Background: With hundreds of journals, and thousands of publications in any given month it is near impossible to sift through all the current medical literature and hope that you find the most pertinent articles that could impact practice. One of the key mission statements of REBEL EM is cutting down the knowledge translation of research to clinical application (i.e. bench to bedside). In the keeping up in EM series, we critically appraise and review some of the most relevant literature over the past year. Read more →
Author Archive for: srrezaie
Concern regarding the Surviving Sepsis Campaign (SSC) guidelines dates back to their inception. Guideline development was sponsored by Eli Lilly and Edwards Life Sciences as part of a commercial marketing campaign (1). Throughout its history, the SSC has a track record of conflicts of interest, making strong recommendations based on weak evidence, and being poorly responsive to new evidence (2-6). Read more →
I was working a busy shift in the ED, like many of us do, and the next patient I was going to see was a 57 year old male with no real medical problems complaining of chest pain. I remember thinking as I walked into the room this guy looks ashen and diaphoretic….he doesn’t look well. He is a paramedic telling me how he has been having off and on chest pain for the past several months. He just had a stress test two months ago that was “negative”. Today he was working on his pool and developed the same chest discomfort as he had been having off and on the past several months, but today, the pain would just not go away. In his mind, he thought this might be an ulcer and just needed some Pepcid to help. He got put on the monitor and an ECG was run…
The patient involved in this case has given permission to share the story, and relevant images with the knowledge that this information will be used for the purposes of education.
Background: There has been lots of research published in past years on how to minimize pain and anxiety in children brought to the ED. Unfortunately, as we all know there is often a lag time from research publication to clinical application. It has been my experience that health care professionals tend to provide inconsistent and inadequate pain control for children. In this episode of REBEL Cast we are going to interview Sebrina Perkins, a pediatric emergency medicine physician working for the Greater San Antonio Emergency Physicians (GSEP) group, on pediatric pain management pearls. Read more →
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 →