February 11, 2016

Background: Headache accounts for approximately 2% of all ED visits. One of the most serious etiologies of headache is aneurysmal subarachnoid hemorrhage (SAH), which accounts for 4 – 12% of ED patients with thunderclap headache. There have been several studies in the past few years suggesting that in neurologically intact patients, the sensitivity of modern CT scanners for SAH approaches 100% if performed within 6 hours of headache onset and interpreted by qualified radiologists. If true this data suggests that an LP may not be necessary to rule out SAH and an initial negative CT can be considered a rule-out test.

December 10, 2015

Welcome to the December 2015 REBELCast, where Swami, Matt, and I are going to tackle a couple of topics in the world of Cardiology and Critical Care. First of all, we all know that the optimal treatment for STEMI is getting the patient to the cardiac catheterization lab, and time is muscle, but does it help to get patients to the catheterization lab even faster than 90 minutes? Or does speeding up the time have bad outcomes? Secondly, it has been drilled into our heads that high-quality CPR with minimal to no interruptions is key in OHCA.  This gives our patients the best chance of neurologically intact survival.  But a new study just published might beg to differ. So with that introduction today we are going to specifically tackle:

Topic #1: Reducing Door to Balloon (D2B) Times to <90 Minutes in STEMI Topic #2: Continuous vs Interrupted CPR in OHCA

November 12, 2015

Welcome to the November 2015 REBELCast, where Swami, Matt, and I are going to tackle a couple of topics in the world of Vascular Access. Peripheral intravenous (PIV) access is one of the most common procedures we perform in the emergency department (ED) and central venous catheter (CVC), although decreasing in frequency, has some very real complications associated with it. It is always good to question clinical practice, especially in procedures that we perform on a daily basis.  IV access is important to patient care for things that we may take for granted such as lab work and initiation of treatment. So with that introduction today we are going to specifically tackle: Topic #1: Intravascular Complications of Central Venous Catheter (CVC) Access Topic #2: US vs Landmark Technique for Peripheral IV Access

October 22, 2015

In case you have not heard or not read it on the twittersphere, the American Heart Association just released their 2015 Guidelines Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) in Circulation. I am joined by Mr. Security, Matt Astin for this episode and we both read through this massive 15 part document and came up with our top 5 updates and recommendations. Now this is just a list of our top 5 new or updated recommendations, that caught our attention, but certainly there are other recommendations. If you want the cliff notes version of the updates look through part I, titled the executive summary or the Highlights PDF which we will attach on the blog, but certainly as always we recommend reading the full document to form your own interpretations and opinions.

October 8, 2015

Welcome to the October 2015 REBELCast, where Swami, Matt, and I are going to tackle a couple of topics in the world of Trauma, specifically ED Thoracotomy. Now we all know that ED thoracotomy is a last ditch salvage effort, performed under specific clinical circumstances, during a traumatic arrest. The purpose of the ED thoracotomy is to evacuate pericardial tamponade, control hemorrhage, improve coronary/cerebral blood flow, and if needed internal cardiac massage. The purpose of this podcast is to discuss specific indications where this already low yield procedure may have some benefit.
  • Topic #1: FAST US Examination as a Predictor of Outcomes After Resuscitative Thoracotomy
  • Topic #2: Blunt Trauma Thoracotomy