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

August 14, 2014

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).....

August 11, 2014

Acute and recurrent pericarditis are frequently diagnosed in the emergency department.  Traditionally, treatment has consisted of anti-inflammatory medications (eg. ASA or NSAIDs) or corticosteroids.  Colchicine is an underutilized therapy for pericarditis and provides significant benefit when combined with NSAIDs/ASA. Addition of colchicine to standard therapy results in earlier reduction in pericarditis symptoms, greater remission at 1 week, and reduces the rate of recurrent pericarditis. Let's review the literature for colchicine for treatment of pericarditis.

August 7, 2014

Renal colic is a common ED presentation. Rarely does a day go by that we don’t see a patient rocking and rolling in acute renal colic. Dan Firestone makes an impassioned argument against the use of CT scanning for diagnosis of renal colic so I won’t address that here. Once we make a diagnosis, our primary goal in the ED is pain relief. Then we turn our attention to disposition planning, follow up and outpatient medications. The majority (90%) of stones will pass spontaneously but it would be nice if we could:
  1. increase the passage rate
  2. shorten the time to passage.
This could potentially reduce ED revisits, reduce the number of invasive procedures and make happy patients. So does the use of tamsulosin in renal colic facilitate stone passage?

August 4, 2014

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