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Rebel Category: REBEL EM

The CLASSIC Trial: IV Fluid Restriction in Septic Shock

Background: The Surviving Sepsis Campaign guidelines recommend an initial fixed volume of 30mL/kg of IDEAL body weight within the first 3 hours of resuscitation (weak recommendation, low-quality evidence). [2].  Additionally, the Surviving Sepsis Campaign Guidelines state there is insufficient evidence …

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Endocrine, Metabolic, Fluid, and ElectrolytesInfectious DiseaseResuscitation

Tenecteplase vs Alteplase in Acute Ischemic Stroke

Background: At my shop we have changed wholesale to the use of tenecteplase over alteplase for acute ischemic stroke meeting criteria for thrombolytic therapy.  This was based on a systematic review and meta-analysis of 6 RCTs and 2 observational trials …

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Neurology

EPIC Trial: Electrode Positioning in Cardioverting Atrial Fibrillation

Background Information: Electrical cardioversion of atrial fibrillation is regularly performed by emergency physicians, intensivists, and cardiologists. Although many approaches to performing this procedure exist, the most common electrode placement is the anterior-lateral compared to the anterior-posterior positioning.1 The literature backing …

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CardiovascularProcedures and SkillsResuscitation

Traumatic Hemothorax: Pigtail vs Chest Tube

Background: Optimal management of pneumothorax and hemothorax with chest thoracostomy has been widely debated over the last decade.  We no longer question the utility of pigtail catheters for pneumothorax and now ask whether a catheter has to be placed at …

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Thoracic and RespiratoryTrauma

The Dirty Epi Drip and IV Flow Rates

Recently, I put out a video on the dirty epi drip (YouTube and TikTok) and in that video I discuss the use of this modality when in a pinch (i.e. can’t get push-dose pressors and/or a pump is not available …

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Resuscitation

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