February 4, 2015

In the United States, trauma is the leading cause of death among patients between the ages of 1 and 44 years of age and the third leading cause of death overall. Approximately 20 to 40% of trauma deaths occur after hospital admission and are a result of massive hemorrhage.  There have been no large, multi-center, randomized clinical trials with survival as a primary end point that support optimal trauma resuscitation practices with approved blood products and therefore there are many conflicting recommendations. The Prosective Observational Multicenter Major Trauma Transfusion (PROMMT) Trial demonstrated that many clinicians were transfusing patients with blood products in a ratio of 1:1:1 or 1:1:2 and that early transfusion of plasma was associated with improved 6-hour survival after admission. The Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial was designed to address the effectiveness and safety of 1:1:1 transfusion ratio vs 1:1:2 in patients with trauma who were predicted to receive a massive transfusion.

February 2, 2015

Background: Hyperkalemia is the most common electrolyte disorder seen in the Emergency Department and treatment of hyperkalemia is core knowledge of EM training for interns and focuses on:
1) Stabilization of cardiac myocytes with calcium salts
2) Temporary shifting of potassium into cells (insulin, beta agonists, normal saline,
      magnesium, sodium bicarbonate)
3) Removal of potassium from the body (i.e. loop diuretics, cathartics)
4) Definitive Treatment (i.e. Hemodyalisis)
Although there is still some debate on the first two areas (i.e. is there truly a role for sodium bicarbonate?) our focus will be on the removal part of the algorithm, specifically, is there a role for kayexalate?

January 10, 2015

Welcome to the January 2015 REBELCast, where Swami and I are going to tackle a very important scenario that comes up in the daily practice of not only Emergency Medicine, but also in Medicine.  Today we are going to specifically tackle one topic: Topic: Is the use of cephalosporin antibiotics in patients with a history of penicillin class antibiotics safe?

January 5, 2015

Background: Streptococcal pharyngitis is a common presentation to primary care and Emergency Department physicians. Every year, 10 million patients in the United States are treated with antibiotics for pharyngitis. However, less than 10% of these patients actually have strep pharyngitis (Barnett 2013). Prescribing of antibiotics for these patients centers on three arguments:
  1. Antibiotics reduce symptomology
  2. Antibiotics reduce the rate of suppurative complications
  3. Antibiotics reduce the rate of non-suppurative complications (primarily Rheumatic Heart Disease).
So, do patients with strep throat need to be treated with antibiotics?

September 2, 2014

Welcome to the September REBELCast 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: The use of Non-Invasive Positive Pressure Ventilation (NIPPV) in the Pre-Hospital Treatment of Patients with Severe Respiratory Distress Topic #2: Once Weekly Dalbavancin for Skin Infections