On the last day of the last SMACC conference, Dr. Ken Milne (The SGEM) and I had a cage match debating four critical care controversies. It was all done in good fun with both of us taking our opportunities to poke a little fun at each other. While we took a pro vs con approach to the presentation, our positions are much closer than the debate demonstrates. Although the literature is far from perfect, development of critical appraisal skills and application of evidence-based medicine to the literature is what we should be using to inform our care but not dictate our care. It is equally as important to incorporate clinical judgment and ask our patients what their values and preferences are before making decisions about care.

Recently, I wrote a post on the use of epinephrine in out-of-hospital cardiac arrest (OHCA) and this triggered some interesting discussion on twitter. Are we at a point that we can just stop using epinephrine in OHCA?  Has anyone stopped actually using epinephrine in OHCA and if so, why or why not? The evidence seems to point to no "good" neurologic benefit over basic life support (BLS).  I would love to hear more peoples thoughts on this.

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.

Welcome back to REBEL Cast, I am your host Salim Rezaie.  In this episode we are going to review a recent focused 2019 update to the American Heart Association (AHA) pediatric advanced life support (PALS) guidelines from 2018-19. This 2019 PALS Update addresses 3 concerns:
  1. Pediatric advanced airway management in pediatric cardiac arrest
  2. Extracorporeal cardiopulmonary resus (ECPR/ECMO) in pediatric cardiac arrest
  3. Pediatric targeted temperature management (TTM) during post-arrest care

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