Rebellion in EM 2018 – DOAC Reversal by Scott Wieters, MD

20 Jun
June 20, 2018

The 1stannual Rebellion in EM Clinical Conference took place in San Antonio, TX on May 11th– 13th, 2018.  If you missed out in 2018, the Rebellion is coming back June 28th – 30th, 2019.  Stay up to date as we plan the conference for this upcoming year at www.rebellioninem.com.

The Missions of Rebellion in EM:

  1. Decrease Knowledge Translation: With 100s of journals and thousands of publications every year, it takes time for research to disseminate to clinical practice. Discussion of current literature and its application to practice is the key to facilitating safe best practices.
  2. Create a Community of Practice: It requires many to take care of the few. Patient care is a team sport that starts pre-hospital, continues through the ED, and finally into the hospital.
  3. Improve Patient Care: Decrease suffering and improve patient oriented outcomes

“Learning is always rebellion…every bit of new truth discovered is revolutionary to what was believed before.” -Margaret lee Runbeck- Read more →

Simplifying Mechanical Ventilation – Part 3: Severe Metabolic Acidosis

18 Jun
June 18, 2018

Before I set up the ventilator, I consider if my patient has one of the following 3 physiologic processes: severe metabolic acidosis, an obstructive process (Asthma or COPD), or refractory hypoxemia. If my patient doesn’t fit into one of these 3 categories then I will default to placing them in the refractory hypoxemia category (Part 5), which is simply a lung protective strategy that will be appropriate for patients. In this part we will discuss setting up your ventilator for the patient with a severe metabolic acidosis. Read more →

Sodium Bicarbonate in Cardiac Arrest Management

15 Jun
June 15, 2018

Background: As with all medications in cardiac arrest (i.e. epinephrine, amiodarone) the benefits of sodium bicarbonate administration have been discussed and debated for decades. While it is clear that sodium bicarbonate can play a role in resuscitation of arrest due to hyperkalemia, it’s role in patients with acidemia resulting from or causing arrest is unclear. In theory, raising the pH may be beneficial but the use of bicarbonate increases serum CO2 which may be deleterious as it creates a respiratory acidosis. Despite the absence of good evidence, sodium bicarbonate continues to be used in non-hyperkalemic cardiac arrest management. Read more →

REBEL Cast Ep53 – GeriKet – Ketamine Analgesia in Older Adults

13 Jun
June 13, 2018

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. As awareness of geriatric oligo-analgesia has risen along with efforts to limit opioid utilization, interest in identifying a data set specific to this population has grown. The authors of this study sought to distinguish the performance and shortcomings of SDK in this unique patient group. Read more →

REBEL Cast Ep 52: A Nightmare Airway with Rob Bryant

11 Jun
June 11, 2018

In terms of airway management, cricothyrotomy is one of the most advanced airway procedures an ED physician will perform.  It is a last resort procedure when a patient is not able to be ventilated/oxygenated and/or intubated.  Typically, this procedure requires the identification of certain landmarks such as the cricothyroid membrane, but what if you can’t identify any landmarks?  What do you do?  We got Rob Bryant on the show to discuss some aspects of a recent nightmare airway case he had.  Read more →

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