Shows
REBEL EM – Emergency Medicine BlogREBEL Core Cast 130.0 – OmphalitisTake 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 progressed and aggressive treatment including surgery is likely indicated
REBEL Core Cast 130.0 – Omphalitis
Click here for Direct Download of the Podcast.
Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter/X: @srre...2024-10-3005 minREBEL CastREBEL Core Cast 130.0 – OmphalitisTake 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 progressed and aggressive treatment including surgery is likely indicated
REBEL Core Cast 130.0 – Omphalitis
Click here for Direct Download of the Podcast.
Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter/X: @srre...2024-10-3005 minREBEL EM – Emergency Medicine BlogREBEL Core Cast 129.0 – Gastric LavageTake 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 are particularly toxic, suspected extreme doses associated with high morbidity/mortality and do not have easily available and effective antidotes.
Secure the airway prior to placing the lavage tube to minimize aspiration risk.
REBEL Core Cast 129.0 – Gastric Lavage...2024-10-1606 minREBEL CastREBEL Core Cast 129.0 – Gastric LavageTake 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 are particularly toxic, suspected extreme doses associated with high morbidity/mortality and do not have easily available and effective antidotes.
Secure the airway prior to placing the lavage tube to minimize aspiration risk.
REBEL Core Cast 129.0 – Gastric Lavage...2024-10-1606 minREBEL EM – Emergency Medicine BlogREBEL Core Cast 128.0 – Toxic AlcoholsTake 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 who presents in a delayed fashion after ingestion may have a normal osmolar gap however will manifest the signs of end-organ damage: anion gap metabolic acidosis, visual impairment, or renal dysfunction.
The osmolar gap is poorly sensitive, specific su...2024-10-0216 minREBEL CastREBEL Core Cast 128.0 – Toxic AlcoholsTake 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 who presents in a delayed fashion after ingestion may have a normal osmolar gap however will manifest the signs of end-organ damage: anion gap metabolic acidosis, visual impairment, or renal dysfunction.
The osmolar gap is poorly sensitive, specific su...2024-10-0216 minREBEL EM – Emergency Medicine BlogREBEL Core Cast 127.0 – Penetrating Neck InjuriesTake 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). The presence of hard signs indicates the need to go to the OR or for angiographic intervention.
Control hemorrhage with a single finger and direct pressure.
REBEL Core Cast 127.0 – Penetrating Neck Injuries
Cl...2024-09-1809 minREBEL CastREBEL Core Cast 127.0 – Penetrating Neck InjuriesTake 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). The presence of hard signs indicates the need to go to the OR or for angiographic intervention.
Control hemorrhage with a single finger and direct pressure.
REBEL Core Cast 127.0 – Penetrating Neck Injuries
Cl...2024-09-1809 minREBEL EM – Emergency Medicine BlogREBEL Core Cast 126.0 – Peds Hem Onc EmergenciesTake 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 headaches that may suggest a brain tumor include signs of increased intracranial pressure, focal neurological signs, seizures or ataxia.
REBEL Core Cast 126.0 – Peds Hem Onc Emergencies
Click here for Direct Download of the Podcast.
...2024-07-1024 minREBEL CastREBEL Core Cast 126.0 – Peds Hem Onc EmergenciesTake 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 headaches that may suggest a brain tumor include signs of increased intracranial pressure, focal neurological signs, seizures or ataxia.
REBEL Core Cast 126.0 – Peds Hem Onc Emergencies
Click here for Direct Download of the Podcast.
...2024-07-1024 min
REBEL CastREBEL Cast Ep115 - Phenobarbital vs Lorazepam in Alcohol Withdrawal2023-03-0214 minREBEL CastREBEL Cast Ep114: High Flow O2, Suspected ACS, and Mortality?Background: Historically, we have treated acute coronary syndrome with supplemental oxygen regardless of the patient’s oxygen saturation. This intervention was based on the belief that pushing the patient’s PaO2 to supra therapeutic levels would increase O2 delivery to ischemic myocardium and help reduce myocardial injury. More recent evidence, however, demonstrates that too much oxygen could ... Read more
The post REBEL Cast Ep114: High Flow O2, Suspected ACS, and Mortality? appeared first on REBEL EM - Emergency Medicine Blog.2023-03-0219 minREBEL CastREBEL Cast Ep113: Defibrillation Strategies for Refractory Ventricular Fibrillation2023-03-0117 minREBEL CastREBEL Cast Ep114 - High vs Low O2 Protocol in Suspected ACS2023-02-2819 minREBEL CastREBEL Core Cast 96.0 – Acute Vision Loss ITake Home Points: Suspect glaucoma in any patient with an acute change in vision and get an intraocular pressure measurement First line treatment in acute angle closure glaucoma is a topical beta blocker Consider giant cell arteritis in patients with unilateral headache, jaw claudication and change in vision Don’t wait for the biopsy to start ... Read more
The post REBEL Core Cast 96.0 – Acute Vision Loss I appeared first on REBEL EM - Emergency Medicine Blog.2023-02-2209 min
REBEL CastREBEL Core Cast 96.0 - Acute Vision Loss ISwami explores some common causes of non-traumatic, acute, monocular vision loss including glaucoma and giant cell arteritis.2023-02-2209 min
REBEL CastREBEL Core Cast 95.0 - Herpetic Keratitis2023-02-0807 min
REBEL CastREBEL Core Cast 94.0 - SBO2023-01-2512 min
REBEL CastREBEL Core Cast 93.0 - Lithium ToxicityThis week, Swami sits down with Dr. Danielle Langan to chat about lithium toxicity.2023-01-1112 min
REBEL CastREBEL Core Cast 92.0 - Perichondritis2022-12-1403 min
REBEL CastREBEL Core Cast 91.0 - Testicular TorsionThis week we discuss testicular torsion focusing on some pearls and pitfalls.2022-11-3008 min
REBEL CastREBEL Core Cast 90.0 - MethemoglobinemiaThis week we discuss the diagnosis and management of Methemoglobinemia.2022-11-1605 min
REBEL CastREBEL Core Cast 89.0 - Spontaneous Bacterial PeritonitisThis week we discuss the diagnosis and management of SBP.2022-11-0205 min
REBEL CastREBEL Core Cast 88.0 - HypocalcemiaThis week we dive into diagnosis and management of hypocalcemia.2022-10-1907 min
REBEL CastREBEL Core Cast 87.0 - Hypercalcemia2022-10-0507 min
REBEL CastREBEL Core Cast 86.0 - Hand Nerve BlocksThis week, we review the median, ulnar and radial nerve blocks and how they can be useful in clinical practice.2022-09-2107 minREBEL CastREBELCast Ep112 - Pre-AeRATE Trial - HFNC vs NC for RSI2022-09-0318 min
REBEL CastREBEL Core Cast 85.0 - Superficial Venous ThrombosisThis week we discuss the diagnosis and management of superficial venous thrombosis.2022-07-2006 minREBEL CastREBEL Cast Ep111: The PREPARE II Trial - Fluid Bolus Prior to Intubation?2022-07-1614 min
REBEL CastREBEL Core Cast 84.0 - AVNRTThis week, we discuss the ins and outs of management of AVNRT.2022-07-0610 min
REBEL CastREBEL Core Cast 83.0 - Post-LP HeadacheThis week we discuss the diagnosis and management of post-LP headache.2022-06-2205 min
REBEL CastREBEL Cast Ep110: The COVI-PRONE Trial - Awake Prone Positioning and COVID-192022-06-2021 min
REBEL CastREBEL Core Cast 82.0 - Abdominal Aortic AneurysmThis week we discuss AAA presentations and diagnosis.2022-06-0809 minREBEL CastREBEL Core Cast - Basics of EM - Introduction2022-06-0106 minREBEL CastREBEL Core Cast - Basics of EM - Mega Summary 12022-06-011h 12REBEL CastREBEL Core Cast - Basics of EM - Mega Summary 22022-06-011h 20REBEL CastREBEL Core Cast - Basics of EM - Syncope2022-06-0125 minREBEL CastREBEL Core Cast - Basics of EM - Weakness2022-06-0121 minREBEL CastREBEL Core Cast - Basics of EM - Dizziness2022-06-0129 minREBEL CastREBEL Core Cast - Basics of EM - Rash2022-06-0122 minREBEL CastREBEL Core Cast - Basics of EM - Fever2022-06-0114 minREBEL CastREBEL Core Cast - Basics of EM - Ankle & Foot Injuries2022-06-0117 minREBEL CastREBEL Core Cast - Basics of EM - Leg Pain2022-06-0118 minREBEL CastREBEL Core Cast - Basics of EM - Lacerations2022-06-0123 minREBEL CastREBEL Core Cast - Basics of EM - Back Pain2022-06-0121 minREBEL CastREBEL Core Cast - Basics of EM - Vaginal Bleeding2022-06-0117 minREBEL CastREBEL Core Cast - Basics of EM - Lower Abdominal Pain2022-06-0115 minREBEL CastREBEL Core Cast - Basics of EM - Diffuse & Flank Pain2022-06-0115 minREBEL CastREBEL Core Cast - Basics of EM - Epigastric Pain2022-06-0118 minREBEL CastREBEL Core Cast - Basics of EM - General Abdominal Pain2022-06-0121 minREBEL CastREBEL Core Cast - Basics of EM - Vomiting2022-06-0116 min
REBEL CastREBEL Core Cast 36.0 – SeizuresTake Home Points When approaching the patient with uspected seizure, focus on questions that matter in determining if the event was a seizure or not...2020-07-0824 min
REBEL CastREBEL Cast Ep85: The HALT-IT Trial – TXA in Acute GI BleedsBackground: Acute gastrointestinal bleeding (GIB) is a common diagnosis dealt with by emergency clinicians. Definitive therapy for acute GIB often includes endoscopy or surgery. However,...2020-06-2719 min
REBEL CastREBEL Core Cast 35.0 – Environmental HyperthermiaTake Home Points Heat stroke is a life-threatening disorder characterized by elevated core temperature, compromise to neurologic function and multi-system organ dysfunction The keystone of...2020-06-2418 min
REBEL CastREBEL Cast Ep84: Here We Go Again with Time is BrainBackground: Here we go again with another “Time is Brain,” acute ischemic stroke study. The authors start out by saying that earlier administration of intravenous...2020-06-1817 min
REBEL CastREBEL Cast Ep83 – COVID-19 in the ICU, ECMO Early, & Steroids with Jeff Dellavolpe, MDI am fortunate to work in a hospital system that is very forward thinking. We have a phenomenal relationship with our intensivists, and I have...2020-05-3132 min
REBEL CastREBEL Core Cast 34.0 – Chest TubesTake Home Points Small to Moderate Size Pneumothorax – consider managing conservatively with observation (need to make sure consulting services on same page) Needle aspiration...2020-05-2716 min
REBEL CastREBEL Cast Ep82: Timing of Endoscopy for UGIBBackground: Upper endoscopy allows for the identification of the source of bleeding as well as hemostatic treatment for actively bleeding lesions In patients with upper...2020-05-2129 min
REBEL CastREBEL Core Cast 33.0 – Needle DecompressionTake Home Points Forget the “traditional” needle decompression landmark Decompress at 4th or 5th intercostal space in the anterior axillary line REBEL Core Cast 32.0...2020-05-1312 min
REBEL CastREBEL Crit Cast Ep 4.0: Lung Protective Mechanical VentilationGoals of lung protective mechanical ventilation: Minimizing harm during mechanical ventilation with a lung-protective strategy with: Low tidal volume (TV) Limit plateau pressure to 2020-05-0713 min
REBEL CastREBEL Cast Ep81: COVID-19, Thrombosis, and AnticoagulationEarly reports have shown that COVID-19 is most likely causing a hypercoagulable state, however the prevalence of acute VTE and exactly how to treat it...2020-04-2827 min
REBEL CastREBEL Cast Ep80: A New War Plan for COVID-19 with Richard LevitanIn this episode of REBEL Cast,I sit down with Richard Levitan and talk about some ideas from his experience in New York, where he spent...2020-04-2442 min
REBEL CastREBEL Core Podcast 32.0 – N95 Mask ReuseTake Home Points N95 masks ideally should be single use but in COVID19 times, safe reuse practices are critical. The best approach to reuse is...2020-04-2210 min
REBEL CastREBEL Crit Cast Ep3.0: Airway Pressure Release Ventilation (APRV) Made SimpleAirway Pressure Release Ventilation (APRV) is a mode of ventilation that allows spontaneous breathing throughout the ventilation cycle. It is a time-cycled mode of ventilation...2020-04-1020 min
REBEL CastREBEL Core Cast 31.0 – HyperthyroidismTake Home Points Hyperthyroidism can present along a spectrum from the minimally symptomatic to severely decompensated and presentation can vary with age If there are...2020-04-0817 min
REBEL CastREBEL Cast Ep79: COVID-19 – Trying Not to Intubate Early & Why ARDSnet may be the Wrong Ventilator ParadigmHey there REBEL Cast listeners, Salim Rezaie here. For me and I am sure many COVID-19 has been quite the whirlwind. So much information, so...2020-04-051h 30
REBEL CastREBEL Cast Ep78: Length Matters – At Least When it Comes to US-Guided Peripheral IV CathetersBackground: Peripheral intravenous (PIV) access is one of the most commonly performed invasive procedures in unwell patients. Although, most patients can have PIVs placed by...2020-04-0214 min
REBEL CastREBEL Cast Ep77: 2019 ACLS UpdateThe American Heart Association (AHA) released a focused update in 2019, for advanced cardiovascular life support (ACLS) guidelines, to addend those published in 2017 and...2020-03-3016 min
REBEL CastREBEL Core Cast 30.0 – Neonatal ResuscitationTake-Home Points Before starting a neonatal resuscitation, take some deep breaths to calm yourself Call in your friends – get a second team to manage...2020-03-2523 min
REBEL CastREBEL Cast Ep 76: The 65 Trial – Shooting for a Lower MAP in Older Patients with Sepsis?Background: Vasopressors are often used to improve hypotension and perfusion in an effort to decrease mortality of patients with septic shock. Mean arterial pressure (MAP)...2020-03-1917 min
REBEL CastREBEL Core Cast 29.0 – Vascular DisastersVascular Disasters Take Home Points Consider vascular pathologies in all of your patients with atraumatic limb pain – especially those with typical and atypical risk...2020-03-1114 min
REBEL CastREBEL Core Cast 28.0 – Conference PearlsTake Home Points No palpable pulse does not equal no perfusion. We aren’t great at feeling pulses Patients with moderate to severe signs and symptoms...2020-02-2611 min
REBEL CastREBEL Core Cast 27.0 – EndocarditisTake-Home Points Endocarditis can have vague and varied presentations and has high morbidity and mortality. Be on the lookout in patients with risk factors including: ...2020-02-1212 min
REBEL CastREBEL Crit Cast Episode 2.0: Overview of High Flow Nasal Cannula (HFNC) – Part 1The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through...2020-02-1019 min
REBEL CastREBEL Core Cast 26.0 – Lactated RingersTake Home Points When compared to 0.9% saline, lactated ringers is a more balanced solution and more closely resembles our serum. SALT ED and SMART...2020-01-2909 min
REBEL CastREBEL Cast Ep74 – Is it all About the VITAMINS in Sepsis?Background: The combination of vitamin C, hydrocortisone and thiamine in sepsis has been a topic of hot debate in the past couple years. There is...2020-01-2723 min
REBEL CastREBEL Core Cast 25.0 – OsteomyelitisTake Home Points Osteomyelitis is an infection in any part of a bone. It has a varied presentation including acute and chronic forms. Patients can...2020-01-1512 min
REBEL CastREBEL Crit Cast Episode 1.0 – Overview of Targeted Temperature Management (TTM) Post Cardiac ArrestTherapeutic Hypothermia (also called targeted temperature management (TTM)) is a deliberate reduction of the core body temperature to 32 – 34°C, in patients who suffer...2020-01-1336 min
REBEL CastREBEL Cast Ep73: Are Peripheral Vasopressors Safe?Background: Traditionally, vasopressors have been given through central venous catheters (CVCs) in the critically ill.However, the time it takes to place a CVC is time...2020-01-0227 min
REBEL CastREBEL Crit Cast Ep 0.0 – The IntroREBEL EM-ers: Salim & I would like to introduce the launch of a new REBEL EM project. We are adding a podcast focused on a...2019-12-3004 min
REBEL CastREBEL Core Cast 24.0 – Stroke Update 2019Take Home Points Important as front line providers to know research and data behind stroke care Patients eligible for endovascular care are those with large...2019-12-1808 min
REBEL CastREBEL Core Cast 23.0 – Vaping Associated Pulmonary InjuryTake Home Points Ask the patient if they vape! Worry about the sick looking patient and those seen recently CXR is nonspecific and CT might...2019-12-1110 min
REBEL CastREBEL Core Cast 22.0 – Decompensated Liver DiseaseTake Home Points End stage liver disease patients have fragile baseline physiology. Minor insults can have profound effects Always start with the basics –...2019-11-2714 min
REBEL CastREBEL Core Cast 21.0 – ECG in SyncopeREBEL Core Cast 21.0 – ECG in Syncope Click here for Direct Download of Podcast Sample ECGs Post Peer Reviewed By: Salim R. Rezaie,...2019-11-1309 min
REBEL CastREBEL Core Cast 20.0 – Takotsubo’s CardiomyopathyTake Home Points Stress cardiomyopathy looks like ACS/STEMI, with patient presenting with chest pain, dyspnea or maybe syncope. It looks like ACS and should be...2019-10-3112 min
REBEL CastREBEL Cast Ep72: Systemic Alteplase in Stroke Mimics is Safe?Background: Currently, alteplase is the mainstay of treatment of acute ischemic stroke. Advocates of alteplase suggest that the benefit of alteplase is greatest when given early...2019-10-3021 min
REBEL CastREBEL Core Cast 19.0 – Acute Angle Closure GlaucomaTake Home Points Acute closed angle glaucoma is an ophthalmologic emergency that usually presents with sudden, painful, monocular vision loss. Physical exam will reveal conjunctival...2019-10-0909 min
REBEL CastREBEL Core Cast 18.0 – DKA Tips and TricksTake Home Points When looking at pH and bicarb, the differences between VBG and ABG are miniscule. For DKA patients, stick with the VBG as...2019-09-2510 min
REBEL CastREBEL Core Cast 17.0 – Penetrating Neck TraumaTake Home Points: Get definitive airway control when necessary Use modality you’re most comfortable with Hard signs – pulsatile bleeding, bruit or thrill, expanding hematoma,...2019-09-1127 min
REBEL CastREBEL Cast Ep71: 2nd Line Therapy for Pediatric Status Epilepticus – EcLiPSE & ConSEPTBackground: Convulsive status epilepticus is the most common pediatric neurological emergency worldwide. Currently, phenytoin (UK & Europe) or fosphenytoin (USA) is the recommended second-line IV...2019-09-0235 min
REBEL CastREBEL Core Cast 16.0 – Decompensated HypothyroidismTake Home Points Myxedema coma is severe, decompensated hypothyroidism with a very high mortality. Classic features include: decreased mental status, hypothermia, hypotension, bradycardia, hyponatremia, hypoglycemia,...2019-08-2113 min
REBEL CastREBEL Cast Ep70 – Time to Antibiotics in SepsisBackground: Antibiotics are one of the cornerstones of therapy in the treatment of sepsis/septic shock, however according to the Surviving Sepsis Campaign (SSC) guidelines, time to...2019-08-1924 min
REBEL CastREBEL Core Cast 15.0 – Syncope Literature UpdatesTake Home Points There is no real distinction between syncope and near syncope. Older folk with near syncope or syncope should be treated the same....2019-08-0708 min
REBEL CastREBEL Cast Episode 69: Rebellion in EM Day 3 Speaker Summaries with Andy LittleThis is a special edition REBEL Cast done by my good friend Andy Little, DO (Twitter: @andylittle). As I was busy running the 2nd annual...2019-07-2912 min
REBEL CastREBEL Cast Ep 68: Rebellion in EM Day 2 Speaker Summaries with Andy LittleThis is a special edition REBEL Cast done by my good friend Andy Little, DO (Twitter: @andylittle). As I was busy running the 2nd annual...2019-07-2222 min
REBEL CastREBEL Core Cast 14.0 – Superficial Venous ThrombosisTake Home Points on SVT Superficial venous thrombosis refers to a clot and inflammation in the larger, or “axial” veins of the lower extremities and...2019-06-2610 min
REBEL CastREBEL Core Cast 13.0 – MeaslesTake Home Points on Measles There is a resurgence of measles worldwide Incubation period is 10 – 14 days and patients are contagious 4 days...2019-06-1208 min
REBEL CastREBEL Cast Episode 67: EXTEND-ing Times for Systemic Thrombolysis in Acute Ischemic Stroke?Background: Despite the lack of replication of the NINDS & ECASS-3 trials, guidelines recommend the use of tPA in the ≤4.5hr window after the onset of...2019-06-0329 min
REBEL CastREBEL Core Cast 12.0 – Tracheostomy EmergenciesTake Home Points on Tracheostomy Emergencies Track is mature in 7 days – don’t blindly replace before then because concern for false track creation All...2019-05-2909 min
REBEL CastREBEL Core Cast 11.0 – EpiglottitisTake Home Points on Epiglottitis Epiglottitis has demonstrated a resurgence in the adult population. It is no longer a pediatric only disease. The classic presentation...2019-05-1514 min