REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce

REBEL Core

, an initiative to improve discussion of core content in emergency medicine/critical care. Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. However, if all you use is FOAMed, then you will have “swiss cheese knowledge”, due to the lack of having foundational knowledge. The entire breadth of emergency medicine is not currently covered by FOAMed with a disproportionate representation of critical care topics (i.e. ECG, Ultrasound, Resuscitation, Procedures). REBEL Core will continue to discuss the foundational knowledge necessary in all aspects of emergency care.

April 3, 2019

Take Home Points on Non-Inferiority Studies

  • Non-inferiority studies should be done when a new treatment (or diagnostic modality) requires less resources (cost or time), is easier for the patient or has a lower side-effect profile.
  • Non-inferiority study design largely negates the protections against bias added by blinding and randomization.
  • Non-inferiority studies can be used to manipulate clinicians when a superiority study would be more appropriate.

March 20, 2019

Take Home Points on Oncologic Emergencies:

  1. Hyperviscosity Syndrome happens when elevated WBCs or severe hyperproteinemia cause high serum viscosity and micro-circulatory problems in patients with Waldenstrom’s macroglobulinemia, multiple myeloma or acute leukemia. Be suspicious of this syndrome in these patient’s when they present with the classic triad of mucosal bleeding, visual disturbances, and neurological symptoms or with any end organ failure.
  2. Tumor Lysis Syndrome results from high turnover of malignant cells resulting in severe metabolic derangements including hypocalcemia, hyperkalemia, hyperphosphatemia, hyperuricemia, AKI, metabolic acidosis. Be suspicious of this in patients presenting with edema, hematuria, fatigue, weakness, altered mental status or symptoms that go along with specific metabolic derangement, particularly if they recently received chemotherapy, radiation or high dose steroids.
 

March 6, 2019

Take Home Points:

  1. If the patient is a clear traumatic arrest, compressions aren’t indicated and, instead we should focus on the important interventions that need to be done.
  2. Ultrasound can be incredibly helpful in traumatic arrest. If you’ve got a traumatic arrest patient with neither pericardial fluid nor cardiac activity, it may be reasonable to stop resuscitation without the thoracotomy.
  3. When decompressing the chest, it’s better to place you angiocath in the 5th intercostal space in the anterior axillary line. This helps you avoid the great vessels in the as well as the thick anterior chest wall
  4. And last, if you are doing a thoracostomy, you may as well go bilaterally. You are doing invasive things to a dying patient, there is no reason to guess where the problem is. Similarly, if you have to do a thoracotomy, you could consider making it a clamshell as it space to look into and making sure the right side of the chest is accessed.

February 20, 2019

Take Home Points:

  1. Hypothermia is neuroprotective and patients can survive prolonged periods of cardiac arrest. Termination of resuscitative efforts in cardiac arrest should not considered until the patient is >32°C or has a K > 12 mEq/L
  2. Active internal rewarming is the keystone of treatment for unstable hypothermic patients. Utilize available resources including ECMO to effectively warm your patient
  3. Consider alternate causes for hypothermia, especially in patients who fail to respond to warming