14 Aug 2014

August 14, 2014

Written by REBEL EM
A 52 year old female with a past medical history of type II diabetes mellitus and tobacco abuse presents with a chief complaint of chest pain. According to the patient she had about 2 - 3 months of stuttering, substernal chest pain without any radiation.  She described the pain as pressure-like, with activity, but that it would typically resolve after a few minutes of rest.  Today she awoke with substernal chest pain that never resolved and continued in the emergency department.  She quantifies her pain as 7/10 and not relieved with 2L nasal cannula of oxygen, 325mg PO aspirin, and SL NTG x3. BP 127/89     HR 76     RR 20      O2 sat 100% on 2L NC     Temp 99.3 Awake, A&Ox3, appears uncomfortable Mild JVD on examination RRR w/o m/r/g CTA B 2+ pulses in her extremities, no edema ECG is shown (No prior ECG for comparison).....
Medical Categories: Cardiovascular
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4 Aug 2014

August 4, 2014

Written by REBEL Cast
Welcome to REBEL Cast August 2014, where Matt, Swami, and I are going to tackle a couple more scenarios to help your clinical practice. Today, we are going to specifically tackle two different topics: Topic #1: Significance of Isolated Vomiting in Pediatric Minor Head Trauma Topic #2: Early Detection of Systemic Inflammatory Response Syndrome (SIRS) in the Emergency Department
Medical Categories: Pediatrics, Resuscitation
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11 Jul 2014

July 11, 2014

Written by REBEL EM
D-dimer has been shown to increase with age, which can cause a lower specificity (i.e. more false positive tests) in older patients. The result of this would be that older patients would often have more diagnostic imaging or downstream testing, but on the other hand, maybe a higher cut-off d-dimer value may lead to increased false negative cases (i.e. missed venothromboembolism) and make this strategy less safe. Recently, I wrote a post on age-adjusted d-dimer testing on REBEL EM, but since that post there was a new article that was published in Chest 2014. This post, will specifically focus on an update of age-adjusted d-dimer testing based on the above article.
Medical Categories: Hematology and Oncology
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1 Jul 2014

July 1, 2014

Written by REBEL Cast
Welcome to REBEL Cast Episode 1, where Matt, Swami, and I are going to tackle a couple of scenarios to help your clinical practice.  Today, we are going to specifically tackle two different topics:
  • Topic #1: Clinically Important Biphasic Anaphylaxis
  • Topic #2: Total Lymphocyte Count (TLC) as a Surrogate Marker for CD4 Counts
Medical Categories: Allergy and Immunology, Infectious Disease
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19 Jun 2014

June 19, 2014

Written by REBEL Cast
For those who haven't checked out the site already R.E.B.E.L. EM stands for Rational Evidence Based Evaluation of Literature in Emergency Medicine. (Edit: name changed 2/2016) The blog was launched in October 2013, and continues to grow every month, and with that growth we are excited to announce the introduction of REBEL Cast. 
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