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.

May 27, 2020

Take Home Points
  • Small to Moderate Size Pneumothorax - consider managing conservatively with observation (need to make sure consulting services on same page)
  • Needle aspiration for spontaneous pneumothorax recommend by British Thoracic and European Respiratory Societies
  • 1 in 5 patients requiring a chest tube will suffer complications - many are iatrogenic in nature. Practice procedure via simulation 
  • Chest tubes placed for traumatic pneumothoraces should get prophylactic antibiotics
  • When deciding on treatment strategy, discuss with your consultants and make sure you have institutional buy-in.

April 22, 2020

Take Home Points
  • N95 masks ideally should be single use but in COVID19 times, safe reuse practices are critical.
  • The best approach to reuse is vaporized H2O2 and UV light decontamination with a total of 3 decon cycles prior to losing mask integrity.
  • A backup method of cycling between 4 masks is likely effective as SARS-CoV-2 cannot survive > 72 hours outside a human host in sufficient numbers to cause infection.
  • Ethanol soaks are effective in decontamination but destroy mask integrity and should not be use.

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.

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