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. 

The Dilt Drop: Can Calcium Break the Fall?

Atrial fibrillation with rapid ventricular response (AF with RVR) is one of the most common dysrhythmias encountered in the emergency department and often requires prompt rate control. Diltiazem remains a go-to agent due to its rapid onset, AV nodal selectivity, ...

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Cardiovascular

Midazolam vs Ketamine as Second Line in Status Epilepticus

Status epilepticus is traditionally defined as a seizure lasting ≥5 minutes or recurrent seizures without return to baseline in between. It is a neurologic emergency associated with increased morbidity and mortality the longer it persists. Some complications include cardiac arrhythmias, ...

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NeurologyResuscitation

The TRAUMOX2 Trial: Early Restrictive vs Liberal Oxygen Strategies in Adult Trauma Patients

The TRAUMOX2 trial was an open-label pragmatic, international randomized controlled trial designed to evaluate whether a restrictive oxygen strategy targeting lower oxygen saturation reduces death and/or major respiratory complications compared with a liberal oxygen strategy in adult trauma patients.

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ResuscitationTrauma

ICARUS ED Trial: Concentrated Albumin for Undifferentiated Sepsis in the Emergency Department

Sepsis is one of the most common emergencies we encounter, yet despite decades of research, it still carries a high burden of morbidity and mortality. Over the years, our attempts to improve outcomes have spanned the spectrum—from clearly lifesaving (like ...

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Resuscitation

The ADAPT-Sepsis Trial: Biomarker-Guided Antibiotic Duration for Hospitalized Patients with Suspected Sepsis

Antibiotic stewardship entails delivering the most appropriate antimicrobial therapy for the most appropriate duration of time to help provide the best outcome for patients with sepsis. An unnecessarily extended course of antibiotics leads to adverse effects, greater cost, medication utilization ...

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Infectious Disease

Is 7 Days Enough? Rethinking Antibiotic Duration in Sepsis — The BALANCE Trial

Current IDSA guidelines for sepsis recommend individualized durations of antibiotic therapy based on source control and clinical response, but definitive guidance remains limited. Three small noninferiority RCTs suggested that 7 days of antibiotics may be sufficient for patients with gram-negative ...

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Infectious Disease

TNK vs tPA — The ORIGINAL Trial

The American Heart Association and the European Stroke Organization have updated their guidelines to recommend TNK as an alternative to tPA in patients eligible for thrombolysis. TNK, a bioengineered variant of tPA, has some advantages, including its single-dose administration, fibrin ...

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Neurology

How Accurate are Blood Gas Electrolyte Measurements?

Bottom Line Up Top: Blood gas electrolytes closely correlate with serum measurements and can be used under most circumstances to guide clinical care. Clinical Scenario: A 62 year old woman with a history of HTN, ESRD on MWF dialysis presents ...

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Endocrine, Metabolic, Fluid, and Electrolytes

IVC Distensibility Index vs Collapsibility Index: Using the Correct Index

Background  In 1979, Hiroshi Natori was the first to appreciate the sonographic changes that occur in the inferior vena cava (IVC)’s diameter with ventilation in spontaneously breathing patients, mechanically ventilated patients, and those with carcinogenic and tuberculoid cardiac tamponade.1 They ...

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CardiovascularResuscitationThoracic and Respiratory

Threading the Needle: Bougie-First Intubation

Background: In 2018, the BEAM Trial, a small single-center randomized clinical trial, conducted in the emergency department at Hennepin County Medical Center, demonstrated that bougie use significantly increased the first-attempt intubation success rate compared to the endotracheal tube with stylet ...

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Procedures and SkillsResuscitation
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