May 21, 2020

Background: Upper endoscopy allows for the identification of the source of bleeding as well as hemostatic treatment for actively bleeding lesions In patients with upper gastrointestinal bleeding (UGIB).  Definitive treatment with endoscopic hemostatic treatment can potentially stop bleeding in high-risk lesions and reduce further bleeding and the need for surgery. The optimal time for endoscopy to be performed is unknown.  The definition of urgent varies depending on which study you read, ranging from 2 hours up to 12 hours. Additionally, most previous studies only enrolled patients who were not hemodynamically unstable or high-risk, which is frequently what we are dealing with in the emergency department. The Glasgow-Blatchford score is a validated risk-assessment score for the prediction of clinical outcomes, including the need for intervention and risk of death.  The score ranges from 0 to 23, with higher scores indicting a higher risk of further bleeding or death. A threshold score of ≥7 has been shown to be the most accurate predictor of whether a patient will need endoscopic treatment.2 There are conflicting results regarding urgent endoscopy (within 6 hours after admission) and mortality.

December 26, 2018

REBEL EM-ers: Salim, Jenny and I would like to announce the launch of a new REBEL EM project. Beginning in 2019, we'll be adding a core content section to the website. This will include core content blog posts and a core content podcast with a dedicated place on the parent site. Instead of creating a separate podcast, we'll be bringing you REBEL Core Cast as part of REBEL Cast. This way, you won't need to download another podcast. Twice a month, Jenny and I will bring you a podcast based on a core topic in EM or based on pearls from our conferences. See you all in the New Year!

March 12, 2018

In Episode 46a we discussed respiratory failure and NIV.  In episode 46b we are going move on to the patient where you have tried NIV and your patient just doesn’t seem to be improving.  You decide to intubate your patient and connect them to the ventilator.  Now the ventilator starts beeping and your patient begins to decompensate.  What are the steps you use to assess the problem and fix it?

February 26, 2018

Imagine you have a patient in respiratory failure sitting right in front of you. The patient has an increased work of breathing and obviously in distress.  Monitors are beeping, nurses are asking you what you want to do, and if you don’t do something, the patient is going to arrest and potentially die.  What is your framework for tackling these patients?  Well, I had a chance to sit down with Haney Mallemat and discuss his framework for managing respiratory failure and NIV.

January 8, 2018

Background: In the United States we are not only seeing an opioid epidemic but also a shortage of IV opioid agents. For both reasons, it is important to find non-opioid options for common pain complaints seen in the ED.  Changing prescribing practices is difficult but an important step in minimizing opioid usage.  Current research suggests that even short term opioid use can cause a predisposition to subsequent opioid dependence. In the spirit of doing no harm, we as a healthcare community should look to find other less harmful ways to decrease pain and suffering.  In this episode, we will review four randomized clinical trials published in the past year on pain control to see if there is evidence to support other non-opioid options.
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