March 1, 2020

The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019.  The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic.  The spread of this virus is now global with lots of media attention.  The virus has been named SARS-CoV-2 and the disease it causes has become known as coronavirus disease 2019 (COVID-19).  This new outbreak has been producing lots of hysteria and false truths being spread, however the data surrounding the biology, epidemiology, and clinical characteristics are growing daily, making this a moving target.  This post will serve as a summary of airway management in regards to COVID-19. 

February 27, 2020

A 57-year-old man is watching his son’s baseball game when he suddenly collapses. Witnesses did not appreciate a pulse, so they started CPR. Unfortunately, an AED was not available. EMS was called and when they arrived within minutes the patient was found to be in vfib arrest and was defibrillated. When the patient arrived to the hospital, he was in PEA arrest. Ultrasound of the patient’s heart showed some coordinated cardiac activity. ACLS doesn’t really tell us how to proceed with cardiac activity but not enough to generate a pulse on the monitor.

February 26, 2020

Take Home Points 
  • No palpable pulse does not equal no perfusion. We aren't great at feeling pulses
  • Patients with moderate to severe signs and symptoms of lithium toxicity should be considered for hemodialysis
  • Always consider serious causes of back pain before simply treating with analgesics
  • Consider trauma as well as other toxic exposures (I.e. CO and CN) in patients with major burns

February 24, 2020

Background: Critical illness and ICU admission comes with significant consequences – not just from the primary pathology but also from the secondary effects of therapies that may be begun to correct the abnormal physiology. One of these consequences in ventilated patients is the development of stress ulcers in the gastrointestinal tract, leading to bleeding. Over two-thirds of patients admitted to the ICU will be prescribed some form of stress ulcer prophylaxis, often in the form of either a proton pump inhibitor (PPI) or a histamine-2 receptor blocker (H2RB)1. But which one is better? Are there any risks? The existing evidence of benefit of one over another is limited. Though one systematic review did show a benefit of PPIs, the reviewed data was limited2. Neither drug is without risk either. These include a potential for immunosuppression and increased risk of infections3. More evidence is needed – which is where the Proton Pump Inhibitors vs Histamine-2 Receptor Blockers for Ulcer Prophylaxis Treatment in the Intensive Care Unit (PEPTIC) randomized clinical trial comes in4.

February 20, 2020

The REBELEM Team is proud to provide you with a Critical Care Education Curriculum that can be used for your residents, medical students, advanced providers as well as many other learners during their rotation. We realize now, more than ever, that providers are under high pressure to perform clinically in high stress environments like the Emergency Department and the Intensive Care Unit and provide high quality education at the same time. Our team would like to provide you with a quality resource to help you deliver a fun, dynamic, multimodal curriculum to your learners.