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. 

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

Is Pip-Tazo Harming Sepsis Patients?

Background: Patients with sepsis are routinely treated with empiric broad-spectrum antibiotics while awaiting source identification, as recommended by the surviving sepsis campaign.2 Vancomycin, in combination with either piperacillin-tazobactam or cefepime, is commonly used for empiric treatment in these cases. Literature ...

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Infectious Disease

The Ducanto Catheter—It Sucks!

Background: Emergency intubations present a unique set of challenges, particularly when dealing with heavily contaminated airways. Anesthesiologist, Dr. James DuCanto, developed the DuCanto catheter to enhance airway management in these high-stakes situations. The commonly used 14 Fr Yankauer catheter, with ...

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Procedures and SkillsResuscitation

The PROTECTION Trial – A Randomized Trial of Intravenous Amino Acids for Kidney Protection

Background Information: Acute kidney injury (AKI) is one of the most frequent complications of cardiac surgery and the cause is complex. Renal hypoperfusion from decreased glomerular filtration rate after cardiopulmonary bypass is a major contributor.1 This in combination with exogenous ...

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CardiovascularRenal and GenitourinaryResuscitation

The REBEL Lit Distillery at ResusX

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Clinical Conundrums: Is an Arterial Lactate Necessary?

Bottom Line Up Top: A peripheral venous blood lactate can reliably be used instead of an arterial blood lactate as a marker of systemic tissue hypoperfusion and to measure response to treatment.  Clinical Scenario: A 63 year old woman with ...

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Endocrine, Metabolic, Fluid, and Electrolytes

The PREOXI Trial: Pre-Oxygenation with NIV vs Facemask

Background: Tracheal intubation is frequently performed in critically ill patients.  Hypoxemia is one of the major adverse events that can occur during intubation and it increases the risk of morbidity and mortality. Preoxygenation before induction of anesthesia increases the amount ...

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ResuscitationThoracic and Respiratory

Automated vs Manual Chest Compressions in Out-of-Hospital Cardiac Arrest

Background Information: Out of hospital cardiac arrest (OHCA) is a medical emergency that requires immediate intervention to increase the chance of survival. The global survival rate of OHCA patients who received CPR has increased in the past 40 years . ...

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CardiovascularResuscitationThoracic and Respiratory

DanGer Shock Trial: Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock

Background: STEMI can be complicated by cardiogenic shock and this complication is associated with a high morbidity and mortality rate. Decreased cardiac output  results in inadequate perfusion and subsequent end-organ damage. Mechanical circulatory support can improve perfusion and, in theory, ...

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CardiovascularResuscitation
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