REBEL Cast

is the blogs audio version. The podcast typically starts by setting a clinical stage with a pertinent clinical question, followed by a discussion of the paper with pertinent results, strengths, limitations, and further discussion. Finally, we end every podcast with clinical take home points from the papers being reviewed. If there are papers you think we should evaluate, email them to srrezaie@gmail.com.

February 25, 2021

Background: Opioid-related emergency department visits have been increasing over the past two decades in correlation with increasing rates of heroin use in the United States. Naloxone, which is used to reverse heroin overdose, has a half-life of approximately 60 to 90 minutes (2). A 4 to 6 hour observation period after naloxone reversal has typically been recommended to account for a duration of 5 half-lives of naloxone, and Goldfrank’s Toxicologic Emergencies recommends several hours of observation following naloxone reversal of heroin overdose (2). Systematic reviews have recommended as low as a 1-hour observation period (3). However, early discharge may be dangerous given both the short half-life of naloxone and the possibility that the purported heroin may have been adulterated or may have been another substance entirely, such as fentanyl analogs. This study attempted to determine the safety of a 2-hour observation period after naloxone administration for heroin overdose, which was chosen based on the half-life of naloxone.

February 13, 2021

Background: Science by press release. Not the way any of us would choose to operate but, the COVID pandemic has made this a reality. It’s vital that we understand that while pharmaceutical companies have a responsibility to release this information, we as clinicians should not be practicing medicine based on press releases. Of course, these press releases don’t only originate from pharma. On January 22nd, 2021, the Montreal Heart Institute released a statement about the results from the COLCORONA study investigating the use of colchicine in COVID-19. The press release painted a very positive picture but, does the pre-peer reviewed publication stand up?

February 10, 2021

Take Home Points
  • Consider ruptured AAA in patients (especially those > 50 years of age) with unexplained hypotension, back or abdominal pain
  • All ruptured AAAs should be considered unstable regardless of vital signs as rapid deterioration is common
  • A ruptured AAA is 100% fatal without surgical or endovascular intervention. Mobilize your surgical colleagues early

January 27, 2021

Take Home Points
  • Frostbite is a severe, localized cold-induced injury due to freezing and thawing of tissue.
  • We usually see these injuries affecting the ears, nose, cheeks, chin, fingers, and toes. Patients will complain of cold, numb or stiff sensations and discoloration of the skin.  
  • Critical ED treatment starts with rewarming in a warm, NOT HOT, water bath, analgesia and wound care.
  • More extensive treatments include blister debridement, tPA, prostacyclin analogues and fasciotomy.  Patients with severe frostbite will likely require multidisciplinary care with surgery and critical care so consider early consults.
  • And last, be sure to check the patients core temp and treat hypothermia complications, such as diuresis