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.

July 28, 2021

Take Home Points

  • Infuse factor first, investigate later
  • Treat when bleeding is suspected, not confirmed. Have a low threshold!
  • It is better to over treat than undertreat. Give full dose when in doubt
    • Factor 8 = 50U/kg
    • Factor 9 = 100 U/kg
  • Beware of hidden bleeds (brain, retroperitoneal, deep muscles)
  • If patient has inhibitors, or no factor available you may use
    • Activated PCC (FEIBA) = 80 -100U/kg
    • Recombinant factor 7a = 90 mcg/kg

July 14, 2021

Take Home Points

1. Debriefing is critical. Studies show numerous benefits in terms of team communication and staff ability to regroup.
2. Start by gathering your team, thanking them for their work and noting that nothing could have changed the patient's ultimate outcome.
3. Summarize the events so everyone is on the same page and then prompt people to offer thoughts by asking "what went well? what could have gone better?"
4. Remember to end on a positive note to get everyone refocused and energized.

June 30, 2021

Take Home Points

- Unexplained tachycardia (or any abnormal vital sign) warrants investigation.
- Pain, induration, "woody" feel of any muscle group should raise suspicion of infection in that muscle group that has spread hematogenously especially in those with predisposing factors (e.g HIV, trauma, IVDA)
- Early pyomyositis will not necessarily have abscess formation
- Treatment consists of IV antibiotics, possible drainage or surgery for source control.

June 16, 2021

Take Home Points
  • Neck movement (both extension and flexion) has the ability to cause cord damage.
  • Using hyperangulated blade in video laryngoscopy improves chances for glottic visualization in patients with a c-collar in place.
  • Ultimately, hypoxemia kills – Intubate the patient with what you have available, as there has not been shown to be a definitively superior technique.