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With high flows, modest PEEP, and effective dead-space washout, HFNC can improve oxygenation and decrease work of breathing while preserving the ability to talk, cough, eat, and interact with staff and family. The RENOVATE trial set out to answer a high-impact question across five distinct etiologic groups: Is HFNC non-inferior to BPAP (NIV) for preventing intubation or death in acute respiratory failure? The post RENOVATE Trial: HFNC vs BPAP in Acute Respiratory Failure appeared first on REBEL EM - Emergency Medicine Blog.

Non-invasive ventilation (NIV) refers to respiratory support provided without endotracheal intubation. The most common modalities include continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), and high-flow nasal cannula (HFNC). These therapies aim to improve oxygenation, reduce the work of breathing, and potentially prevent invasive mechanical ventilation. The post REBEL Core Cast 148.0–Demystifying Non-Invasive Ventilation & HiFlow appeared first on REBEL EM - Emergency Medicine Blog.

Etomidate or ketamine? The debate over the ideal agent for emergency rapid sequence intubation (RSI) has raged for years with no clear winner. Etomidate has been touted in the past for its rapid onset and minimal intrinsic effects on hemodynamics. However, the drug is well known as a transient adrenal suppressant though the impact of this suppression isn’t clear. Ketamine has risen in recent years as an alternative, due to its perceived hemodynamic stability, analgesic properties and absence of adrenal suppression. Additionally, recent data points towards improved mortality when ketamine was selected over etomidate (Kotani 2023). High quality randomized controlled trials are needed to further elucidate which agent should be selected in critically ill patients. The post The RSI Trial: Ketamine vs Etomidate in Rapid Sequence Intubation appeared first on REBEL EM - Emergency Medicine Blog.

In this episode and blog post, hosts Mark Ramzy and Kim Bambach (Assistant Professor of Emergency Medicine, The Ohio State University) explore a deceptively simple question: How accurately can we assess our own performance? The answer hinges on a classic cognitive bias that touches all of us in emergency medicine. The post REBEL MIND – The Dunning Kruger Effect: Why Looking Inward Improves Patient Care appeared first on REBEL EM - Emergency Medicine Blog.

Shock is a life threatening condition that requires rapid resuscitation, and targeted treatment. Due to its complex nature, shock management poses many challenges for physicians in the acute care setting, more specifically, in the emergency department (ED). Point-of-care-ultrasound (POCUS) has emerged as a promising diagnostic and therapeutic clinical tool in this context, allowing ED physicians to assess hemodynamics and guide treatment interventions in real-time at the bedside. The post POCUS Use in Shock Resuscitation: Evidence for Patient and System-Level Benefits appeared first on REBEL EM - Emergency Medicine Blog.

Rib fractures are among the most common injuries in older trauma patients and can look deceptively “benign” early—until pain-limited ventilation, atelectasis, pneumonia, and respiratory failure develop hours to days later. Disposition decisions based on fracture count alone often miss the interaction between anatomic injury burden and physiologic reserve, especially in frail patients with limited pulmonary “margin.” RibScore offers an anatomy/CT-based estimate of pulmonary complication risk, while SCARF captures dynamic bedside physiology and functional respiratory performance that can worsen despite stable imaging. Using both together helps identify who needs earlier admission, aggressive multimodal analgesia, and closer respiratory monitoring—before decompensation declares itself. The post Rib Fracture Risk: Using RibScore + SCARF to Predict Decline appeared first on REBEL EM - Emergency Medicine Blog.

Annual influenza cases exceed one billion worldwide, with the vast majority of patients experiencing mild to moderate severity of illness. This massive health burden explains the extensive research into antivirals, including oseltamivir (Tamiflu). Initial studies supported the utility of oseltamivir for preventing complications, hospitalization and shortening disease course in patients with mild to moderate influenza. However, subsequent analysis determined that Roche (the manufacturer of oseltamivir), purposefully hid data from reviewers, biasing the initial interpretations (Krumholz 2014, Fremantle 2014). Subsequent analysis of the full set of data tempered expected benefits (Jefferson 2014). The post Clinical Conundrum: How Effective is Oseltamivir in Influenza? appeared first on REBEL EM - Emergency Medicine Blog.

This episode reviews essential ventilator pressures and how to interpret them during ICU rounds. The post REBEL Core Cast 147.0–Ventilators Part 5: Key Mechanical Ventilator Pressures & Definitions Made Simple appeared first on REBEL EM - Emergency Medicine Blog.

Antithrombotic therapy is a cornerstone in the treatment of atrial fibrillation (AFib), though it carries a significant risk of bleeding. While Vitamin K antagonists (VKAs), the oldest anticoagulants, were largely supplanted by direct oral anticoagulants (DOACs) following trials like ARISTOTLE and ROCKET AF, the risk of bleeding with these newer agents still exists. Enter Abelacimab, a novel drug designed to provide thrombosis protection while minimizing the impact on hemostasis. Abelacimab is a fully human monoclonal antibody that specifically targets and inhibits both Factor XI (FXI) and its activated form, Factor XIa (FXIa). Its pharmacokinetics suggest complete suppression of FXIa, requiring a single intravenous dose administered once a month. The post Is Abelacimab the Next Step in AF Anticoagulation? Early Signals and Remaining Questions appeared first on REBEL EM - Emergency Medicine Blog.

Nausea with or without vomiting is very common in early pregnancy, affecting approximately 70% of pregnancies (Maisal 2012). Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy that can lead to significant maternal dehydration, electrolyte abnormalities, and weight loss if not properly managed. Pharmacologic treatment is crucial to break the cycle of vomiting, restore oral intake, and prevent complications such as Wernicke’s encephalopathy or hospitalization. Timely and effective treatment improves maternal quality of life, prevents adverse fetal outcomes related to malnutrition, and reduces the need for invasive interventions. The post Clinical Conundrum: Pregnant and Puking: What’s Safe and Effective in the ED? appeared first on REBEL EM - Emergency Medicine Blog.

Ventilator management can feel overwhelming—there are so many knobs to turn, numbers to watch, and changes to make. But before adjusting any settings, it’s crucial to understand why the patient is in distress in the first place, because the right strategy depends on the underlying cause. In this episode, we’ll walk through three different cases to see how the approach changes depending on the problem at hand. The post REBEL Core Cast 146.0–Ventilators Part 4: Setting up the Ventilator appeared first on REBEL EM - Emergency Medicine Blog.

Welcome to the Rebel Core Content Blog, where we delve into crucial knowledge for emergency medicine. Today, we share insightful tips from PEM specialist Dr. Elise Perelman, shedding light on respiratory challenges in infants, toddlers, and young children during the viral season. Understanding that most cases involve typical viruses, we aim to equip you with diagnostic pearls to identify more serious pathologies. The post REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season appeared first on REBEL EM - Emergency Medicine Blog.

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, and reliable heart rate reduction. However, hypotension occurs in up to 13% of patients, occasionally symptomatic in 4% of patients, and particularly concerning in those with limited reserve (Ellenbogen 1995).  The post The Dilt Drop: Can Calcium Break the Fall? appeared first on REBEL EM - Emergency Medicine Blog.

Pneumonia season doesn’t just fill your waiting room – it fills your brain with decisions: Admit or discharge? Floor or ICU? CURB-65, PSI/PORT, and SMART-COP all promise to help, but they’re not built to answer the same question. This quick comparison walks you through how each score thinks, where each one shines, and when a “low-risk” patient might actually be one bad hour away from crashing. Don’t just diagnose pneumonia — predict who might acutely decompensate. The post Winter is Coming: Are You Using the Right Pneumonia Score? appeared first on REBEL EM - Emergency Medicine Blog.

Host Dr. Mark Ramzy shines a spotlight on three distinguished speakers: Dr. Jess Mason, Dr. Tarlan Hedayati, and Dr. Simon Carley, who shared their expertise and experiences at this transformative gathering last spring. The post REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Tarlan Hedayati, Jess Mason and Simon Carley appeared first on REBEL EM - Emergency Medicine Blog.

The QT interval is a vital part of ECG interpretation, reflecting the heart’s electrical recovery after each beat. When prolonged, it can set the stage for torsades de pointes. Understanding how to measure and correct the QT interval, identify high-risk medications, and act quickly when TdP occurs is essential for every clinician. This guide walks you through the physiology, interpretation, common causes, and emergency management of QTc prolongation to keep your patients safe. The post REBEL Core Cast 145.0: Understanding QTc Prolongation: Causes, Risks, and Management appeared first on REBEL EM - Emergency Medicine Blog.

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, respiratory failure, aspiration pneumonia, and recurrent status epilepticus. The established treatment paradigm includes first line treatment with benzodiazepines (midazolam IM, lorazepam IV, diazepam IV). Second line treatments include antiepileptics (fosphenytoin, levetiracetam, valproate). Third line treatments include anesthetic agents (propofol, ketamine, midazolam infusions). The post Midazolam vs Ketamine as Second Line in Status Epilepticus appeared first on REBEL EM - Emergency Medicine Blog.

In this episode of the Rebel Core Content podcast, Swami provides crucial tips on using tourniquets. Highlighting the significance of these life and limb-saving devices, the discussion focuses on the optimal placement of tourniquets, emphasizing placing them 2-3 inches (5-6 cm) above the bleeding source and avoiding joints. Swami also advises on the correct way to tighten the tourniquet using the Velcro strap first, followed by minimal use of the windless. The importance of noting the application time to avoid prolonged arterial flow interruption is also discussed. The episode concludes with a reminder to visit the podcast's website for more valuable content. The post REBEL Core Cast 144.0: Tourniquet Tips appeared first on REBEL EM - Emergency Medicine Blog.

Predicting severity in acute pancreatitis matters — it guides where patients go, how closely we watch them, and how aggressively we manage fluids and complications. Two of the most commonly used tools are Ranson’s Criteria and the BISAP Score. Ranson’s offers a comprehensive, data-rich assessment once labs and time points are available, while BISAP gives a fast, bedside estimate of mortality risk that’s perfect for the early phase of care. The post MDCalc Wars – The Rise of BISAP: Is Ranson Retiring? appeared first on REBEL EM - Emergency Medicine Blog.

🧭 REBEL Rundown 📝Introduction In this exciting episode of REBEL Cast, host Dr. Mark Ramzy joins forces with renowned educator and speaker, Dr. George Willis. Broadcasting straight from the ACEP 25 in Salt Lake City, the duo talk about bringing together the international emergency medicine community, as they reflect on their experiences at the Increment ... Read more The post REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy appeared first on REBEL EM - Emergency Medicine Blog.

Managing diabetic ketoacidosis (DKA) requires careful consideration of fluid therapy, especially in severe cases. In part two of our REBEL Cast DKA series, we shifted from insulin strategies to fluid choice in severe DKA, diving into the SCOPE-DKA trial—a cluster, crossover, open-label RCT from Australia. While normal saline (NS) is commonly used, concerns about its high chloride content and impact on acidosis have sparked growing interest in balanced solutions like Plasma-Lyte. The post REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial appeared first on REBEL EM - Emergency Medicine Blog.

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. The post The TRAUMOX2 Trial: Early Restrictive vs Liberal Oxygen Strategies in Adult Trauma Patients appeared first on REBEL EM - Emergency Medicine Blog.

In this episode of REBEL Cast, we dive into part one of our Diabetic Ketoacidosis (DKA) series with a twist—subcutaneous insulin instead of the traditional IV drip. We explore the SQuID Protocol (Subcutaneous Insulin in DKA), which could potentially shift how we manage mild to moderate DKA—from the ICU to the general floor. The post REBEL Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol appeared first on REBEL EM - Emergency Medicine Blog.

Emergency medicine physicians were trailblazers during the opioid epidemic, and now we have the same opportunity with alcohol use disorder (AUD). Treating AUD deserves the same attention we give to opioid overdose, diabetic ketoacidosis, or hypertensive emergencies. Even when alcohol use doesn’t present as an immediate crisis, each ED encounter is a chance to intervene—one that could help prevent future withdrawal, traumatic injury, or upper gastrointestinal bleed. Naltrexone and other Medications for Alcohol Use Disorder (MAUD) can reduce alcohol use, and just 12 patients need to be treated to prevent one from returning to heavy drinking. By recognizing alcohol use disorder as a critical health issue and leveraging simple, evidence-based tools, emergency physicians can transform routine encounters into life-changing opportunities. Initiating MAUD in the Emergency Department (ED) is feasible and impactful. Even a single dose of naltrexone in the ED can jump-start treatment and is generally safe and well-tolerated. However, MAUD has rarely been offered in the ED, but the growing evidence suggests it increases treatment engagement and reduces drinking. Many of these medications have been thoroughly investigated, are safe to administer, and are effective at reducing alcohol consumption. Furthermore. In 2024, the Society for Academic Emergency Medicine (SAEM) published Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4) on alcohol use disorder and recommend prescribing MAUD. Many patients with alcohol use disorder face numerous societal obstacles and are less likely to access follow-up care. Therefore, initiating MAUD in the emergency department might be the only opportunity to start treatment. The post Treatment for Alcohol Use Disorder appeared first on REBEL EM - Emergency Medicine Blog.

Each year, about 1 in 7 men and 1 in 11 women in the United States meet criteria for alcohol use disorder (AUD)—affecting nearly 29 million people, roughly the entire population of Texas. Patients with AUD face staggering health risks: they are 3.5 times more likely to die than the general population, and their life expectancy is up to 25 years shorter. Over the past decade, alcohol-related emergency department (ED) visits have climbed by nearly 50%. Between 2021 and 2023 alone, alcohol accounted for approximately 8.6 million substance use-related ED visits—double the number linked to opioids. Effective treatments and resources for AUD are underutilized and screening rates in the ED are as low as 8%, leaving millions of high-risk patients unidentified and untreated. This mismatch between disease burden and screening represents a critical missed opportunity. Closing this gap is possible. Naltrexone, for example, has a number needed to treat of just 12 to prevent relapse into heavy drinking. It is widely available, easy to prescribe, and can be life-altering—even life-saving. This post highlights practical screening tools for identifying it in the ED, and offers recommendations for seamlessly integrating these approaches into everyday workflow to deliver more comprehensive patient-centered care. The post Screening for Alcohol Use Disorder appeared first on REBEL EM - Emergency Medicine Blog.

When you take the airway, you take the wheel and you now control the patient’s oxygenation and ventilation. In this REBEL Crit episode, Dr. Lodeserto and Dr. Acker walk through the physiology, ventilator strategies, and clinical curveballs that separate calm control from chaos at the bedside. The post REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator appeared first on REBEL EM - Emergency Medicine Blog.

PECARN has been THE  decision rule for guidance on management of kids with head injuries, but the Infant Scalp Score dives even deeper—built just for babies with scalp hematomas.  Which rule is best in this situation? The post MDCalc Wars – Tiny Patient, Big Decision: Head CT or no Head CT? appeared first on REBEL EM - Emergency Medicine Blog.

Procalcitonin is a protein that is upregulated during inflammatory states. An elevation in procalcitonin should be specific to bacterial infections. Viral infections should result in decreased procalcitonin levels thus allowing us to differentiate bacterial from viral and help guide antibiotic prescription. However, this differentiation isn’t what we see in real life data. The post Clinical Conundrum: What is the Utility of Procalcitonin in the ED? appeared first on REBEL EM - Emergency Medicine Blog.

Mechanical ventilation can feel overwhelming, especially when faced with a sea of ventilator modes and unfamiliar terminology. In Part 2 of the series, we go beyond breath types and delivery mechanics to explore the most used modes in the ICU. We will break down each one; explaining how it works, when to use it, and why the goal isn’t the “best mode” but the most comfortable one for the patient. The post REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes appeared first on REBEL EM - Emergency Medicine Blog.

In this special episode of Rebel Cast, we spotlight the Incrementum Conference in Spain, a significant event in emergency medicine. Hosts welcome Dr. Francisco 'Paco' Campillo Palma and Dr. Carmen Maria Cano, founders of Incrementum, to discuss the recognition of emergency medicine as a specialty in Spain. They share their journey of creating the conference, emphasizing the importance of education, collaboration, and growth. The discussion also touches on this year's conference highlights, including sessions on mental health and evidence-based medicine, and the exceptional lineup of speakers. Listeners are encouraged to attend the conference in April 2026 for an enriching experience. The post Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain appeared first on REBEL EM - Emergency Medicine Blog.