April 4, 2016

Welcome back to the April 2016 edition of REBELCast. For this episode I was lucky enough to get Scott Weingart on the show to talk to us about all things Apneic Oxygenation (ApOx). ApOx is a concept that has been around for some time in the operating room literature, but only recently been gaining acceptance in the ED, especially after the publication of this concept by Scott and Richard Levitan in the Annals of Emergency Medicine in 2011 [1]. Many nay sayers will argue that the OR studies were in controlled settings with elective surgical patients who were not in critical condition. The believers would argue that ApOx makes sense, its low cost,  and low complexity.  To date there has been no randomized controlled trials (RCTs) on ApOx in the ED.  There has been one ICU Trial (i.e. The FELLOW Trial) [2] and an even more recent observational trial in the ED [3] that have been published on the topic of ApOx. So the question remains: Is Apneic Oxygenation Overhyped?

March 28, 2016

So this is the second installation of Advice to Graduating Residents. Again, many 3rd year residents will be graduating in just a few short months and taking on their first jobs as attending physicians. I was lucky enough to sit down with the amazing Amal Mattu and pick his brain. He gave some valuable words of wisdom, which I will try and summarize in this post, but for the full advice, be sure to checkout the podcast.  

March 14, 2016

Lead aVR is a commonly ignored lead and I have even heard of it referred to as the Rodney Dangerfield of ECG leads as it gets no respect. I have anecdotally heard many EM physicians activate the cath lab for STE in lead aVR and many cardiologists say that these are not STEMI patients. So is lead aVR now getting too much respect? Well, I thought it would be a great idea to bring the great Amal Mattu on to the show to answer a few questions for us regarding STE in lead aVR. If you don’t know Amal Mattu by now, I am not sure where you have been. Currently he is a tenured professor of Emergency Medicine at the University of Maryland School of Medicine in Baltimore. He has presented at numerous national and international conferences on ECG interpretation, published several books on the topic and if you want more from him just checkout his site ecgweekly.com

February 29, 2016

We are getting closer to the end of the year and pretty soon 3rd year residents will be graduating and moving on to their first jobs as attending physicians.  My own residents have been asking for advice, and I thought this would be a great opportunity to ask some EM educators what their advice would be. Essentially, I asked each of them two basic questions and let them steal the show. For our inaugural first episode I asked Anand Swaminathan if he could give us some of his words of wisdom.

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.