April 8, 2020

Take Home Points
  1. Hyperthyroidism can present along a spectrum from the minimally symptomatic to severely decompensated and presentation can vary with age
  2. If there are a lot of interconnecting systems complaints consider obtaibning a TSH, t3 and t4 
  3. Once you’ve diagnosed hyperthyroidism, dont anchor on it. Look for what might have caused it especially in those with comorbidities
  4. If the patient is stable and reliable you can discharge them home with Atenolol. Make sure to have the patient follow up with their PCP or Endocrinologist. If, however, you feel uncomfortable doing that or the patient needs more social support, call your endocrinologist on call and get their recommendations.

April 5, 2020

Hey there REBEL Cast listeners, Salim Rezaie here.  For me and I am sure many COVID-19 has been quite the whirlwind.  So much information, so little time to process all of it.  Meanwhile, many of us are on the frontlines having to take care of these patients.  Personally, I have never been so wrong, so many times about a single disease process.  What I say today, may be different tomorrow.  This podcast was recorded on April 3rd, 2020 so any information that comes out after this, might change the viewpoints that are expressed today.

April 2, 2020

Background: Peripheral intravenous (PIV) access is one of the most commonly performed invasive procedures in unwell patients.  Although, most patients can have PIVs placed by palpation, there is a subset of patients with difficult vascular access that will require ultrasound-guided peripheral IVs. We have covered this topic before with Jacob Avila (The Ultrasound Podcast, 5 Minute Sono) in REBEL Cast Ep 62. One thing we did not cover was catheter dwell rates.  Catheter dwell rate is an important endpoint as it takes time to perform the procedure, but more importantly for the patient, premature IV failure can include complications such as infiltration, phlebitis, ischemia, necrosis, as well as delays in receiving medications. Therefore, an important concept worth covering is the length of the catheter that is in the vein.

Midline catheters, which we have also covered on REBEL EM are catheters with lengths of 6 to 20cm and represent a potential solution.  These catheters have high success rates and longevity, but insertion requires institutional protocols and specialized training.  A nice go between is the peripheral ultralong catheter (ULC), which is 6.35cm. As with anything new in medicine, it is important to review the evidence to ensure we are performing best practices for our patients.

March 30, 2020

The American Heart Association (AHA) released a focused update in 2019, for advanced cardiovascular life support (ACLS) guidelines, to addend those published in 2017 and 2018 for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care.  These recommendations were based on evidence identified by the 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) from the International Liaison Committee on Resuscitation (ILCOR).  This ACLS Update addresses three main concerns:
  1. Advanced Airway management
  2. Vasopressors in cardiac arrest
  3. Extracorporeal CPR (ECPR) during cardiac arrest

March 25, 2020

Take-Home Points
  1. Before starting a neonatal resuscitation, take some deep breaths to calm yourself
  2. Call in your friends - get a second team to manage the mother, call OB, call the NICU - all hands on deck
  3. Anticipate the equipment you'll need, get it to the bedside and don't forget to turn the warmer on
  4. Assign roles so everyone knows what they're supposed to do
  5. Initiate transfer to a NICU as soon as possible