March 11, 2020

Vascular Disasters Take Home Points
  1. Consider vascular pathologies in all of your patients with atraumatic limb pain - especially those with typical and atypical risk factors
  2. Early diagnosis is imperative. Time is tissue. Catch this as early as possible. Pain is the earliest symptom. First presents with pain then paresthesia then paralysis
  3. Perform vascular exam on every patient with pain
  4. If concerned for ischemic limb, call the vascular surgeon and get patient to CT for imaging of aorta and affected limb. 

March 5, 2020

Welcome back to REBEL Cast, I am your host Salim Rezaie.  In this episode we are going to review a recent focused 2019 update to the American Heart Association (AHA) pediatric advanced life support (PALS) guidelines from 2018-19. This 2019 PALS Update addresses 3 concerns:
  1. Pediatric advanced airway management in pediatric cardiac arrest
  2. Extracorporeal cardiopulmonary resus (ECPR/ECMO) in pediatric cardiac arrest
  3. Pediatric targeted temperature management (TTM) during post-arrest care

February 26, 2020

Take Home Points 
  • No palpable pulse does not equal no perfusion. We aren't great at feeling pulses
  • Patients with moderate to severe signs and symptoms of lithium toxicity should be considered for hemodialysis
  • Always consider serious causes of back pain before simply treating with analgesics
  • Consider trauma as well as other toxic exposures (I.e. CO and CN) in patients with major burns

February 12, 2020

Take-Home Points
  1. Endocarditis can have vague and varied presentations and has high morbidity and mortality. Be on the lookout in patients with risk factors including: 
    1. Congenital heart disease
    2. Cardiac prosthesis or devices
    3. Immunocompromise
    4. IV drug use
    5. Recent invasive procedure
    6. Hx of prior IE
  2. Patients may present with fever, sepsis of unclear source or may have manifestations of emboli to the skin, eyes, brain, lungs, spleen or kidney.
  3. Diagnosis is based on the modified Duke Criteria and workup should include THREE good sets of blood cultures. 
  4. ED management includes consultation with ID and cardiothoracic surgery and starting antibiotics based on whether the patient has a native or prosthetic valve. Basic starting antibiotic regimen includes:
    1. For patients with native valve disease a good starting regimen is:
      1. Vancomycin 25-30 mg/kg IV loading dose followed by 15-20 mg/kg twice daily AND
      2. Cefepime 2 g IV TID
    2. For patients with prosthetic valve disease, we have to go a bit bigger:
      1. Vancomycin 25-30 mg/kg IV loading dose followed by 15-20 mg/kg IV twice daily AND
      2. Rifampin 300 mg PO/IV TID AND
      3. Gentamicin 1 mg/kg IV TID AND
      4. Some recommendations include the Cefepime 2 g IV TID

February 10, 2020

The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups.  Over the past several years, many studies have come out reviewing the mechanisms of action as well as its use in a variety of conditions.  In this episode, I will summarize how it works and for part 2, I will discuss the main indications for its use in both adult and pediatric patients and practical tips on how to use it.