REBEL Cast
Summary: For those who haven’t checked out the site already R.E.B.E.L. EM stands for Rational Evidence Based Evaluation of Literature in Emergency Medicine. The blog was launched in October 2013, and continues to grow every month, and with that growth we are excited to give you REBEL Cast. This podcast will review evidence based literature and end with a clinical take home point for your clinical practice.
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- Artist: Salim R. Rezaie, MD
Podcasts:
Take Home Points Approach leg pain with the seconds, minutes, hours mindset – think about acute limb ischemia, compartment syndrome, and necrotizing fasciitis Do a thorough physical exam – get their shoes and socks off – you will find crazy stuff when you actually look Palpate and image the joint above and below any injury ... Read more
Take Home Points Don’t make bite width to small – look at the curvature of the needle – start the bite at half the curvature of the needle Don’t pull too tight – this will pucker the skin and lead to poor healing due to ischemia at the wound borders Laceration repairs are not sterile! ... Read more
Take Home Points Ask about the red flags: cancer, fever, IVDA, FND, point tenderness, saddle/perianal anesthesia, trauma, urinary retention, bowel incontinence, weight loss Most don’t need XR’s – set this expectation and advise against bed rest Consider XR’s: h/o cancer, extremes of age, osteoporosis, new back pain in the elderly, trauma Perform POCUS and check ... Read more
Take Home Points Get a upreg on any childbearing age female with vaginal bleeding – this is an ectopic pregnancy until proven otherwise Confirm vaginal vs rectal bleeding – it can be hard for patients to tell, especially the elderly Quantify the amount of blood loss – soaking thru >1 pad/hr is a lot Ask ... Read more
Take Home Points Get a upreg on every female patient of child bearing age with lower abdominal pain – this is an ectopic pregnancy until proven otherwise Always consider ovarian/testicular pathology for lower abdominal pain Always have a chaperone when performing genitourinary physical exams Ovarian cysts >5 cm are at high risk for torsion, consider ... Read more
Take Home Points Diffuse abdominal pain can be anything – keep a broad differential and work from there Old patient and flank pain = aortic catastrophe – aortic dissections and aneurysms can knock off flow to the kidneys Appendicitis and diverticulitis can presents diffusely early in their clinical presentation before they localize Kidney stones are ... Read more
Take Home Points Patients don’t necessarily know what’s important – ask lots of questions, find out if they’ve been taking a ton of NSAID’s or Tylenol for their pain and now they have an ulcer or hepatitis Keep a broad differential – the kidneys, the aorta, and consider chest pain differentials in any patient with ... Read more
Take Home Points Go in thinking sick vs not sick – this can take time to develop and that’s ok, this skill will come as you see more patients If you’re thinking about getting a scan or u/s – just get it! You don’t want to go home thinking you should have gotten a scan ... Read more
Background:There is a lack of high quality RCTs investigating optimal airway management in patients with out-of-hospital cardiac arrest (OHCA). The majority of evidence comes from observational studies and expert opinion. The observational trials have consistently favored basic airway management (i.e. BVM) over tracheal intubation [3]. Supraglottic airway(SGA) devices offer an alternative advanced airway management technique to endotracheal […]
Background: POCUS has been touted as the stethoscope 2.0, a true game changer in patient care. There is no patient population that this statement should hold more true for, than in patients with undifferentiated shock (SBP 1). Everyone has a story about how ultrasound changed their management or even saved a patient’s life. Unfortunately, […]
Background: In the ED, POCUS has become one of the most important tools in discovering both the diagnosis and in the management of critically ill patients. cardiac arrest, is ultimately as sick as a person can get in the spectrum of critical illness. I mean how can someone be deader than dead, right? There has been […]
Background: Epinephrine(adrenaline) has been used in advanced life support in cardiac arrest since the early 1960s. Despite the routine recommendation for its use, evidence to support administration is less than ideal. Although it is clear from multiple observational studies that epinephrine improves return of spontaneous circulation (ROSC) and short-term survival, most evidence suggests an absence of […]
Background: Critically ill patients come to the ED all the time and it is almost reflexive to liberally administer oxygen in these acutely ill patients. Many providers may consider supplemental oxygen a harmless and potentially beneficial therapy in these patients, irrespective of the presence or absence of hypoxemia (i.e. hyperoxia). There have been several trials (Stroke […]
Background: Pulseless electrical activity (PEA) is an organized electrical activity without a palpable pulse. 1/3 of cardiac arrest cases will be pulseless electrical activity and the overall prognosis of these patients is worse than patients who have shockable rhythms (ventricular fibrillation or pulseless ventricular tachycardia). It can be a challenge to decide when to terminate or […]
Background: The provision of safe and judicious analgesia is an important task for the emergency physician. Recent literature has demonstrated the effectiveness of sub-dissociative ketamine (SDK) in the emergency department (ED) setting (Motov 2015), however concerns regarding increased rates of hemodynamic and psychoperceptual adverse effects have limited application of this analgesic strategy in older populations. […]
