogenic shock does the use of microaxial flow pumps in addition to standard medical care improve 180d mortality compared to standard medical care alone?
Don’t Forget About the IO in the Critically Ill Patient - REBEL EM - Emergency Medicine Blog
Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. In these situation intraosseous (IO) access is often overlooked.