Critical care is the moment when time, physiology, and decisions collide—and the margin for error is thin. It’s not defined by an ICU bed; it’s defined by the need for emergent care to prevent or treat life-threatening illness.

REBEL Crit exists to help clinicians deliver the best possible care to the sickest patients. We critically appraise the latest literature, translate findings into bedside practice, and publish review articles on complex topics designed for busy providers. 

JC: Time to put the REBOA Balloon Away? Maybe, Maybe Not…

The management of the critically hemorrhaging trauma patient has seen a large amount of change over last decade, from bringing care far forward to the field to early use of blood products to civilian translation and application tourniquets to name a ...

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Trauma

PreVent: Bag-Mask Ventilation Prior to Intubation

Background: Rapid Sequence Intubation (RSI)  is a common procedure performed by both emergency clinicians and intensivists. Although the procedure is complex, the major pieces are pre-oxygenation, administration of a sedative agent in close proximity with a paralytic, laryngoscopy and placement of ...

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Resuscitation

HiTEMP: Procalcitonin-Guided Antibiotic Therapy in the ED

Background: With CMS core measures requiring timely use of antibiotics in patients with fever and suspected sepsis, many patients receive antibiotics up front that may ultimately end up having another non-bacterial etiology as the cause of their fever.  On the one ...

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Infectious Disease

ANDROMEDA-SHOCK: Peripheral Perfusion vs Serum Lactate in Septic Shock

Background: Based on the Surviving Sepsis Campaign, hemodynamic resuscitation of sepsis patients is done by repeating serum lactic acid levels every 2 – 4 hours until normalization. The issue with this strategy is that there are other things that may elevate ...

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Infectious Disease

The CENSER Trial: Early Norepinephrine in Septic Shock

Background: Standard management of septic shock has included, IV fluids until optimal intravascular volume is achieved, appropriate early antibiotics, and source control.  Typically, only after all these measures have been undertaken is vasopressor infusion initiated if a MAP of ≥65mmHg is ...

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Infectious Disease

SUP-ICU: Ending the Confusion About Stress Ulcer Prophylaxis in ICU. So I Don’t Give it Right, or do I?

Background: Stress related gastrointestinal mucosal damage is a commonly encountered problem in the critically ill patients admitted to the intensive care unit. The incidence ranges from 0.6-7% and is decreasing partly due to aggressive resuscitation strategies and focus on early enteral ...

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Approach to the Critically Ill Child: Shock

If you mainly treat adults or both adults and children like me, then you have probably heard the (very annoying) quote, “kids are not just small adults”, and so I won’t say it again. Well, I guess I just did, ...

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Pediatrics

Simplifying Mechanical Ventilation – Part 6 – Choosing Your Initial Settings

Choosing Your Initial Settings: I hope you now see what physiologies to consider when setting up the ventilator and your goals for each. If your patient doesn’t fit into one of these three categories, then I set up my ventilator as ...

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Thoracic and Respiratory

High Flow Nasal Cannula (HFNC) – Part 2: Adult & Pediatric Indications

The use of heated and humidified high flow nasal cannula has become increasing popular in the treatment of patients with acute respiratory failure through all age groups.  In part 1 we summarized how High Flow Nasal Cannula (HFNC) works.  In ...

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Thoracic and Respiratory

High Flow Nasal Cannula (HFNC) – Part 1: How It Works

The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups.  I first started using it as a pediatric intensive care fellow, but ...

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Thoracic and Respiratory
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