September 25, 2017

Background: One of the most common imaging modalities used in the emergency department (ED) today is computed tomography (CT) scans using intravenous radiocontrast agents. Use of IV contrast can help increase visualization of pathology as compared to non-contrast CTs. However, many patients do not get IV contrast due to fear of contrast induced nephropathy.  Furthermore, waiting for renal function values delays the care of patients and prolongs time spent in the ED with a potential to increase adverse effects on patient centered outcomes due to delays.

June 22, 2017

Angiotensin Converting Enzyme Inhibitors (ACE-I) are prescribed to millions of patients in the US. Though they are relatively safe, upper airway angioedema is one of the life-threatening adverse effects that we see frequently in the Emergency Department. Though this disorder is routinely treated with medications for anaphylaxis (i.e. epinephrine, histamine blockers, corticosteroids) the underlying mechanism of action predicts that these medications will fail. There is no well established treatment algorithm other than airway control if the angioedema is severe and appears to be causing a mechanical obstruction and cessation of the medication. A 2015 phase 2 study published in the NEJM touted the role for Icatibant in the treatment of these patients. Despite being heralded as “the cure,” the data set in this article was small questioning the validity of the findings. Enter the CAMEO study which attempts to further elucidate the benefits of this medication.

March 24, 2017

Background: In patients with compromised renal function, the use of intravascular iodinated contrast material is generally not given to avoid contrast induced nephropathy (CIN). Currently, there is no treatment for contrast-induced nephropathy, therefore the focus has been on prevention. Guidelines recommend prophylactic prehydration in the prevention of CIN in high risk patients.  These recommendations are based on expert consensus and until now, there has not been a prospective randomized trial of IV hydration versus no hydration in high-risk patients.

March 20, 2017

Background: Use of contrast media in CT scans has been cited as one of the most common causes of iatrogenic acute kidney injury.  Its use however improves the diagnostic accuracy of CT scans.  Some studies have even reported an incidence of contrast induced nephropathy (CIN) as high as 14%.  Many of the studies coming to these conclusions were performed before the use of low- and iso-osmolar contrast agents. Also to date, all controlled studies on this topic have been observational and not randomized controlled trials.  More recent propensity-scored analyses have had conflicting results. One study found no increased risk of acute kidney injury, dialysis or mortality regardless of baseline renal function, while others have found increased acute kidney injury in patients with renal dysfunction. This current study tried to clarify the incidence of acute kidney injury attributable to IV contrast media administration.

May 14, 2015

Welcome to the May 2015 REBELCast, where Swami, Matt, and I are going to tackle a couple of articles just published this year.  First, there is a lack of research examining the efficacy of steroids in patients with allergic reactions or anaphylaxis. Despite this, corticosteroids are standard care for patients with these disorders. Second, current regulations permit storage of PRBCs for up to 42 days, but maybe fresh PRBCs may improve outcomes in the critically ill by enhancing oxygen delivery while minimizing toxic effects from cellular changes and accumulation of bioactive materials in blood components during prolonged storage. So with that introduction today we are going to specifically tackle:
  • Topic #1: Corticosteroids in Allergic Reactions & Anaphylaxis
  • Topic #2: Age of Packed Red Blood Cells (PRBCs) in Critically Ill Adults
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