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.

January 21, 2021

As EM physicians, we are taught how to manage and treat many serious and life threatening conditions, most of them we know like the back of our hands, and some we look up on shift. The most important things to know are the “think on your feet” situations, when patients are actively trying to die in front of you, and you don’t have the time to look things up. We all know how to manage a bleed, whether internal or external, but do you know how to treat bleeding in a Hemophilia patient?! I didn’t until April, 2018 when my newborn son was diagnosed with Hemophilia A.  In this segment, I will explain and simplify hemophilia for you down to the “need to know” essential information so when you are managing a hemophilia patient in the ED, like my son, you will know what to do. 

January 18, 2021

Case: A 51-year-old woman, with no pertinent past medical history, presented to the Emergency Department (ED) complaining of right hand pain after a large fragment from a wooden cooking spoon penetrated her right palm approximately 1 week ago. She reported immediately removing the splinter and starting old, previously prescribed amoxicillin prior to her visit. She was prompted to visit the ED after her pain gradually increased, affecting her ability to flex and extend her right fourth digit.

On physical exam, the patient was afebrile with all other vital signs within normal limits. There was significant tenderness localized to the base of the right fourth digit near the proximal interphalangeal (PIP) joint, associated with edema, ecchymosis, and erythema. While the patients right hand remained neurovascularly intact, significant restrictions in passive motion, including flexion and extension, was noted to the right fourth digit. On visual inspection, no foreign bodies were appreciated.

A radiograph of the right hand was ordered, which was negative for any acute abnormalities, including foreign body. However, due to the patients clinical presentation and the potential radiolucency of the suspected foreign body, a point-of-care ultrasound was performed.

January 13, 2021

Take Home Points
  • Nausea and Vomiting has an exceedingly large differential - don’t just anchor on GI presentations
  • H&P important - Duration, frequency, content, and associated symptoms
  • Alcohol swab -> If no line and want quick treatment give swab
  • Ondansetron -> oral you can give without hesitation but if giving IV check QTC / electrolytes and give slowly
  • Droperidol / Haloperidol -> Works really well, QTc prolongation has been overhyped and dont give to parkinsons patient.

December 16, 2020

Take Home Points
  • This is a resuscitative hysterotomy - focus is on saving the mother first. Delivering the fetus can improve venous return thus increasing chance to save mom
  • Don’t focus on gestational age to make the decision - if you think the belly is big enough to be causing compression of vascular structures, the procedure is indicated
  • Once you’ve made the decision - it’s go time. The faster you do it, the more likely you can salvage mom and the fetus
  • Large vertical incision to maximize exposure, locate uterus, vertical incision with scalpel and extend with scissors

December 2, 2020

Take Home Points
  • Be sure to consider mesenteric ischemia in any elderly patient with abdominal pain or lower gastrointestinal (GI) complaints.  Remember, the presentation can be tricky to find and they may have a reassuring abdominal exam.
  • Ask about artherosclerotic risk factors, history of cardiovascular disease including atrial fibrillation and prior embolic events, and a history of intestinal angina to help clue you in to the diagnosis.
  • Lab abnormalities could include leukocytosis, lactemia or elevated d-dimer.  But normal labs cannot exclude this disease.
  • The money is in the CTA.  Get it as fast as possible because time is bowel.
  • Consult your surgeons and interventional radiologists eary, because again TIME IS BOWEL