We believe that critical care is not simply a location or a unit in a hospital, but the practice of providing care to those who need urgent support to treat or prevent a life-threatening illness. Whether you’re a paramedic, nurse, EM, IM, CCM doc, etc…

REBEL Crit

will help you critically appraise the literature so that you can deliver the highest quality, evidence based and compassionate care to your patients.

REBELCrit not only review’s recent publications, but has many review article’s, on often complex topics, to help you, the busy provider, continue to provide the best care possible. Soon, REBELCrit will be launching a critical care podcast through our already popular REBELCast!

REBELCrit strives to give you the most up to date and timely information so that you can be the best provider you can be and deliver the best care to your critically ill patients!

January 13, 2020

Therapeutic Hypothermia (also called targeted temperature management (TTM)) is a deliberate reduction of the core body temperature to 32 - 34°C, in patients who suffer cardiac arrest with return of spontaneous circulation, but also don't regain consciousness.  In REBEL Crit Cast episode 1, I will go through the evidence for cooling adults and children, potential adverse effects, and what temperature to shoot for.

January 9, 2020

Background: Rapid sequence intubation (RSI) is the most widely utilized approach for patients requiring emergency tracheal intubation.  RSI typically requires the use of a induction agent followed by the use of a neuromuscular blocking agent (NMBA) to improve the overall intubation conditions and therefore improve first-attempt intubation success rate. Historically, succinylcholine has been the preferred NMBA, due to its fast onset (45 – 60 seconds) and fast offset (6 – 8 minutes of paralysis). Recent studies, however, show that rocuronium is an effective agent (similar timing of onset for ideal intubating conditions) as well.  When used at a dose of 1.2mg/kg, rocuronium has a similar onset time to succinylcholine of about 1 minute. Additionally, succinylcholine has several contraindications (see bottom of the post) while rocuronium has no contraindications (except for hypersensitivity) which has increased the debate about the paralytic agent of choice for RSI.

December 30, 2019

REBEL EM-ers: Salim & I would like to introduce the launch of a new REBEL EM project. We are adding a podcast focused on a wide variety of resuscitation and critical care topics in both Adult & Pediatric Medicine to the website. The podcast will be called REBEL Crit Cast, and will compliment are already popular REBEL Crit content on our parent site.  This will include blog posts and podcast content with a dedicated place on the parent site. Instead of creating a separate podcast, we’ll be bringing you REBEL Crit Cast as part of REBEL Cast. This way, you won’t need to download another podcast. The format may change over time, and I'd love to know your questions, and ideas for topics so that I can make this as practical and useful to YOU, our audience, as possible.

December 23, 2019

Background: Dealing with a patient in status epilepticus, refractory to treatment with benzodiazepines, can be a sphincter tightening ordeal.  While most seizure activity responds to appropriately dosed benzodiazipines, some will not respond. The choice of second line medication has been hotly debated (i.e. Levetiracetam, fosphenytoin, and valproate).  One of the key aspects of management of status epilepticus is early termination.  The longer the seizure continues, the more likely patients can have cardiac/respiratory complications, brain injury, rhabdomyolysis, hyperkalemia, and acidosis. Thus, prompt termination of seizure activity with second line agents is critical. Despite recent pediatric studies (ConSEPT, ECLIPSE etc) there is limited guidance on the efficacy or safety of second line mediations for status epilepticus.

December 12, 2019

Background: The 2015 American Heart Association guidelines for Adult Advanced Cardiac Life Support recommend adenosine in non-hypotensive patients in regular narrow-complex supraventricular tachycardia (SVT).  Adenosine has a rapid onset and a half-life that is <10 seconds, which makes it an ideal agent for hemodynamically stable SVT. Typically, adenosine is administered as an initial 6mg rapid IV bolus over 1 – 2 seconds followed by a rapid 10 – 20mL saline flush.  If SVT is not terminated and normal sinus rhythm maintained within 1 – 2 minutes, a repeat dose of 12mg is given followed by a 10 – 20mL saline flush, and this can be repeated for a total of 3 doses. Because of the short half-life of adenosine, several advocate for a two-way stopcock, where adenosine and a 10 – 20mL saline flush are given in tandem. The logistics and timing with using a two way stopcock can be challenging and can result in less rapid flush than intended.