25 Mar 2020

March 25, 2020

Written by REBEL Cast, REBEL Core
Take-Home Points
  1. Before starting a neonatal resuscitation, take some deep breaths to calm yourself
  2. Call in your friends - get a second team to manage the mother, call OB, call the NICU - all hands on deck
  3. Anticipate the equipment you'll need, get it to the bedside and don't forget to turn the warmer on
  4. Assign roles so everyone knows what they're supposed to do
  5. Initiate transfer to a NICU as soon as possible
Medical Categories: Pediatrics, Resuscitation
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23 Mar 2020

March 23, 2020

Written by REBEL Reviews

Background: The publication of the MR CLEAN trial in January 2015 changed the face of ischemic stroke care. This was the first study demonstrating a benefit to endovascular treatment of a specific subset of ischemic stroke patients: those with a large vessel occlusion (LVO) presenting within 6 hours of symptom onset. MR CLEAN was followed by a flurry of publications seeking to replicate and refine treatment as well as expand the window for treatment. The REBEL team reviewed this literature back in 2018 and, with the help of Dr. Evie Marcolini, created the below workflow:

Medical Categories: Neurology
1 Like
11 Mar 2020

March 11, 2020

Written by REBEL Cast, REBEL Core
Vascular Disasters Take Home Points
  1. Consider vascular pathologies in all of your patients with atraumatic limb pain - especially those with typical and atypical risk factors
  2. Early diagnosis is imperative. Time is tissue. Catch this as early as possible. Pain is the earliest symptom. First presents with pain then paresthesia then paralysis
  3. Perform vascular exam on every patient with pain
  4. If concerned for ischemic limb, call the vascular surgeon and get patient to CT for imaging of aorta and affected limb. 
Medical Categories: Cardiovascular
2 Likes
26 Feb 2020

February 26, 2020

Written by REBEL Cast, REBEL Core
Take Home Points 
  • No palpable pulse does not equal no perfusion. We aren't great at feeling pulses
  • Patients with moderate to severe signs and symptoms of lithium toxicity should be considered for hemodialysis
  • Always consider serious causes of back pain before simply treating with analgesics
  • Consider trauma as well as other toxic exposures (I.e. CO and CN) in patients with major burns
Medical Categories: Resuscitation, Toxicology
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12 Feb 2020

February 12, 2020

Written by REBEL Cast, REBEL Core
Take-Home Points
  1. Endocarditis can have vague and varied presentations and has high morbidity and mortality. Be on the lookout in patients with risk factors including: 
    1. Congenital heart disease
    2. Cardiac prosthesis or devices
    3. Immunocompromise
    4. IV drug use
    5. Recent invasive procedure
    6. Hx of prior IE
  2. Patients may present with fever, sepsis of unclear source or may have manifestations of emboli to the skin, eyes, brain, lungs, spleen or kidney.
  3. Diagnosis is based on the modified Duke Criteria and workup should include THREE good sets of blood cultures. 
  4. ED management includes consultation with ID and cardiothoracic surgery and starting antibiotics based on whether the patient has a native or prosthetic valve. Basic starting antibiotic regimen includes:
    1. For patients with native valve disease a good starting regimen is:
      1. Vancomycin 25-30 mg/kg IV loading dose followed by 15-20 mg/kg twice daily AND
      2. Cefepime 2 g IV TID
    2. For patients with prosthetic valve disease, we have to go a bit bigger:
      1. Vancomycin 25-30 mg/kg IV loading dose followed by 15-20 mg/kg IV twice daily AND
      2. Rifampin 300 mg PO/IV TID AND
      3. Gentamicin 1 mg/kg IV TID AND
      4. Some recommendations include the Cefepime 2 g IV TID
Medical Categories: Cardiovascular, Infectious Disease
2 Likes
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