January 3, 2019

Introduction: Beyond the Data

The evolution from eminence-based to evidence-based care has come to define bedside emergency medicine, with rigorous skepticism and scholarly consideration accelerated by the power of global connectivity. Where anecdote and opinion once drove therapy, clinicians now approach clinical conundrums with deliberate reflection, expecting—and at times demanding--ever-higher proof of perfection prior to implementing or incorporating therapies, tests, or approaches into their own practice. Such cogitation ensures excellence and safety and avoids pitfalls of over-adoption or confounding. Unfortunately, so many of our daily decisions are made in a space devoid of definitive data, and require a synthesis of relevant literature with our accumulated knowledge and experience—a departure from evidence-based medicine into the pragmatic world of evidence-informed medicine. It is only at this precipice—where studies and statistics simply don’t exist—that we change, where we push forward the boundaries of care, and develop not only experience, but the very questions which will define the next advances in emergency medicine. It’s with this in mind that we present this REBEL post, an entry not so much a look back on manuscripts which dictate our practice, but a treatise to help us look forward. To not inform, but to inspire thought and inquiry.  

December 26, 2018

REBEL EM-ers: Salim, Jenny and I would like to announce the launch of a new REBEL EM project. Beginning in 2019, we'll be adding a core content section to the website. This will include core content blog posts and a core content podcast with a dedicated place on the parent site. Instead of creating a separate podcast, we'll be bringing you REBEL Core Cast as part of REBEL Cast. This way, you won't need to download another podcast. Twice a month, Jenny and I will bring you a podcast based on a core topic in EM or based on pearls from our conferences. See you all in the New Year!

November 5, 2018

Background: Care of trauma patients with severe bleeding has advanced in recent years with a focus on damage control resuscitation which includes permissive hypotension, hemostatic resuscitation (blood component resuscitation), and hemorrhage control. Minimizing crystalloids in favor of blood component-based resuscitation in the prehospital setting has the potential to reduce downstream complications by intervening closer to the time of injury before the development of coagulopathy, irreversible shock, and inflammatory response.  There is a paucity of high level evidence showing the efficacy and safety of plasma transfusions in the prehospital setting including retrospective studies which suffered from survivor bias (patients had to survive long enough to receive plasma) and small randomized clinical trials not showing survival benefit.  This has led to the publication of two randomized controlled trials: COMBAT and PAMPer.

September 27, 2018

Background:There is a lack of high quality RCTs  investigating optimal airway management in patients with out-of-hospital cardiac arrest (OHCA).  The majority of evidence comes from observational studies and expert opinion. The observational trials have consistently favored basic airway management (i.e. BVM) over tracheal intubation [3]. Supraglottic airway(SGA) devices offer an alternative advanced airway management technique to endotracheal intubation (ETI) during OHCA. SGA devices may offer an advantage over ETI as they are simpler and faster to placeAdditionally, proficiency  with SGAs requires less training and ongoing practice. Although there have been several recent studies published on airway management in OHCA, this post/podcast will focus on the recently published AIRWAYS-2 trial.

August 6, 2018

Background: POCUS has been touted as the stethoscope 2.0, a true game changer in patient care.  There is no patient population that this statement should hold more true for, than in patients with undifferentiated shock (SBP <100mmHg or SI > 1). Everyone has a story about how ultrasound changed their management or even saved a patient’s life. Unfortunately, the plural of anecdote is not data.  To date, there have not been any prospective randomized controlled trials examining POCUS outcomes on survival in this population.  Enter the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) trial.