February 18, 2019

Background: The use of intravenous lidocaine for analgesia in patients presenting to the emergency department (ED) with renal colic has gained recent traction and interest, and was previously explored on the REBEL EM blog. Literature has been mixed, with one trial (Soleimanpour 2012) demonstrating analgesic benefit, but two smaller trials (Firouzian 2016) (Motamed 2017) finding no such role for IV lidocaine. Nonetheless, uptake has been brisk (Fitzpatrick 2016). The authors of this study (The LIDOKET Trial) sought to better define the utility of IV lidocaine for the treatment of renal colic.

February 7, 2019

Welcome back to REBELCast.  In this episode we talked with Jacob Avila about US guided PIVs. Difficult IV access in an already busy department can be a frustrating thing, but it doesn’t have to be.  Patients and providers are often frustrated for different reasons.  Patients for multiple IV attempts and providers because of the time it can take to perform the procedure, delays in care, or lack of success. If you want to get better at this all-important procedure, read/listen on.

February 6, 2019

Take Home Points

  1. Bed Up Head Elevated (BUHE) position is a simple intervention that can reduce the rate of intubation-related complications.
  2. The bougie should be considered standard practice in all intubations and has an NNT = 11 for 1st pass success.
  3. Consider using Suction Assisted Laryngoscopy for Airway Decontamination (SALAD) for all intubations to avoid the failed airway due to contamination.

January 23, 2019

Take Home Points
  1. Single dose oral dexamethasone is an excellent choice for asthma exacerbations. It takes away the compliance issue for patients who have trouble getting medications or filling medications once they leave the ED.
  2. Antibiotics aren’t always indicated in COPD exacerbations, but are used much more frequently than in asthma exacerbations because the structural changes in the patient’s lung lead to increased bacterial colonization. In general, if the patient has increased cough or sputum production, they probably would benefit from a course of antibiotics
  3. In general, azithro alone is no longer a good choice as solo covereage for community acquired pneumonia.  Adding either amoxicillin or cefdinir to you amoxicillin should get you good coverage of both strep pneumo and atypicals.

January 9, 2019

Take Homes

  1. Calcium Channel Blocker (CCB) toxicity usually present with bradycardia and hypotension, but with preserved mental status. This can help differential from Beta Blocker (BB) toxicity, where the patients often have altered mental status.
  2. Hyperglycemia is the other hallmark of CCB toxicity, which can help you differentiate from BB. This hyperglycemia may be a harbinger of impending circulatory collapse, so be on guard in a pt with CCB overdose, normal vitals and hyperglycemia
  3. Don’t be afraid to use and infuse hyperinsulinemia-euglycemia therapy for BB and CCB toxicity. Have a frank and open conversation with your team about how it works to get everyone on board before your start.
  4. TCA overdoses present with a a number of signs and symptoms including anticholinergic symptoms, AMS, hypotension and seizures. Once you identify the TCA toxicity, you’re going to start with fluids and pressors and then move on the antidote which is sodium bicarbonate 1-2 mEq/kg as a bolus followed by a drip. You want to keep pushing sodium bicarb until you see the QRS narrow