January 5, 2021

“A little starvation can really do more for the average sick man than can the best medicines and the best doctors.” -Mark Twain- Let me start off by saying, this is not a typical blog post for REBEL EM.  This is a post about a personal journey for me.  Anyone who follows me on my personal Facebook page knows I have been on a journey toward a healthier life over the past 4 years or so.  I used to weigh 240lbs (109kg) and was able to get my weight down to 205lbs (93kg) with carefully changing my diet and being more cognizant of my daily exercise.  I however hit a plateau. As my journey has continued, I began to read a lot more about intermittent fasting. I figured let’s give it a shot. Well, the rest as they say is history.  The transformation has been amazing with a further drop in my weight to 180lbs (82kg). As I have been sharing this with others, I have received lots of questions about this and wanted to share what I have learned about it in the hopes of helping others realize their own health journey. First let me start off by saying if you want to learn more consider reading The Complete Guide to Fasting (Heal Your Body Through Intermittent, Alternate-Day, and Extended Fasting [Link is HERE]. This is a phenomenal book on all the ins and outs of intermittent fasting and I highly recommend it for anyone interested in this topic.

December 28, 2020

Background: Blunt cerebrovascular injury (BCVI) is defined as carotid or vertebral artery injury due to blunt trauma.  There are several screening criteria that have been developed to screen for this injury, however a significant number of patients may still be missed by these screening criteria. Although this is not a common injury, the potential complications if undiagnosed and untreated can be devastating. Current screening criteria (see below) have been refined and expanded over the years, but just how good are they?

December 20, 2020

Background: Despite continued focus on equity in healthcare, it has yet to be realized in the United States. Healthcare can be considered a microcosm of society where resources are not allocated fairly among the population.  A recent editorial in the NEJM demonstrates that even equipment designed to give objective information can harbor important biases.  Pulse oximetry is a diagnostic tool that is ubiquitous in hospitals.  Triage and oxygen therapy administration decisions are made based on the readings from pulse oximetry. The development and validation of this tool was not performed in racially diverse populations but how this impacts the obtained information is unknown.

December 19, 2020

Back in April 2020, on REBEL Cast episode 79 we sat down to discuss COVID-19.  Specifically, we focused on not intubating patients early and why ARDSnet may not be the best ventilator paradigm for patients with COVID-19.  By popular demand, we decided to follow up on this podcast.  We are now just about 9 months since we recorded this podcast and I wanted to sit down with the same group and see if they had any amendments, they wanted to make regarding what we discussed.

December 17, 2020

Background: Intravenous alteplase is the current standard care for treatment of acute ischemic stroke (AIS) despite active debate on the research supporting its use.  The window for its use has been restricted to <3h of symptom onset based on the results of the NINDS trial and extended to a time window of <4.5h based on the results of the ECASS-3 trial. Both studies excluded patients with unknown time of onset and these patients are excluded from consideration for thrombolytics in real life as well. These trials are the only randomized studies showing benefit of intravenous alteplase vs placebo in acute ischemic stroke to date.  Of note, both of these trials have undergone reanalysis calling the validity of their results into question.  Despite which side of the debate you fall on, stroke care has moved on with advanced perfusion imaging and thrombectomy in large vessel occlusion strokes. Increased use of perfusion imaging has challenged the idea that time is a critical determinant of which patients should be considered for thrombolytics.