REBEL Review 93: Myasthenia Gravis

Created December 28, 2019 | Neurology | DOWNLOAD

REBEL Review 92: Identification & Treatment of Spontaneous Bacterial Peritonitis

Created December 26, 2019 | Abdominal and Gastroinstestinal | DOWNLOAD

December 23, 2019

Background: Dealing with a patient in status epilepticus, refractory to treatment with benzodiazepines, can be a sphincter tightening ordeal.  While most seizure activity responds to appropriately dosed benzodiazipines, some will not respond. The choice of second line medication has been hotly debated (i.e. Levetiracetam, fosphenytoin, and valproate).  One of the key aspects of management of status epilepticus is early termination.  The longer the seizure continues, the more likely patients can have cardiac/respiratory complications, brain injury, rhabdomyolysis, hyperkalemia, and acidosis. Thus, prompt termination of seizure activity with second line agents is critical. Despite recent pediatric studies (ConSEPT, ECLIPSE etc) there is limited guidance on the efficacy or safety of second line mediations for status epilepticus.

December 19, 2019

Background: E-cigarettes or “vapes” are now the most popular tobacco product among US teens and are used by 20% of all high-schoolers2. Vapes are used to heat and vaporize a liquid (e-juice or vape juice) that may contain nicotine, tetrahydrocannabinol (THC), cannabidiol (CBD), or ultraconcentrated THC resin (hash oil, wax, or dabs.)3. Since their introduction, vaping devices have been studied for the numerous potentially harmful chemicals they can introduce into users, including: heavy metals (cadmium, nickel, lead), plastic-related toxic gases (like cyanide and phosgene), volatile organic compounds, ultrafine particles, and diacetyl flavoring (linked to a chronic pulmonary syndrome known as ‘popcorn lung,’ which is not as appealing as it sounds)4. More recently, a spectrum of lung illnesses related to vaping have become the focus of a national public health investigation. These cases have been described in almost every US state since early summer 2019; as of November 2019, there have been over 2000 cases of ‘Vaping-Associated Lung Injury’ (VALI) reported to the CDC, with 42 associated deaths. The article discussed below is a large case series from the Midwest depicting the clinical characteristics and outcomes of patients with VALI from April to August 2019.  Since then, several more epidemiological and analytical investigations have been published, and studies are ongoing to clarify the causes and best treatments for this disorder. We chose this article for REBEL EM because it represents a well-done early investigation of an emerging epidemic which contributed valuable clinical insights for emergency medicine practice.

December 18, 2019

Take Home Points

  • Important as front line providers to know research and data behind stroke care
  • Patients eligible for endovascular care are those with large vessel occlusion in the anterior circulation - anterior cerebral artery, middle cerebral artery, distal intracranial carotid artery and they have to have perfusion mismatch (small infarcted core with a large penumbra).