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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.

In the first trimester, fever is associated with increased risk of birth defects such as cleft lip and palate, as well as serious neural-tube defects such as spina bifida and anencephaly. In late pregnancy, fevers can boost the risk of miscarriage, stillbirth, and preterm birth (Antoun 2021). Acetaminophen is the most commonly used antipyretic/analgesic medications with up to 62% of women using it during pregnancy (Bandli 2020). The drug does cross the placenta making it important to research fetal effects, particularly neurodevelopmental disorders (NDDs) including autism, ADHD and intellectual disability. For decades, the American College of Obstetrics and Gynecology (ACOG) has recommended acetaminophen as the safest antipyretic/analgesic during pregnancy (ACOG 2021). The post Clinical Conundrum: Is Acetaminophen Safe in Pregnancy? appeared first on REBEL EM - Emergency Medicine Blog.

POCUS diastology doesn’t diagnose chronic diastolic dysfunction—it estimates left atrial pressure in real time. Learn how to capture E and e’ from an apical 4-chamber view, calculate E/e’, and rapidly distinguish cardiogenic pulmonary edema from other causes of acute dyspnea in the ED. The post Diastology: Use E/e’ to Estimate Left Atrial Pressure appeared first on REBEL EM - Emergency Medicine Blog.

Today we are exploring the imperative topic of rest and why it’s not just about sleeping. The first of a two part series, hosted by Dr. Mark Ramzy with guests Dr. Maureen Aiad and Dr. Amil Badoolah, our discussion sheds light on the multifaceted nature of rest, especially in the demanding field of emergency medicine. The post REBEL MIND – How to Sleep When the World Says You Can’t appeared first on REBEL EM - Emergency Medicine Blog.

The optimal treatment strategy for intermediate-risk (submassive) pulmonary embolism remains controversial. These patients are not in shock, but they have right ventricular (RV) dysfunction and myocardial injury, which are associated with higher risk for clinical decompensation and adverse outcomes. The post The PEERLESS Trial: Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis in Intermediate-Risk PE appeared first on REBEL EM - Emergency Medicine Blog.

Need a quick, reliable coma scale in real ED chaos? SMS simplifies assessment, while FOUR adds brainstem and respiratory data when it matters most. The post MDCalc Wars: GCS Alternatives in the ED: SMS and FOUR Score 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: Is Tamsulosin Effective in Increasing Spontaneous Passage Rate of Ureteral Stones? appeared first on REBEL EM - Emergency Medicine Blog.

In this episode, we're excited to continue collaboration with Arena Labs, where host Dr. Mark Ramzy interviews Allyn Abadie, Arena Labs’ Principal Scientist on how we can apply performance science in and out of the emergency department. The post REBEL MIND: Applying Performance Science In and Out of the Emergency Department appeared first on REBEL EM - Emergency Medicine Blog.

The cornerstone of acute ischemic stroke (AIS) management involves timely reperfusion of the ischemic brain tissue. Intravenous thrombolysis with alteplase has been the standard of care for AIS within 4.5 hours of symptom onset, based on pivotal trials such as NINDS and ECASS III, which demonstrated improved functional outcomes despite an increased risk of intracerebral hemorrhage. However, many patients present outside this narrow therapeutic window, excluding many patients from the potential benefits of thrombolytics. For some, mechanical thrombectomy is an option if their stroke is the result of a medium or large vessel occlusion and is amenable to aspiration or stent retrieval. Recent advances in neuroimaging, particularly perfusion-based techniques, have allowed for the identification of salvageable brain tissue beyond traditional time limits. This imaging-guided approach has spurred clinical trials evaluating the safety and efficacy of thrombolysis in the extended and late time windows. The post The Hope Trial: Alteplase 4.5–24 Hours After Stroke (CT Perfusion Selected) appeared first on REBEL EM - Emergency Medicine Blog.

Consults aren’t a formality—they’re a patient-care intervention. In this post, Swami breaks down how to call a consult in the ED using a simple 4-step framework (introduce yourself, lead with the ask, give a focused summary, and close the loop), plus practical strategies for handling pushback, refusals, and when to escalate to protect patient care. The post REBEL Core Cast 150.0: Emergency Medicine Consults: How to Call a Consult + Handle Pushback (With Scripts) appeared first on REBEL EM - Emergency Medicine Blog.

Prior research has shown that deep tracheal suctioning can result in more rapid development of hypoxemia. It is unclear if continuous suctioning during intubation poses a similar risk. Does the application of continuous suctioning during rapid sequence intubation (RSI) result in more rapid deoxygenation? The post Continuous Suctioning Doesn’t Hasten Hypoxemia appeared first on REBEL EM - Emergency Medicine Blog.

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 REBEL CAST – RENOVATE Trial: HFNC vs BPAP in Acute Respiratory Failure appeared first on REBEL EM - Emergency Medicine Blog.

Today we are exploring the imperative topic of rest and why it’s not just about sleeping. The first of a two part series, hosted by Dr. Mark Ramzy with guests Dr. Maureen Aiad and Dr. Amil Badoolah, our discussion sheds light on the multifaceted nature of rest, especially in the demanding field of emergency medicine. The post REBEL MIND – Rest Is Not Sleep: The Seven Dimensions of True Recovery appeared first on REBEL EM - Emergency Medicine Blog.

Corticosteroids have long sparked debate in the treatment of bacterial pneumonia — once viewed with skepticism, now increasingly supported by high-quality evidence. In this episode, Dr. Alex Chapa joins the REBEL Core Cast team to explore how the 2023 Cape Cod Trial (NEJM) reshaped practice and guideline recommendations for severe community-acquired pneumonia (CAP). The post REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia appeared first on REBEL EM - Emergency Medicine Blog.

Host Dr. Mark Ramzy shines a spotlight on two phenomenal educators: Drs. Sara Crager and Ryan Ernst who shared their expertise and experiences at this transformative gathering last spring. The post REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Sara Crager and Ryan Ernst appeared first on REBEL EM - Emergency Medicine Blog.

In this episode, we're excited to continue collaboration with Arena Labs, where host Dr. Marco Propersi interviews Jackie Pen, Heading of Performance Coaching at Arena Labs. The post REBEL MIND: The Power of Performance Coaching in Medicine appeared first on REBEL EM - Emergency Medicine Blog.