June 11, 2018

In terms of airway management, cricothyrotomy is one of the most advanced airway procedures an ED physician will perform.  It is a last resort procedure when a patient is not able to be ventilated/oxygenated and/or intubated.  Typically, this procedure requires the identification of certain landmarks such as the cricothyroid membrane, but what if you can’t identify any landmarks?  What do you do?  We got Rob Bryant on the show to discuss some aspects of a recent nightmare airway case he had. 

June 6, 2018

Many of us have heard the saying that emergency medicine is the best 15 minutes of every other specialty. This, is in part, due to the wide breadth of disease and knowledge one must have to take care of patients.  In emergency medicine we typically focus on acute disease specific problems  and life sustaining treatments, but as the population gets older we are also having to deal with chronic conditions as well.  This was not an area that I was trained in residency, but certainly one that I am seeing more and more often.  There was a great review article published in the Journal of Emergency Medicine in January of 2018 titled, Palliative Care Symptom Management in the Emergency Department: The ABC’s of Symptom Management for the Emergency Physician. The lead author of this paper is Mari Siegel, MD, who I had the pleasure of interviewing for this episode.

May 7, 2018

Background: Visits to the ED for alcohol intoxication can create quite the clinical conundrum both for acute medical and traumatic reasons.  Acutely intoxicated patients, just like young kids, don’t always have the ability to communicate due to sedation, agitation, or some other critical medical/traumatic process that is ongoing.  This makes getting a complete history or depending on the physical exam unreliable at best.

April 26, 2018

Background: There has been lots of research published in past years on how to minimize pain and anxiety in children brought to the ED.  Unfortunately, as we all know there is often a lag time from research publication to clinical application.  It has been my experience that health care professionals tend to provide inconsistent and inadequate pain control for children.  In this episode of REBEL Cast we are going to interview Sebrina Perkins, a pediatric emergency medicine physician working for the Greater San Antonio Emergency Physicians (GSEP) group, on pediatric pain management pearls.

April 13, 2018

Recently I was asked to speak at the Texas College of Emergency Physicians (TCEP) conference April 2018.  The particulars of this session were, five, 10 minute lectures on new indications for old drugs.  My topic was the use of octreotide and somatostatin for undifferentiated upper gastrointestinal bleeding.  This is a particular topic I have been getting more and more requests for, but didn’t really know the evidence behind why I was doing it.  Does it help my patients or just another expensive medication, that takes up an IV with no clear patient oriented outcome?