REBEL Cast

Background: Hypoxemia is a commonly encountered adverse event during rapid sequence intubation (RSI) in the ED.  Critically ill patients in the ED often have a lack of physiologic reserve, decreased cardiac output, increased shunting, and reduced pulmonary reserves.  Therefore, a strategy that safely avoids desaturation and prolongs safe apnea times would be beneficial. There are ... Read more

Background:  Some of the feared complications of endotracheal intubation include hypotension, cardiac arrest, and death (cardiovascular collapse).  These complications can result from numerous causes including medication-induced vasodilation and decreased venous return to the heart due to increased intrathoracic pressure from positive pressure ventilation. In recent years there has been an increased focus on resuscitation prior ... Read more

Take Home Points SVT >5cm or <3 cm from the SFJ should be treated with anti-coagulation.  The rate of concurrent DVT and PE in patients with SVT is 25% and 5%, respectively.  REBEL Core Cast 85.0 – Superficial Venous Thrombosis Click here for Direct Download of the Podcast Definition: The presence of a clot in ... Read more

Take Home Points AVNRT is a common tachydysrhythmia that results from a reentrant loop within the AV node. Unstable patients with AVNRT should be considered for immediate synchronized electrical cardioversion. Stable patients with AVNRT can have a trial of vagal maneuvers followed by chemical cardioversion with adenosine or verapamil and synchronized electrical cardioversion if that ... Read more

Take Home Points Post dural-puncture headache affects up to 30% of patients after lumbar puncture. Suspect PDPH in all patients who recently underwent an LP or epidural anesthesia regardless of whether they meet the IHS criteria. The best way to treat PDPH is to prevent it from developing. Techniques proven to reduce risk include large ... Read more

Background: Early in the COVID-19 pandemic, clinicians were looking for practical, widely available, and low-cost interventions to help patients with hypoxemia.  One of those interventions was awake prone positioning.  Potential mechanisms of benefit in awake proning include more uniform distribution of tidal volume, recruitment of areas in the posterior part of the lung, improved ventilation/perfusion, ... Read more

Take Home Points Consider AAA in patients with acute onset of back or abdominal pain particularly in patients > 50 and in those with a history of hypertension Consider ruptured AAA in patients (especially those > 50 years of age) with unexplained hypotension, back or abdominal pain All ruptured AAAs should be considered unstable regardless ... Read more

Take Home Points Emergency medicine revolves around the differential diagnosis History and physical exam should significantly narrow your differential diagnosis Have an idea of what specific diagnoses are being ruled out when ordering diagnostic tests Always consider the most life-threatening and most common disease processes first – we are a rule out specialty “Red flags” are ... Read more

Take Home Points Emergency medicine revolves around the differential diagnosis History and physical exam should significantly narrow your differential diagnosis Have an idea of what specific diagnoses are being ruled out when ordering diagnostic tests Always consider the most life-threatening and most common disease processes first – we are a rule out specialty “Red flags” are ... Read more

Take Home Points Break the differentials down into bad & painless, bad & painful, and other causes – WOMAN-PE Cardiac causes – mechanical or electrical – look for the obvious and 5 non-obvious causes (WPW, HCOM, ARVD, prolonged QT, and Brugada) Ask the red flag questions – was there a prodrome, signs of seizure activity ... Read more

Take Home Points Be prepared to do everything with these cases, if they can’t provide information, dive into their medication list, history, contact whoever you have to to get more information Keep differentials wide – then approach these cases with the mindset of focal vs generalized weakness and work from there Focal – ask about ... Read more

Take Home Points Key point is to discern between central and peripheral causes – become familiar with the nuances of one and concentrate on that Assume central and convince yourself its peripheral in nature, if at the end of the evaluation, you can’t do that, assume a central cause and do a work-up Using timing ... Read more

Take Home Points Examine all parts of the body, even inside the mouth – this can be the difference between benign and life threatening rashes Truly emergent causes: meningococcemia, TTP, DIC, TSS, SJS, TEN, and necrotizing fasciitis Toxic appearing patients with petechia/purpura = sepsis until proven otherwise Look for medication reactions: Sulfa, Penicillins, NSAID’s, ABX, ... Read more

Take Home Points Look for the red flags – hypotension, environmental exposures, medications (SS, NMS), SIRS/qSOFA criteria Be on the lookout for neutropenic fever – isolate patients, administer abx early, and admit Sepsis definition is changing all the time – be aware of current guidelines Remove pre-existing indwelling lines/catheters in the setting of sepsis – ... Read more

Take Home Points Sprains need more support than just an ace wrap – place them in an aircast or a splint Perform a thorough physical exam – take off their shoes and socks Lisfranc and Maisonneuve injuries are often missed – make sure to exam the bottom of the foot for echymosis, eval for mid ... Read more