R.E.B.E.L. ECG of the Week: Wellens’ Syndrome or STEMI

14 Aug
August 14, 2014

Wellens' Syndrome or STEMI

A 52 year old female with a past medical history of type II diabetes mellitus and tobacco abuse presents with a chief complaint of chest pain.

According to the patient she had about 2 – 3 months of stuttering, substernal chest pain without any radiation.  She described the pain as pressure-like, with activity, but that it would typically resolve after a few minutes of rest.  Today she awoke with substernal chest pain that never resolved and continued in the emergency department.  She quantifies her pain as 7/10 and not relieved with 2L nasal cannula of oxygen, 325mg PO aspirin, and SL NTG x3.

BP 127/89     HR 76     RR 20      O2 sat 100% on 2L NC     Temp 99.3

Awake, A&Ox3, appears uncomfortable
Mild JVD on examination
RRR w/o m/r/g
CTA B
2+ pulses in her extremities, no edema

ECG is shown (No prior ECG for comparison)…..

Read more →

Colchicine for Treatment of Pericarditis

11 Aug
August 11, 2014

PericarditisAcute and recurrent pericarditis are frequently diagnosed in the emergency department.  Traditionally, treatment has consisted of anti-inflammatory medications (eg. ASA or NSAIDs) or corticosteroids.  Colchicine is an underutilized therapy for pericarditis and provides significant benefit when combined with NSAIDs/ASA. Addition of colchicine to standard therapy results in earlier reduction in pericarditis symptoms, greater remission at 1 week, and reduces the rate of recurrent pericarditis. Let’s review the literature for colchicine for treatment of pericarditis. Read more →

Does Use of Tamsulosin in Renal Colic Facilitate Stone Passage?

07 Aug
August 7, 2014

Does Use of Tamsulosin in Renal Colic Facilitate Stone PassageRenal colic is a common ED presentation. Rarely does a day go by that we don’t see a patient rocking and rolling in acute renal colic. Dan Firestone makes an impassioned argument against the use of CT scanning for diagnosis of renal colic so I won’t address that here. Once we make a diagnosis, our primary goal in the ED is pain relief. Then we turn our attention to disposition planning, follow up and outpatient medications. The majority (90%) of stones will pass spontaneously but it would be nice if we could:

  1. increase the passage rate
  2. shorten the time to passage.

This could potentially reduce ED revisits, reduce the number of invasive procedures and make happy patients. So does the use of tamsulosin in renal colic facilitate stone passage? Read more →

REBELCast August 2014

04 Aug
August 4, 2014

REBELCast LogoWelcome to REBELCast August 2014, where Matt, Swami, and I are going to tackle a couple more scenarios to help your clinical practice. Today, we are going to specifically tackle two different topics:

Topic #1: Significance of Isolated Vomiting in Pediatric Minor Head Trauma
Topic #2: Early Detection of Systemic Inflammatory Response Syndrome (SIRS) in the Emergency Department Read more →

Elevated Asymptomatic Hypertension: To Treat or Not to Treat?

21 Jul
July 21, 2014
Image obtained from idealbite.com

Image obtained from idealbite.com

As emergency physicians, we are constantly on the look out for elevated blood pressures and the potential devastating consequences. We are concerned about intracranial bleeds and acute pulmonary edema from heart failure. But what about the patient that comes in with high blood pressures, yet has no symptoms? Do we need to treat the number or the patient? In this post we will tackle this clinical dilemma of elevated asymptomatic hypertension: To treat or not to treat? Read more →

Medical Myths in the Management of Dog Bites

17 Jul
July 17, 2014

Management of Dog BitesAnimal bites are a common cause of injury in the United States. About 4.5 million Americans/year (5% of all traumatic wounds in the ED) will sustain a bite injury. Dog bites compromise a majority of these wounds. The classic teaching is that dog bites should not be closed primarily and they should all be prophylactically treated with antibiotics. When dog bites become infected, Pasteurella species, specifically P. canis, are the most common pathogens. Amoxicillin-clavulanate (AKA “dog-mentin”) is the antibiotic of choice. It’s also important to keep in mind that Emergency Department repaired lacerations (not just dog bites but all comers) have a 3-7% infection rate. As usual, the dogma (pun intended) is based on minimal if any evidence. Additionally, there are some recent articles that are relevant to the discussion that should be discussed.

Read more →

Topical Tranexamic Acid for Epistaxis or Oral Bleeds

14 Jul
July 14, 2014

Topical Tranexamic Acid for Epistaxis or Oral BleedsRecently, there has been a lot of buzz about the use of topical tranexamic acid for epistaxis or oral bleeds on multiple social media platforms. Everyone seems so happy that it works so well, but we thought we would look through the literature and see what the evidence for use of topical tranexamic acid (TXA) is and how best to compound it for these clinical dilemma. We performed a PubMed, and Ovid search using the terms “topical” AND/OR “oral solution” AND/OR “intranasal” PLUS “tranexamic acid” to answer our questions at hand. Read more →

Update on Age-Adjusted D-Dimer

11 Jul
July 11, 2014

Update on Age-Adjusted D-DimerD-dimer has been shown to increase with age, which can cause a lower specificity (i.e. more false positive tests) in older patients. The result of this would be that older patients would often have more diagnostic imaging or downstream testing, but on the other hand, maybe a higher cut-off d-dimer value may lead to increased false negative cases (i.e. missed venothromboembolism) and make this strategy less safe. Recently, I wrote a post on age-adjusted d-dimer testing on REBEL EM, but since that post there was a new article that was published in Chest 2014. This post, will specifically focus on an update of age-adjusted d-dimer testing based on the above article. Read more →

REBELCast Episode 1

01 Jul
July 1, 2014

REBELCast LogoWelcome to REBELCast Episode 1, where Matt, Swami, and I are going to tackle a couple of scenarios to help your clinical practice.  Today, we are going to specifically tackle two different topics:

  • Topic #1: Clinically Important Biphasic Anaphylaxis
  • Topic #2: Total Lymphocyte Count (TLC) as a Surrogate Marker for CD4 Counts

Read more →

Introduction of REBEL Cast

19 Jun
June 19, 2014

REBEL Cast LogoFor those who haven’t checked out the site already R.E.B.E.L. EM stands for Rezaie’s 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 announce the introduction of REBEL Cast.  Read more →

© Copyright 2014 - R.E.B.E.L. EM