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.

August 7, 2019

Take Home Points

  • There is no real distinction between syncope and near syncope.

  • Older folk with near syncope or syncope should be treated the same.

  • Patient with high risk features its reasonable to admit but if they’re low risk, well-appearing and have reasonable follow up discharge home is fine.

June 26, 2019

Take Home Points on SVT

  • Superficial venous thrombosis refers to a clot and inflammation in the larger, or “axial” veins of the lower extremities and superficial thrombophlebitis refers to clot and inflammation in the tributary veins of the lower extremities. While we previously thought of this as a benign entity, we actually found the superficial venous thrombosis has been associated with concomitant DVT and PE.
  • Small, superficial clots can be treated with compression, NSAIDs, and elevation. These patients should be seen for follow up within 7-10 days to make sure the clot has not progressed.
  • Clots that are longer than 5 cm should be treated with prophylactic dosing of anticoagulation: fondaparinux 2.5mg subq once daily for 45 days or enoxaparin 40 mg subq once daily for 45 days. 
  • Clots that are within 3 cm of the sapheno-femoral junction should be treated the same as a DVT. 
  • A superficial thrombus could mean there is a deeper clot elsewhere, even in the other leg! Take a good history, perform a thorough physical exam and consider a bilateral lower extremity DVT study in concerning patients.

June 12, 2019

Take Home Points on Measles

  • There is a resurgence of measles worldwide
  • Incubation period is 10 – 14 days and patients are contagious 4 days before rash develops and up to 5 days after
  • Suspect measles in any patient with an acute febrile illness who is either un- or undervaccinated
  • Know about Post Exposure Prophylaxis (PEP) schedules and isolation times of various populations
  • Healthcare workers should wear N95 masks while taking care of patients with suspected measles, and report cases to their local health department.

May 29, 2019

Take Home Points on Tracheostomy Emergencies

  • Track is mature in 7 days - don't blindly replace before then because concern for false track creation
  • All bleeding needs to be taken seriously and should be evaluated by surgery
  • If not ventilating through trach - go through it systematically to find malfunction

May 27, 2019

Background: In 2000, the U.S. achieved the elimination of measles, defined as the absence of sustained transmission of the virus for more than 12 months [3,7]. Unfortunately, this success was short lived.  According to the CDC, 555 cases of measles have already been confirmed from Jan 1st – April 11th, 2019 [3]. This resurgence in measles is frustrating as it has a safe and highly effective vaccine, and it has no animal reservoir to maintain circulation.  Failure to get vaccinated unfortunately stems from misconceptions about vaccine safety (i.e. the now-debunked claim connecting vaccination to autism [4,5]), poor health education, lack of access to health care, and complacency.  This is now a global epidemic as disease does not respect borders.