Author Archive for: srrezaie

The BEST AF Trial: What is the Optimal Energy Selection for Cardioversion in Patients with Afib?

23 Apr
April 23, 2018

Background:There are two trains of thought in using transthoracic direct current cardioversion (DCCV) when it comes to converting atrial fibrillation.  The first is an escalating energy approach which allows cardioversion to occur at the lowest energy for each individual patient and potentially decrease post-shock arrhythmias.  The second train of thought is to start at the highest energy approach in order to minimize total number of shocks delivered and duration of the procedural sedation.  There is a considerable variation in practice that exists as I recently discovered based on conversations on social media.  The authors of this study aimed to compare an escalating energy protocol starting at 100J with a non-escalating energy protocol of 200J to establish the efficacy and safety of both practices of cardioversion using biphasic DCCV of atrial fibrillation. Read more →

Stroke Workflow in 2018

22 Apr
April 22, 2018

With the publication of the DAWN and DEFUSE-3 trials came a new era in stroke management.  We have discussed the specific literature pertaining to endovascular therapy on REBEL EM before in our 2hour CME activity HERE.  Along with the two new publications came the 2018 AHA/ASA guidelines for endovascular therapy in acute ischemic stroke.  Anand Swaminathan and myself wanted to place a stand alone post on the workflow of stroke in 2018.  Read more →

Bougie 1st Intubation in the ED?

19 Apr
April 19, 2018

Background: Successful first-pass endotracheal intubation is the desired outcome of all ER physicians as this can stave off hypoxemia and aspiration.  The bougie is one tool we have in our armamentarium that may be able to help with intubation. Many providers use this device as a rescue device after a failed attempt at intubation, instead of as a primary device in intubation.  This study sought to investigate the use of the bougie as a primary intubation device (Bougie 1st Intubation) in the ED instead of as a backup or adjunct in the ED. Read more →

The SIRS & qSOFA Confusion in Sepsis

16 Apr
April 16, 2018

Background: It is well established that the rapid identification of patients with sepsis is needed in order to initiate timely care to improve morbidity and mortality.  The systemic inflammatory response syndrome (SIRS) criteria have been used for some time for screening, however the sensitivity and specificity of these criteria have been brought to question based on recent evidence [2]. This may have been one of the many reasons why the Sepsis-3 task force recommended the quick sequential (Sepsis-related) organ failure assessment (qSOFA) for prediction of mortality in sepsis. qSOFA consists of low blood pressure (SBP ≤100mmhg), increased respiratory rate (≥22bpm), and altered mental status (GCS ≤14).  2 or more of these criteria indicates  an increased risk of death.  There have been several studies calling into question the sensitivity of this criteria.  In this post, we will review a recent systematic review and meta-analysis assessing the prognostic value of qSOFA vs SIRS in adult patients with suspected infection in the ED, hospital wards, and the ICU. Read more →

REBEL Cast Ep 48: Octreotide and Somatostatin for Undifferentiated Upper Gastrointestinal Bleed

13 Apr
April 13, 2018

Recently I was asked to speak at the Texas College of Emergency Physicians (TCEP) conference April 2018.  The particulars of this session were, five, 10 minute lectures on new indications for old drugs.  My topic was the use of octreotide and somatostatin for undifferentiated upper gastrointestinal bleeding.  This is a particular topic I have been getting more and more requests for, but didn’t really know the evidence behind why I was doing it.  Does it help my patients or just another expensive medication, that takes up an IV with no clear patient oriented outcome? Read more →

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