Archive for category: Clinical

February 2017 REBEL Cast: The All Hyperoxia Edition

20 Feb
February 20, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Many providers and health care workers place oxygen on patients as a way to overcome hypoxemia or for patient comfort. Also in STEMI patients, many of us have learned the mnemonic “MONA” to remember the treatments for acute coronary syndrome. MONA stands for morphine, oxygen, nitroglycerin, and aspirin. […]

Chemical Sedation of the Agitated Patient

16 Feb
February 16, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Acutely agitated and aggressive patients have become an unfortunate commonality in emergency departments throughout the world.  They are often the most difficult patient encounters during a shift. Initially, when these patients’ present, medical providers are trying to figure out the underlying etiology including organic, psychiatric, or drug related illness.  […]

Outcomes After Aggressive Management of Recent-Onset Atrial Fibrillation in the ED

13 Feb
February 13, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Atrial fibrillation (AF) is one of the most common dysrhythmias encountered in the ED. The management of recent-onset AF and atrial flutter (AFl) in the ED continues to be debated. The discussion centers on whether patients with recent-onset AF should be rhythm controlled (e.g. converted back to sinus […]

Normalization of Vital Signs Does Not Reduce the Probability of Pulmonary Embolism

09 Feb
February 9, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit Pocket Background: In patients with symptoms of pulmonary embolism (PE), we often turn to vital signs, including heart rate, respiratory rate and pulse oximetry, as part of our initial impression of the patient.  Before even considering further testing, such as d-dimer or CTPA, we look first at the vital signs […]

The Ketorolac Analgesic Ceiling

19 Jan
January 19, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Ketorolac is a commonly used parenteral analgesic in the Emergency Department (ED) for a variety of indications ranging from musculoskeletal injuries to renal colic. This non steroidal anti-inflammatory drug (NSAID) is available in oral, intranasal and parenteral routes. Ketorolac has a number of side effects including nausea, vomiting, […]

Alpha Blockers in Renal Colic: A Systematic Review

16 Jan
January 16, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Ureteric (renal) colic is a common, painful condition encountered in the Emergency Department (ED). Sustained contraction of smooth muscle in the ureter as a kidney stone passes the length of the ureter leads to pain. The majority of stones will pass spontaneously (i.e. without urologic intervention). For over […]

Intraosseous (IO) Needle Length in Obese Patients

09 Jan
January 9, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Intraosseous (IO) access can play an important role in the resuscitation of the critically ill patient to help expedite delivery of critical medications (i.e. RSI). Much like with peripheral or central access, obesity can present a challenge to placement of an IO as accurate placement relies on use of […]

The PEAPETT Trial: Half Dose tPA for PEA due to Massive Pulmonary Embolism

05 Jan
January 5, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Anyone who has run a code, knows that pulseless electrical activity (PEA) during cardiac arrest has a worse prognosis compared to patients with shockable rhythms.  In patients with suspected massive PE as the cause of their cardiac arrest the Advanced Cardiac Life Support (ACLS) and American Heart Association […]

Question Tradition: Glucagon for Food Boluses

02 Jan
January 2, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: How many of you have had this scenario…patient comes into ED, just ate a big steak and now they can’t swallow.  You call gastroenterology, who asks… “Did you try glucagon yet?” OK, well maybe not exactly like that, but you get what I am asking.  Esophageal foreign body […]

December 2016 REBEL Cast: Obstructive Left Main Coronary Artery Disease

19 Dec
December 19, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketThe standard treatment for patients with obstructive left main coronary artery disease has typically been coronary-artery bypass grafting (CABG), however some newer trials have suggested that maybe drug-eluting stents may be an acceptable alternative to CABG in select patients. In this episode we will be reviewing the two most […]

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