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.

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

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. 

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

January 29, 2020

Take Home Points

  • When compared to 0.9% saline, lactated ringers is a more balanced solution and more closely resembles our serum.
  • SALT ED and SMART trials show normal saline may increase the occurrence of major adverse kidney events in comparison to a balanced solution like LR. For large volume resuscitations, LR is a better choice.
  • Certain medications cannot be run with LR in the same IV line. Ampicillin, Carbapenems, Phenytoin, Potassium Phosphate, Nicardipine
  • Ceftriaxone and LR should never be running at the same time in children less than 28 days old.