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REBEL Cast Ep72: Systemic Alteplase in Stroke Mimics is Safe?

Background: Currently, alteplase is the mainstay of treatment of acute ischemic stroke.  Advocates of alteplase suggest that the benefit of alteplase is greatest when given early and declines with increasing time from stroke symptom onset (i.e. time is brain).  Therefore, the ...

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Neurology

Slide Design Tip: How Does an Eyedropper Improve Slides?

Have you ever wondered how to get your text color to match your image color?  It’s not hard and can make a good slide become an amazing slide.  Matching colors make consistent, professional-looking PowerPoint or Keynote slides.  The steps to ...

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Can a Novel Intervention Improve Patient Follow-Up After ED Discharge?

Background: Follow-up with a primary care (PC) provider is an important part of healthcare.  Many countries have a robust outpatient system, and the US is no different. However, in the US, there are many challenges to follow up including: appointment availability, insurance ...

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Comparison of Chemical vs Electrical Cardioversion of Acute Uncomplicated Atrial Fibrillation

Background Information: Atrial fibrillation is the most commonly encountered dysrhythmia in the emergency department (ED) and is associated with an increased long-term risk of stroke, heart-failure and all-cause mortality.1,2 In fact, the overall mortality rate for patients with atrial fibrillation is ...

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Cardiovascular

Another RCT of the Modified Valsalva Maneuver

Background: In patients with hemodynamically stable supraventricular tachycardia (SVT), vagal maneuvers are the traditional first step in management.  There are several  vagal techniques in the literature which include, standard valsalva maneuver (sVM), modified Valsalva maneuver (mVM), and carotid sinus massage (CSM). ...

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Cardiovascular

CRASH-3: TXA for ICH?

Background: Evidence from the CRASH-2 trial showed an absolute reduction in mortality of 1.5% (NNT = 67) in patients with extracranial bleeding treated with tranexamic acid  (TXA) within 3 hours of injury. However, CRASH-2 did not answer the question of ...

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Trauma

Critical Care Fundamentals: Management of Shock Part 2B

Shock is defined as circulatory failure leading to decreased organ perfusion.  In a shock state there is an inadequate delivery of oxygenated blood to tissues that results in end-organ dysfunction.  Effective resuscitation includes rapid identification and correction of inadequate circulation. ...

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Resuscitation

Does Lactated Ringers (LR) Raise Serum Lactate?

Background: Serial lactate measurements is a common core measure that we follow in septic shock resuscitation. A number of readers have written in enquiring about whether resuscitation with lactated ringers instead of 0.9% saline would lead to increases in serum lactate.   ...

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Endocrine, Metabolic, Fluid, and Electrolytes

REBEL Core Cast 19.0 – Acute Angle Closure Glaucoma

Take Home Points  Acute closed angle glaucoma is an ophthalmologic emergency that usually presents with sudden, painful, monocular vision loss. Physical exam will reveal conjunctival redness, corneal haziness or cloudiness due to edema and a pupil that is mid sized ...

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Head, Eye, Ear, Nose, and Throat

Critical Care Fundamentals: Management of Shock Part 2A

Shock is defined as circulatory failure leading to decreased organ perfusion.  In a shock state there is an inadequate delivery of oxygenated blood to tissues that results in end-organ dysfunction.  Effective resuscitation includes rapid identification and correction of inadequate circulation. ...

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Resuscitation
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