July 16, 2018

The 1stannual Rebellion in EM Clinical Conference took place in San Antonio, TX on May 11th– 13th, 2018.  If you missed out in 2018, the Rebellion is coming back June 28th – 30th, 2019.  Stay up to date as we plan the conference for this upcoming year at www.rebellioninem.com. The Missions of Rebellion in EM:
  1. Decrease Knowledge Translation: With 100s of journals and thousands of publications every year, it takes time for research to disseminate to clinical practice. Discussion of current literature and its application to practice is the key to facilitating safe best practices.
  2. Create a Community of Practice: It requires many to take care of the few www.bestintime.me. Patient care is a team sport that starts pre-hospital, continues through the ED, and finally into the hospital.
  3. Improve Patient Care: Decrease suffering and improve patient oriented outcomes
“Learning is always rebellion…every bit of new truth discovered is revolutionary to what was believed before.” -Margaret lee Runbeck-

May 23, 2018

Background: Congestive Heart Failure (CHF) is one of the leading causes of hospitalization among adults over the age of 65 years of age. Despite improvement in outcomes with optimal medical treatment, admission rates still remain high with many patients requiring rehospitalization.  The staples of CHF management include ACE inhibitors, ARBs, beta blockers, diuretics, aldosterone antagonists, hydralazine/nitrates, and digoxin. Recently, I have seen an increase of patients with CHF on a new medication called Entresto (Valsartan-Sacubitril or LCZ696)  I did not know much about this medication, or the evidence base for it.

April 30, 2018

I was working a busy shift in the ED, like many of us do, and the next patient I was going to see was a 57 year old male with no real medical problems complaining of chest pain.  I remember thinking as I walked into the room this guy looks ashen and diaphoretic….he doesn’t look well.  He is a paramedic telling me how he has been having off and on chest pain for the past several months.  He just had a stress test two months ago that was “negative”.  Today he was working on his pool and developed the same chest discomfort as he had been having off and on the past several months, but today, the pain would just not go away.  In his mind, he thought this might be an ulcer and just needed some Pepcid to help. He got put on the monitor and an ECG was run… The patient involved in this case has given permission to share the story, and relevant images with the knowledge that this information will be used for the purposes of education.

April 30, 2018

I was working a busy shift in the ED, like many of us do, and the next patient I was going to see was a 57 year old male with no real medical problems complaining of chest pain.  I remember thinking as I walked into the room this guy looks ashen and diaphoretic….he doesn’t look well.  He is a paramedic telling me how he has been having off and on chest pain for the past several months.  He just had a stress test two months ago that was “negative”.  Today he was working on his pool and developed the same chest discomfort as he had been having off and on the past several months, but today, the pain would just not go away.  In his mind, he thought this might be an ulcer and just needed some Pepcid to help. He got put on the monitor and an ECG was run… The patient involved in this case has given permission to share the story, and relevant images with the knowledge that this information will be used for the purposes of education.

April 23, 2018

Background:There are two trains of thought in using transthoracic direct current cardioversion (DCCV) when it comes to converting atrial fibrillation.  The first is an escalating energy approach which allows cardioversion to occur at the lowest energy for each individual patient and potentially decrease post-shock arrhythmias.  The second train of thought is to start at the highest energy approach in order to minimize total number of shocks delivered and duration of the procedural sedation.  There is a considerable variation in practice that exists as I recently discovered based on conversations on social media.  The authors of this study aimed to compare an escalating energy protocol starting at 100J with a non-escalating energy protocol of 200J to establish the efficacy and safety of both practices of cardioversion using biphasic DCCV of atrial fibrillation.
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