RSS Feed

🧭 REBEL Rundown 🗝️ Key Points 👀 HINTS requires the right patient: Ongoing acute vestibular syndrome with nystagmus—and a trained examiner. 🧮 Sudbury assesses broader risk: It estimates the likelihood of serious central diagnoses in patients with dizziness, vertigo, or imbalance. 🚩 Concerning HINTS findings demand action: Central or equivocal results warrant stroke evaluation and ... Read more The post MDCalc Wars: HINTS vs Sudbury Vertigo Risk Score — Which Tool Fits the Dizzy Patient? appeared first on REBEL EM - Emergency Medicine Blog.

Does primary sedation with dexmedetomidine or clonidine reduce the time to successful extubation in mechanically ventilated critically ill patients compared to propofol-based sedation? The post The A2B Trial: Are Alpha-2 Agonists Better than Propofol for ICU Sedation? appeared first on REBEL EM - Emergency Medicine Blog.

In adults with cirrhosis and upper gastrointestinal bleeding, does shorter‑duration or no antibiotic prophylaxis, compared with longer‑duration prophylaxis, lead to better clinical outcomes such as reduced mortality, infection, or adverse events? The post Revisiting a Core Practice: Antibiotic Prophylaxis in Cirrhotic Bleeds appeared first on REBEL EM - Emergency Medicine Blog.

Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. MIND stands for Mastering Internal Negativity during Difficulty. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. In this episode, Dr. Kim Bambach talks with emergency physician and neuroscientist Dr. Adrienne Taren as well as emergency physician and wilderness medicine expert Dr. Linda Keyes about the Nature Reset: how exposure to nature can restore attention, downshift our stress response, and help our brains recover from the cognitive demands of medicine.  The post REBEL MIND – The Nature Reset appeared first on REBEL EM - Emergency Medicine Blog.

Compare the strengths, limitations, and ideal use cases of Alvarado, PAS, and pARC to choose the right appendicitis score for your next pediatric patient. The post MDCalc Wars: Pediatric Appendicitis – Three Scores, One Diagnosis appeared first on REBEL EM - Emergency Medicine Blog.

Is there any moderate or high-level evidence that SEP-1 compliance and/or implementation is associated with improvement in sepsis mortality? The post Effect of Sepsis Bundle (SEP-1) Compliance and Implementation on Mortality appeared first on REBEL EM - Emergency Medicine Blog.

Is HFNC as effective as NIV in reducing respiratory rate and improving respiratory distress within 2 hours in ACPE? The post SPICE III Trial: Does Early Dexmedetomidine Improve Survival in Mechanically Ventilated ICU Patients? appeared first on REBEL EM - Emergency Medicine Blog.

For uncomplicated, radiographically confirmed toddler’s fractures, a removable walking boot may be a practical alternative to casting, reducing caregiver burden without worsening pain outcomes. The post Casting Doubt on Tradition: Boot vs Cast for Toddler’s Fractures appeared first on REBEL EM - Emergency Medicine Blog.

Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. In this episode, we introduce an innovative teaching tool called Rapid Sequence, aimed at revolutionizing how clinicians learn critical care through gamified experiences. The post REBEL MIND – Teaching Towards Expertise with Gamification appeared first on REBEL EM - Emergency Medicine Blog.

Is HFNC as effective as NIV in reducing respiratory rate and improving respiratory distress within 2 hours in ACPE? The post HFNC vs. NIV in Acute Cardiogenic Pulmonary Edema: Go with the Flow? appeared first on REBEL EM - Emergency Medicine Blog.

In adults with sickle cell disease hospitalized for acute chest syndrome (ACS) without pulmonary artery macrothrombosis, does therapeutic-dose anticoagulation with tinzaparin shorten ACS duration compared with prophylactic-dose anticoagulation? The post The TASC Trial: Therapeutic vs Prophylactic Anticoagulation for Acute Chest Syndrome appeared first on REBEL EM - Emergency Medicine Blog.

Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. MIND stands for Mastering Internal Negativity during Difficulty. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. In this episode, host Dr. Kim Bambach chats with master educator Dr. Jennifer Yee about the science of performance through mastery learning and deliberate practice.  The post REBEL MIND – Mastery Learning and Deliberate Practice appeared first on REBEL EM - Emergency Medicine Blog.

The ABC Score is a rapid, 4-variable bedside tool for immediate massive transfusion decisions — before labs are back; TASH provides a more precise probability estimate once labs and imaging are available The post MDCalc Wars: Massive Transfusion in Trauma – ABC vs. TASH appeared first on REBEL EM - Emergency Medicine Blog.

Does rocuronium delay post-intubation sedation and analgesia compared with succinylcholine after RSI? This REBEL EM post appraises a retrospective ED cohort study examining paralytic choice, analgosedation timing, and the risk of awareness during paralysis. The post Rocuronium vs Succinylcholine for RSI: Awareness, Paralysis, and Post-Intubation Sedation appeared first on REBEL EM - Emergency Medicine Blog.

Nitrous oxide, commonly known as “whippets,” is often perceived as harmless. However, frequent use can lead to functional vitamin B12 deficiency, subacute combined degeneration, and potentially permanent neurologic dysfunction. This review covers the pathophysiology, clinical presentation, diagnosis, and treatment of nitrous oxide toxicity. The post REBEL Core Cast—Nitrous Oxide Toxicity: Whippets and Neurologic Injury appeared first on REBEL EM - Emergency Medicine Blog.

Is there a lower rate of recurrent cardiac arrest in patients who received norepinephrine versus epinephrine post-ROSC? The post Meta-Analysis of Norepinephrine vs Epinephrine After Cardiac Arrest appeared first on REBEL EM - Emergency Medicine Blog.

Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. In this episode, host Dr. Mark Ramzy chats with special guests and master educators about the concept of human factors. The post REBEL MIND – Human Factors: The Hidden Architecture of Emergency & Critical Care Medicine appeared first on REBEL EM - Emergency Medicine Blog.

Not every normotensive PE patient is truly low risk. sPESI helps identify patients who may be safe for outpatient management, while Bova helps recognize patients at risk for early deterioration despite initially stable vital signs. The post MDCalc Wars: sPESI vs Bova Score — PE Risk Stratification Made Practical appeared first on REBEL EM - Emergency Medicine Blog.

In patients with intermediate-risk pulmonary embolism (PE), does ultrasound-facilitated, catheter-directed fibrinolysis (US-CDT) plus anticoagulation improve clinical outcomes compared to anticoagulation alone? The post HI-PEITHO Trial: Ultrasound-facilitated, Catheter Directed Fibrinolysis for PE appeared first on REBEL EM - Emergency Medicine Blog.

CTA is the preferred initial test for unstable patients with suspected active lower GI bleeding, but it should not be routinely ordered in all cases. Here’s how to decide who actually benefits. The post Clinical Conundrum — Lower GI Bleeding: Who Needs a CTA? appeared first on REBEL EM - Emergency Medicine Blog.

In this secondary analysis of the DOSE-VF Trial, one of the first RCTs assessing alternative defibrillation strategies in OHCA, the authors reviewed defibrillation files from the initial study to answer whether reduced time in VF between shocks could explain the survival benefits noted in the original RCT. The post Alternate Defibrillation Strategies for Refractory Ventricular Fibrillation appeared first on REBEL EM - Emergency Medicine Blog.

Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. Hosted by Dr. Mark Ramzy, with special guest Dr. Dan Dworkis, an emergency physician and author of "The Emergency Mind," this episode dives into the complex journey from junior to senior leadership in medical settings. The post REBEL MIND – The Mental Jump: Moving from Junior to Senior Leadership in Emergency Care appeared first on REBEL EM - Emergency Medicine Blog.

Not every knee injury needs an x-ray. This post compares the Ottawa and Pittsburgh Knee Rules, highlighting when each rule applies, how they perform, and common pitfalls for ED clinicians. The post MDCalc Wars: Ottawa vs Pittsburgh — Which Knee Rule Should You Use? appeared first on REBEL EM - Emergency Medicine Blog.

There are a number of accepted treatments for dysfunctional uterine bleeding (DUB) endometrial ablation and hysterectomy as well as medical treatments like hormonal therapy, NSAIDs and tranexamic acid (TXA). The American College of Obstetrics and Gynecology (ACOG) recommends the use of TXA in both acute and chronic DUB in non-pregnant, reproductive aged women.  The post Clinical Conundrum: What Is the Role of TXA in Dysfunctional Uterine Bleeding? appeared first on REBEL EM - Emergency Medicine Blog.

What are the differences in efficacy and safety of HFNC, NIPPV, and facemask oxygen for preoxygenation of patients who are critically ill requiring tracheal intubation? The post Systematic Review and Meta-Analysis of Preoxygenation Strategies For Intubation of Critically Ill Patients appeared first on REBEL EM - Emergency Medicine Blog.

The OPTION trial evaluated IV tenecteplase (0.25 mg/kg) in CT perfusion–selected non-LVO ischemic stroke patients treated 4.5–24 hours after last-known-well. Tenecteplase improved excellent 90-day outcomes (mRS 0–1) but increased symptomatic intracranial hemorrhage, with the benefit–harm balance sensitive to outcome and sICH definitions; larger international replication is needed before broad adoption. The post The OPTION Trial: Late-Window TNK for Non-LVO Stroke appeared first on REBEL EM - Emergency Medicine Blog.

The EVERDAC trial sought to determine if managing shock with noninvasive brachial cuff monitoring is noninferior to early ( The post The EVERDAC Trial: Non-Invasive BP vs Arterial Lines in the Critically Ill appeared first on REBEL EM - Emergency Medicine Blog.

Mindset shapes everything we do in medicine—from how we teach and learn to how we show up for patients at the bedside. In this episode, we delve into how the mindset of clinicians can profoundly influence their performance, professional growth, and ultimately patient care The post REBEL MIND – Growth vs Fixed Mindset in Medicine appeared first on REBEL EM - Emergency Medicine Blog.

The HAT and SEDAN scores help estimate symptomatic intracranial hemorrhage risk after stroke thrombolysis. This comparison reviews what each tool measures, when to use them, and the key limitations clinicians should know. The post MDCalc Wars: HAT vs SEDAN — Hemorrhage Risk After Stroke Thrombolysis appeared first on REBEL EM - Emergency Medicine Blog.

STEMI-equivalent and STEMI-mimic ECGs are among the most difficult tracings to interpret. This study examines how Queen of Hearts AI performed against physicians when accuracy in cath lab activation decisions mattered most. The post The Queen of Hearts Returns: AI vs Physicians in STEMI-Equivalent and STEMI-Mimic ECGs appeared first on REBEL EM - Emergency Medicine Blog.