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All Categories
  • All Categories
  • Abdominal and Gastrointestinal
  • Allergy and Immunology
  • Cardiovascular
  • Dermatology
  • EMS and Disaster
  • Endocrine, Metabolic, Fluid, and Electrolytes
  • Environmental
  • Ethical and Legal
  • Head, Eye, Ear, Nose, and Throat
  • Hematology and Oncology
  • Human Behavior
  • Infectious Disease
  • Neurology
  • Obstetrics and Gynecology
  • Orthopedics
  • Pediatrics
  • Procedures and Skills
  • Psychiatry/Behavioral Health
  • Renal and Genitourinary
  • Resuscitation
  • Team Performance
  • Thoracic and Respiratory
  • Toxicology
  • Trauma

The Great Debate Between Balanced and Unbalanced Crystalloids Continues

Background: Although the debate over balanced (i.e. lactated ringers, PlasmaLyte) vs unbalanced (i.e. 0.9% saline) crystalloids has not been settled, fluid resuscitation continues to be a fundamental therapy given to critically ill patients.  0.9% saline is one of the most common ...

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Endocrine, Metabolic, Fluid, and Electrolytes

Still Worthless – Orthostatic Vitals and 30-Day Outcomes

Background: Syncope and presyncope are common presenting complaints to the Emergency Department. Orthostatic vital signs are often included in the ED evaluation of syncope to assess for volume depletion despite their poor performance characteristics as previously discussed. In particular, it ...

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Cardiovascular

If You’re Going to do the Thoracotomy…do a Clamshell

Every now and again someone raises the issue on social media about resuscitative thoracotomy.  What are the indications (we have the EAST guidelines for that), what are the risks (highlighted in this important recent paper), and of course, whether EM ...

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Trauma

REBEL Core Cast 9.0 – Pediatric Status Epilepticus

Pediatric Status Epilepticus Shownotes Definition: Seizure that has been going on for >5 minutes OR recurrent seizures without return to baseline. If the patient was seizing at home and still seizing when they get to the ED, consider it to ...

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Pediatrics

FLORALI-2: Non-Invasive Ventilation (NIV) vs High-Flow Nasal Cannula (HFNC) as Pre-Oxygenation Prior to Intubation

Background:Tracheal intubation is a common procedure performed on critically ill patients. In these patients, there is a high risk of life-threatening complications associated with the procedure, with severe hypoxemia being one of the more common. Development of severe hypoxemia, in turn, ...

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Resuscitation

Endovascular Therapy for Acute Ischemic Stroke: The New Shiny Toy in Stroke Care?

The shiny new toy in stroke treatment is endovascular therapy.  There have now been 12 randomized controlled trials (RCTs) on endovascular stroke therapy (EST), with eight of the last nine showing positive results – stunningly positive.  This flood of positive ...

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Neurology

Tramadol or Tramadont

Background: Multiple guidelines recommend tramadol or NSAIDs as 1stline treatment for patients with osteoarthritis (OA).  Tramadol is viewed as a weak opioid because it binds to the mu receptor at a significantly lower affinity than morphine.It also inhibits the reuptake of serotonin ...

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Trauma

Contrast Induced Nephropathy: A Modern-Day Medical Myth

Background: Computed tomography (CT) scans using IV contrast agents are one of the most common imaging modalities used in the emergency department (ED). The reason for this is no secret. CT scans with IV contrast offer a large amount of information ...

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Renal and Genitourinary

REBEL Core Cast 8.0 – The NEJM + Non-Inferiority Studies

Take Home Points on Non-Inferiority Studies Non-inferiority studies should be done when a new treatment (or diagnostic modality) requires less resources (cost or time), is easier for the patient or has a lower side-effect profile. Non-inferiority study design largely negates ...

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Extending the tPA Window to 4.5 – 9 Hours in Acute Ischemic Stroke (AIS)?

Background: No matter which side of the debate you sit on in regard to systemic thrombolysis in acute ischemic stroke (AIS), there is one truth: systems have undergone major changes to ensure tPA is offered to patients in the ≤4.5-hour window.  ...

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Neurology
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