October 19, 2015

Background: Acetaminophen (paracetamol) is commonly used to lower the temperature of patients with fever suspected to be causeed by an infection in both homes across the world and the hospital. There are, however, opposing theories to the utility of decreasing fever in these situations. One side argues that fever places “additional physiological stress on patients,” who are already ill (Young 2015). Removing this source of increased metabolic demand would allow the body to allocate additional resources to fighting infection, respiratory function etc. On the other hand, fever may “enhance immune-cell function” and inhibit further growth and spread of an infecting pathogen (Young 2015). From a simple evolutionary standpoint, fever, which entails a significant cost likely evolved and persists because it benefits the host. To date we don’t have high-level evidence that acetaminophen treatment of fever due to probable infection is beneficial, ineffective, or harmful.

October 15, 2015

There has been a lot of debate over the recent years about the safety of crystalloid fluid therapy in acutely ill patients. Several observational studies have shown an increased risk of acute kidney injury (AKI)  with the use of normal saline (NS). Other observational studies have shown a decreased risk of AKI when using a buffered solution (Hartmann’s solution, Plasma-Lyte (PL)). What is the best fluid to give to our patients who need fluid resuscitation? The answer to this question is not known, but another step in finding the answer was taken with the release of the SPLIT trial online by JAMA on October 7, 2015.

October 12, 2015

Background: Every year there are a handful of “game changing” publications that truly change how we care for our patients. One such paper was a paper by Scott Weingart and Richard Levitan in the Annals of Emergency Medicine in 2011 on the topics of preoxygenation and apneic oxygenation (This paper was already reviewed on REBEL EM – Preoxygenation and Apneic Oxygenation). As many of us know, one of the most common and feared complications dealt with in critically ill patients requiring endotracheal intubation is hypoxemia. Hypoxemia can subsequently lead to cardiac arrest and death. Since the advent of apneic oxygenation this common complication seems to have decreased in occurrence, but is apneic oxygenation effective in all settings?

October 8, 2015

Welcome to the October 2015 REBELCast, where Swami, Matt, and I are going to tackle a couple of topics in the world of Trauma, specifically ED Thoracotomy. Now we all know that ED thoracotomy is a last ditch salvage effort, performed under specific clinical circumstances, during a traumatic arrest. The purpose of the ED thoracotomy is to evacuate pericardial tamponade, control hemorrhage, improve coronary/cerebral blood flow, and if needed internal cardiac massage. The purpose of this podcast is to discuss specific indications where this already low yield procedure may have some benefit.
  • Topic #1: FAST US Examination as a Predictor of Outcomes After Resuscitative Thoracotomy
  • Topic #2: Blunt Trauma Thoracotomy

October 5, 2015

I recently gave a talk at my old alma mater (Texas A&M College of Medicine) on creating a Professional and Scholarly Community with FOAM in early September of 2015.  One of the things I was most amazed by was how many people had not heard of the concept of FOAM, but more importantly the number of questions I received after my talk on how to get started and how to consume FOAM.  Now many people in the FOAM world have posted blog posts, videos, and even podcasts on how to do this, but I thought I would write a blog post on how I keep up and stay organized for anyone who is new to the FOAM world or if someone simply asks you how to get started feel free to just refer them here.