March 11, 2015

Epinephrine is widely used and recommended by Advanced Cardiovascular Life Support (ACLS) in out-of-hospital cardiac arrest (OHCA), but its effectiveness in neurologic outcomes has never been truly established.  To verify effectiveness of epinephrine confounders, such as patients, CPR quality, CPR by bystanders, time from call to arrival at scene or hospital, and much much more, must be controlled for in a trial. This type of study is not easily performed due to ACLS being the current standard of care.

February 2, 2015

Background: Hyperkalemia is the most common electrolyte disorder seen in the Emergency Department and treatment of hyperkalemia is core knowledge of EM training for interns and focuses on:
1) Stabilization of cardiac myocytes with calcium salts
2) Temporary shifting of potassium into cells (insulin, beta agonists, normal saline,
      magnesium, sodium bicarbonate)
3) Removal of potassium from the body (i.e. loop diuretics, cathartics)
4) Definitive Treatment (i.e. Hemodyalisis)
Although there is still some debate on the first two areas (i.e. is there truly a role for sodium bicarbonate?) our focus will be on the removal part of the algorithm, specifically, is there a role for kayexalate?

January 10, 2015

Welcome to the January 2015 REBELCast, where Swami and I are going to tackle a very important scenario that comes up in the daily practice of not only Emergency Medicine, but also in Medicine.  Today we are going to specifically tackle one topic: Topic: Is the use of cephalosporin antibiotics in patients with a history of penicillin class antibiotics safe?

January 5, 2015

Background: Streptococcal pharyngitis is a common presentation to primary care and Emergency Department physicians. Every year, 10 million patients in the United States are treated with antibiotics for pharyngitis. However, less than 10% of these patients actually have strep pharyngitis (Barnett 2013). Prescribing of antibiotics for these patients centers on three arguments:
  1. Antibiotics reduce symptomology
  2. Antibiotics reduce the rate of suppurative complications
  3. Antibiotics reduce the rate of non-suppurative complications (primarily Rheumatic Heart Disease).
So, do patients with strep throat need to be treated with antibiotics?

May 1, 2014

Frequently, patients with acute alcohol intoxication are brought to the emergency department (ED) for evaluation and treatment.  Although practice patterns vary, it is not an uncommon practice to give normal saline to these patients in the hopes that the saline will cause a dilution effect on the level of alcohol helping patients sober faster and therefore having a shorter length of stay in the ED.  At the end of 2013 a study was published evaluating intravenous fluids and alcohol intoxication.