July 11, 2019

REBEL EM has been committed to critical appraisal of current research with application at the bedside to improve patient care. The constant influx of new published research makes it difficult to stay current with the latest and greatest. We had our 2nd annual Rebellion in EM conference from June 28th - 30th, 2019 in San Antonio, TX.  The opening keynote on day 3 of the conference was given by Anand Swaminathan, MD on the most powerful words in medicine. As emergency clinicians, our words matter. Some words, though, matter more than others. Here we explore the most powerful words in medicine, why they are so powerful and how understanding their power can help us develop and grow.

July 8, 2019

REBEL EM has been committed to critical appraisal of current research with application at the bedside to improve patient care. The constant influx of new published research makes it difficult to stay current with the latest and greatest. We had our 2nd annual Rebellion in EM conference from June 28th - 30th, 2019 in San Antonio, TX.  The opening keynote on day 2 of the conference was given by myself, on the impact we have on our patients & the impact they have on us. We see thousands of patients a year…we are kind, professional, and get the job done. But every once in a while, perhaps only a couple times a year…there is a patient, or family that we really connect with. There’s no real “science” behind what selects out some people from the flocks of other patients that we see. For me, the story I’m about to share with you is about a patient that I personally connected with. He and his family opened up my eyes about the importance of human connection. He reminded me why we do what we do, and it’s important to learn from the patients’ perspective…that our interaction with them can also leave a long lasting impact.”

July 1, 2019

EMS rolls in with a 28 year-old male brought in for severe agitation after being found smashing glass bottles in the street. As police approached him, he cut himself with the broken glass and was bleeding significantly, though they could not fully evaluate his wounds due to his agitation. He was restrained by 6 officers and brought to you without IV access. He is thrashing around on the gurney in 4-point restraints, with blood soaking through the gauze bandages on his arms. What do you do?

June 3, 2019

Background: Despite the lack of replication of the NINDS & ECASS-3 trials, guidelines recommend the use of tPA in the ≤4.5hr window after the onset of symptoms of acute ischemic stroke [2]. These recommendations used non-contrast computed tomography (NCHCT) for the selection of patients.  More recent endovascular studies have shown that perfusion-based imaging can show potential viable brain tissue beyond the 4.5 hour mark in patients with large vessel occlusions and result in good neurologic outcomes.  This advance has prompted investigators to look at perfusion-based technology to identify a larger cohort of patients without large vessel occlusion that may be candidates for systemic thrombolysis.  One of the big fears in stroke management is the concept of indication creep: finding more uses for a medication or product without strong evidence to support its use. The bigger question is, does this increase in use help the company’s bottom line or the patient? It is no wonder physicians are skeptical of industry sponsored trials, as we sometimes question the motives behind the study.  Now we have another industry sponsored trial: EXTEND. In this trial.

May 27, 2019

Background: In 2000, the U.S. achieved the elimination of measles, defined as the absence of sustained transmission of the virus for more than 12 months [3,7]. Unfortunately, this success was short lived.  According to the CDC, 555 cases of measles have already been confirmed from Jan 1st – April 11th, 2019 [3]. This resurgence in measles is frustrating as it has a safe and highly effective vaccine, and it has no animal reservoir to maintain circulation.  Failure to get vaccinated unfortunately stems from misconceptions about vaccine safety (i.e. the now-debunked claim connecting vaccination to autism [4,5]), poor health education, lack of access to health care, and complacency.  This is now a global epidemic as disease does not respect borders.
0