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Simplifying Mechanical Ventilation – Part I: Types of Breaths

Mechanical Ventilation is a modality commonly used in the critically ill, but many providers, may not have a strong understanding of the basics. Emergency Medicine and Critical Care Physicians need to have a firm grasp of the basic concepts of ...

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Thoracic and Respiratory

(Dis)utility of Orthostatics in Volume Depletion

Definition: Orthostatic hypotension (OH) is a form of low blood pressure that occurs with positional change (i.e. sitting up from lying down, standing up from sitting). It is commonly used for the diagnosis of volume depletion Orthostatic Vital Signs A ...

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Cardiovascular

Milk of Amnesia (Propofol) for Pediatric Migraines?

Background: There are several classes of medications available to treat pediatric migraines and because of this many providers have different combinations that they like to use.  Typically, NSAIDs, anticholinergics, and dopamine antagonists are used with varying degrees of success.  There ...

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Neurology

Is the Great Debate Between Balanced vs Unbalanced Crystalloids Finally Over?

Background:  Normal Saline (NS) is one of the most commonly used IVFs in resuscitation today.  The use of balanced vs unbalanced crystalloids has been one of the biggest debates in resuscitation of the critically ill in recent history due to ...

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Endocrine, Metabolic, Fluid, and Electrolytes

REBEL Cast Ep 46a – Respiratory Failure and NIV with Haney Mallemat

Imagine you have a patient in respiratory failure sitting right in front of you. The patient has an increased work of breathing and obviously in distress.  Monitors are beeping, nurses are asking you what you want to do, and if ...

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Thoracic and Respiratory

More Trials Showing Harm of Opioids in ACS…or do They?

Background: Typical medical treatment of ACS patients include dual antiplatelet therapy (DAPT) and revascularization with primary percutaneous coronary intervention (PPCI).  Nitroglycerin is first line therapy in the treatment of pain in ACS with morphine as a common adjunct. Morphine helps ...

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Cardiovascular

Is it PROPER to PERC it Up?

Background: The diagnosis of PE is a tricky thing.  We want to limit over-testing patients and therefore, over-diagnosis. On the other hand, we don’t want to limit testing so much that we miss the diagnosis where treatment would make a ...

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Thoracic and Respiratory

Peripheral Vasopressors: Safe or Dangerous?

Background: We have discussed the safety of peripheral vasopressors on REBEL EM before. In that review by Loubani et al was a systematic review of 85 articles and 270 patients.  95% of the extravasation events occurred in PIVs with infusions ...

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Resuscitation

REBEL Cast Ep 45: How to Build a Great Presentation

What’s Wrong With Lectures/Presentations Now? Lecturing style has remained stagnant despite the fact that our understanding of how people learn has changed. Most presentations make the supportive media (i.e. slides) the focus of the presentation without thought about the story ...

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An Emergency Difficult Airway Predictor Would be From HEAVEN

Background: Predicting an anatomically and/or physiologically challenging airway is not a straightforward task by any stretch of the imagination.  There are some existing difficult-airway prediction tools available (i.e. LEMON = Look externally, Evaluate 3-3-2 rule, Mallampati score, Obstruction, Neck mobility), ...

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Resuscitation
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