27 Jan 2021

January 27, 2021

Written by REBEL Cast, REBEL Core
Take Home Points
  • Frostbite is a severe, localized cold-induced injury due to freezing and thawing of tissue.
  • We usually see these injuries affecting the ears, nose, cheeks, chin, fingers, and toes. Patients will complain of cold, numb or stiff sensations and discoloration of the skin.  
  • Critical ED treatment starts with rewarming in a warm, NOT HOT, water bath, analgesia and wound care.
  • More extensive treatments include blister debridement, tPA, prostacyclin analogues and fasciotomy.  Patients with severe frostbite will likely require multidisciplinary care with surgery and critical care so consider early consults.
  • And last, be sure to check the patients core temp and treat hypothermia complications, such as diuresis
Medical Categories: Environmental
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21 Jan 2021

January 21, 2021

Written by REBEL Core
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. 
Medical Categories: Hematology and Oncology
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18 Jan 2021

January 18, 2021

Written by REBEL Core

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 patient’s 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 patient’s clinical presentation and the potential radiolucency of the suspected foreign body, a point-of-care ultrasound was performed.

Medical Categories: Procedures and Skills
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13 Jan 2021

January 13, 2021

Written by REBEL Cast, REBEL Core
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.
Medical Categories: Abdominal and Gastroinstestinal
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16 Dec 2020

December 16, 2020

Written by REBEL Cast, REBEL Core
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
Medical Categories: Obstetrics and Gynecology
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