HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. DEXAMETHASONE VS METHYLPREDNISOLONE IN ICU PATIENTS WITH Background Information: Over one year into the pandemic many therapies to treat COVID-19 have targeted innumerable aspects of the virus. Most recently, the use of corticosteroids to treat the virus’ excessive inflammatory effects has become the front and center of therapy in patients requiring oxygen therapy. 1 The RECOVERY trial showed a mortality benefit when using Dexamethasone in COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment GLUCOCOVID: A CONTROLLED TRIAL OF METHYLPREDNISOLONE IN Dr. Mark Ramzy is an Emergency Medicine Physician. He is currently completing two simultaneous fellowships in Critical Care and Ultrasound at the University of Pittsburgh Medical Center in the

United States.

REBEL CORE CAST 30.0 Before starting a neonatal resuscitation, take some deep breaths to calm yourself. Call in your friends – get a second team to manage the mother, call OB, call the NICU – all hands on deck. Anticipate the equipment you’ll need, get it to the bedside and don’t forget to turn the warmer on. Assign roles so everyone knows what they’re THE SALSA TRIAL: SYMPTOMATIC HYPONATREMIA AND HYPERTONIC The SALSA Trial: Symptomatic Hyponatremia and Hypertonic Saline. Background: Hyponatremia is one of the most common electrolyte abnormalities seen in clinical practice. Under-correction could lead to cerebral edema, whereas overcorrection could result in osmotic demyelination syndrome (ODS). The current recommendation is to use

hypertonic

HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. DEXAMETHASONE VS METHYLPREDNISOLONE IN ICU PATIENTS WITH Background Information: Over one year into the pandemic many therapies to treat COVID-19 have targeted innumerable aspects of the virus. Most recently, the use of corticosteroids to treat the virus’ excessive inflammatory effects has become the front and center of therapy in patients requiring oxygen therapy. 1 The RECOVERY trial showed a mortality benefit when using Dexamethasone in COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment GLUCOCOVID: A CONTROLLED TRIAL OF METHYLPREDNISOLONE IN Dr. Mark Ramzy is an Emergency Medicine Physician. He is currently completing two simultaneous fellowships in Critical Care and Ultrasound at the University of Pittsburgh Medical Center in the

United States.

REBEL CORE CAST 30.0 Before starting a neonatal resuscitation, take some deep breaths to calm yourself. Call in your friends – get a second team to manage the mother, call OB, call the NICU – all hands on deck. Anticipate the equipment you’ll need, get it to the bedside and don’t forget to turn the warmer on. Assign roles so everyone knows what they’re THE SALSA TRIAL: SYMPTOMATIC HYPONATREMIA AND HYPERTONIC The SALSA Trial: Symptomatic Hyponatremia and Hypertonic Saline. Background: Hyponatremia is one of the most common electrolyte abnormalities seen in clinical practice. Under-correction could lead to cerebral edema, whereas overcorrection could result in osmotic demyelination syndrome (ODS). The current recommendation is to use

hypertonic

REBEL CORE CAST 58.0 REBEL Core Cast 58.0 – Wound Care IV Click here for Direct Download of Podcast Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter:

@srrezaie)

ELECTRONIC WEDDING SPOTS Whether you are worried about social isolating, want to reduce your wedding spending plan, or have an overseas travel-prohibitive location marriage ceremony, incorporating friends and relatives through live-streaming is mostly a thoughtful way to allow REBEL CAST EP99: THE INTUBE STUDY Paper: Russotto V et al. Intubation Practices and adverse Peri-Intubation Events in Critically Ill Patients From 29 Countries.JAMA 2021. PMID: 33755076 Clinical Question: Among critically ill patient undergoing tracheal intubation worldwide, how common are major adverse events during the peri-intubation period? What They Did: COVID-19: POTENTIAL WORKFLOWS AND TELEMEDICINE COVID-19: Potential Workflows and Telemedicine. The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019. The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic. The spread of this virus is now global

with

HOW TO LOCATE A RUSSIAN FEMALE WIFE Russian ladies are viewed as to be the the majority of desirable and sought after females in the whole of Italy. In fact , you are able to that a man who has positive cash-flow of more than one million roubles will normally have a single Russian wife. THE DANMASK-19 TRIAL: MASKS NOT EFFECTIVE TO PREVENT COVID Background: Face masks can reduce transmission of respiratory viruses by both being a potential physical barrier and by reducing droplet transmission. Additionally, the presence of a mask reduces the users frequency of touching their face which may also reduce transmission. Despite strong, consistent public health messaging about the utility of wearing masks, their use continues to be debated. HOW TO CALL A CONSULT Six Reasons Why Consult Calls can go Badly ( From Nadim Lalani MD) 1. Caller is not ready. We need to have our ducks in a row when the consultant returns our call. This means having our ‘one liner’ introductory sentence to hook the listener, and having all relevant

(and

BACLOFEN WITHDRAWAL

Presentation. Baclofen withdrawal mimics symptoms seen with other CNS depressant withdrawal syndromes. History. The patient may report a reduction in baclofen dose or cessation of the drug. Increased spasticity. Fever. Myalgias. Neuropsychiatric Symptoms: confusion, altered mental status, visual hallucinations. D-DIMER AND PREGNANCY: THE DIPEP STUDY D-Dimer and Pregnancy: The DiPEP Study. Background: Pulmonary embolism is the leading cause of death in pregnancy and the puerperium – accounting for nearly 20% of maternal deaths in the United States – making rapid and accurate diagnosis critically important for emergency physicians, OB/GYNs, and all who take care of these women on a SECONDARY FALL PREVENTION IN GERIATRIC PATIENTS Secondary Fall Prevention in Geriatric Patients. Background: Falls are the most common cause of traumatic mortality in geriatric patients. Each year, about 1/3 of community-dwelling adults over the age of 65 suffer standing-level falls. Over age 80, the incidence rises to nearly half ( Carpenter 2014 ). HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. GLUCOCOVID: A CONTROLLED TRIAL OF METHYLPREDNISOLONE IN Dr. Mark Ramzy is an Emergency Medicine Physician. He is currently completing two simultaneous fellowships in Critical Care and Ultrasound at the University of Pittsburgh Medical Center in the

United States.

THE SALSA TRIAL: SYMPTOMATIC HYPONATREMIA AND HYPERTONIC The SALSA Trial: Symptomatic Hyponatremia and Hypertonic Saline. Background: Hyponatremia is one of the most common electrolyte abnormalities seen in clinical practice. Under-correction could lead to cerebral edema, whereas overcorrection could result in osmotic demyelination syndrome (ODS). The current recommendation is to use

hypertonic

THE STOIC TRIAL: INHALED BUDESONIDE IN THE TREATMENT OF Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness. Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a BOUGIE-ASSISTED CRICOTHYROTOMY Bougie-Assisted Cricothyrotomy. Written by Salim Rezaie REBEL EM Medical Category: Procedures and Skills 4 Comments. Background: Cricothyrotomy is a high acuity low occurrence (HALO) procedure that is time critical. It is the common final step in the cannot intubate cannot oxygenate (CICO) and/or cannot intubate cannot ventilate (CICV)

situation.

SIMPLIFYING MECHANICAL VENTILATION Mechanical Ventilation is a modality commonly used in the critically ill, but many providers, may not have a strong understanding of the basics. Emergency Medicine and Critical Care Physicians need to have a firm grasp of the basic concepts of mechanical ventilation because without it, we can do serious harm to our patients. THE HAVOC TRIAL: IV HALOPERIDOL VS ONDANSETRON FOR Background/Introduction: Emergency department visits related to cannabis use appear to be increasing nationally secondary to continued trends of legalization, decriminalization, or less restrictive medical cannabis use laws in many states. The number of individuals with daily cannabis use in the United States increased from 5.1 million in 2005 to 8.1 million in 2013 (Bollom 2018). AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection. HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. GLUCOCOVID: A CONTROLLED TRIAL OF METHYLPREDNISOLONE IN Dr. Mark Ramzy is an Emergency Medicine Physician. He is currently completing two simultaneous fellowships in Critical Care and Ultrasound at the University of Pittsburgh Medical Center in the

United States.

THE SALSA TRIAL: SYMPTOMATIC HYPONATREMIA AND HYPERTONIC The SALSA Trial: Symptomatic Hyponatremia and Hypertonic Saline. Background: Hyponatremia is one of the most common electrolyte abnormalities seen in clinical practice. Under-correction could lead to cerebral edema, whereas overcorrection could result in osmotic demyelination syndrome (ODS). The current recommendation is to use

hypertonic

THE STOIC TRIAL: INHALED BUDESONIDE IN THE TREATMENT OF Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness. Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a BOUGIE-ASSISTED CRICOTHYROTOMY Bougie-Assisted Cricothyrotomy. Written by Salim Rezaie REBEL EM Medical Category: Procedures and Skills 4 Comments. Background: Cricothyrotomy is a high acuity low occurrence (HALO) procedure that is time critical. It is the common final step in the cannot intubate cannot oxygenate (CICO) and/or cannot intubate cannot ventilate (CICV)

situation.

SIMPLIFYING MECHANICAL VENTILATION Mechanical Ventilation is a modality commonly used in the critically ill, but many providers, may not have a strong understanding of the basics. Emergency Medicine and Critical Care Physicians need to have a firm grasp of the basic concepts of mechanical ventilation because without it, we can do serious harm to our patients. THE HAVOC TRIAL: IV HALOPERIDOL VS ONDANSETRON FOR Background/Introduction: Emergency department visits related to cannabis use appear to be increasing nationally secondary to continued trends of legalization, decriminalization, or less restrictive medical cannabis use laws in many states. The number of individuals with daily cannabis use in the United States increased from 5.1 million in 2005 to 8.1 million in 2013 (Bollom 2018). AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection. DATA FROM ISRAEL IN HEALTH-CARE WORKERS VACCINATED WITH Background: Israel has succeeded in ramping up its vaccination program faster than any nation in the world. In December 2020, Israel began a national immunization campaign prioritizing health-care workers. In the original clinical trial REBEL CORE CAST 58.0 REBEL Core Cast 58.0 – Wound Care IV Click here for Direct Download of Podcast Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter:

@srrezaie)

SIMPLIFYING MECHANICAL VENTILATION Mechanical Ventilation is a modality commonly used in the critically ill, but many providers, may not have a strong understanding of the basics. Emergency Medicine and Critical Care Physicians need to have a firm grasp of the basic concepts of mechanical ventilation because without it, we can do serious harm to our patients. ELECTRONIC WEDDING SPOTS Whether you are worried about social isolating, want to reduce your wedding spending plan, or have an overseas travel-prohibitive location marriage ceremony, incorporating friends and relatives through live-streaming is mostly a thoughtful way to allow INFECTIOUS ACUTE TRANSVERSE MYELITIS SECONDARY TO COVID-19 Infectious Acute Transverse Myelitis Secondary to COVID-19. The Coronaviridae family and its genera coronaviruses have been implicated as having neurotropic and neuroinvasive capabilities in human hosts (Bohmwald 2018). They have been associated with the development of neuropsychiatric symptoms, seizure activity, encephalomyelitis, acute THE MENDS2 TRIAL: DEXMEDETOMIDINE VS PROPOFOL FOR SEDATION Background: In patients requiring mechanical ventilation, sedative medications are used for patient comfort and safety. However, these medications can also lead to brain dysfunction (i.e. delirium or coma) and long-term cognitive impairment. Currently, the Society of Critical Are Medicine recommends sedation with either dexmedetomidine or propofol targeted to light levels of sedation in HIGH FLOW NASAL CANNULA (HFNC) The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups. In this part we will summarize how it works and for part 2 we will discuss the main indications for its use in adult and pediatric patients. IT’S RAINING STEROIDS IN COVID-19: REMAP-CAP, CODEX Background: Over the past few years, corticosteroids have gained traction in the treatment of patients with ARDS and septic shock. Trials such as APROCCHSS and ADRENAL have shown that the use of corticosteroids is associated with more rapid resolution of shock, weaning from mechanical ventilation in septic shock, and, potentially lower mortality. The RECOVERY trial, the largest RCT to NEW AND INTERESTING: TIMOLOL EYEDROPS TO TREAT MIGRAINE Background: Acute migraine headaches are a common presentation to emergency departments. Treatment can be challenging: multiple medications are often required and allergies can limit options. Oral timolol maleate is approved by the FDA for migraine prophylaxis but is not typically effective once the migraine has started. D-DIMER AND PREGNANCY: THE DIPEP STUDY D-Dimer and Pregnancy: The DiPEP Study. Background: Pulmonary embolism is the leading cause of death in pregnancy and the puerperium – accounting for nearly 20% of maternal deaths in the United States – making rapid and accurate diagnosis critically important for emergency physicians, OB/GYNs, and all who take care of these women on a HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. THE STOIC TRIAL: INHALED BUDESONIDE IN THE TREATMENT OF Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness. Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment DATA FROM ISRAEL IN HEALTH-CARE WORKERS VACCINATED WITH Background: Israel has succeeded in ramping up its vaccination program faster than any nation in the world. In December 2020, Israel began a national immunization campaign prioritizing health-care workers. In the original clinical trial data, the Pfizer vaccine was estimated to prevent 52.4% of COVID-19 before dose two and 90.5% on days 2 – 7

after dose two.

MONOCLONAL ANTIBODIES ARCHIVES Monoclonal antibody infusions have gained national attention as a potential therapeutic. This drug class works by binding to domains on SARS-CoV2 spike protein blocking its ability to bind to ACE2 receptors on cells and thus stopping cellular invasion. Previously, we reviewed the interim analysis of BLAZE-1 which demonstrated a small reduction THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a THE HAVOC TRIAL: IV HALOPERIDOL VS ONDANSETRON FOR Background/Introduction: Emergency department visits related to cannabis use appear to be increasing nationally secondary to continued trends of legalization, decriminalization, or less restrictive medical cannabis use laws in many states. The number of individuals with daily cannabis use in the United States increased from 5.1 million in 2005 to 8.1 million in 2013 (Bollom 2018). POST LUMBAR PUNCTURE HEADACHES Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection. THE PATCH TRIAL: HOLD THE PLATELETS IN SPONTANEOUS Background: Hemorrhagic stroke accounts for 11 – 22% of strokes, half of all stroke deaths, and a significant amount of disability in many of the remaining survivors. Spontaneous, non-traumatic, intracerebral hemorrhage (ICH) accounts for 2/3 of hemorrhagic strokes; estimated at > HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. THE STOIC TRIAL: INHALED BUDESONIDE IN THE TREATMENT OF Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness. Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment DATA FROM ISRAEL IN HEALTH-CARE WORKERS VACCINATED WITH Background: Israel has succeeded in ramping up its vaccination program faster than any nation in the world. In December 2020, Israel began a national immunization campaign prioritizing health-care workers. In the original clinical trial data, the Pfizer vaccine was estimated to prevent 52.4% of COVID-19 before dose two and 90.5% on days 2 – 7

after dose two.

MONOCLONAL ANTIBODIES ARCHIVES Monoclonal antibody infusions have gained national attention as a potential therapeutic. This drug class works by binding to domains on SARS-CoV2 spike protein blocking its ability to bind to ACE2 receptors on cells and thus stopping cellular invasion. Previously, we reviewed the interim analysis of BLAZE-1 which demonstrated a small reduction THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a THE HAVOC TRIAL: IV HALOPERIDOL VS ONDANSETRON FOR Background/Introduction: Emergency department visits related to cannabis use appear to be increasing nationally secondary to continued trends of legalization, decriminalization, or less restrictive medical cannabis use laws in many states. The number of individuals with daily cannabis use in the United States increased from 5.1 million in 2005 to 8.1 million in 2013 (Bollom 2018). POST LUMBAR PUNCTURE HEADACHES Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection. THE PATCH TRIAL: HOLD THE PLATELETS IN SPONTANEOUS Background: Hemorrhagic stroke accounts for 11 – 22% of strokes, half of all stroke deaths, and a significant amount of disability in many of the remaining survivors. Spontaneous, non-traumatic, intracerebral hemorrhage (ICH) accounts for 2/3 of hemorrhagic strokes; estimated at > DATA FROM ISRAEL IN HEALTH-CARE WORKERS VACCINATED WITH Background: Israel has succeeded in ramping up its vaccination program faster than any nation in the world. In December 2020, Israel began a national immunization campaign prioritizing health-care workers. In the original clinical trial REBEL CORE CAST 58.0 REBEL Core Cast 58.0 – Wound Care IV Click here for Direct Download of Podcast Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter:

@srrezaie)

COVID-19 UPDATE: IVERMECTIN Background: Throughout the COVID-19 pandemic, numerous therapeutic agents have been repurposed and applied empirically and within clinical trials. Prophylactic medications for COVID-19 could have a huge benefit, but studies to date haven’t panned out.Initially many therapeutic medications were used late in illness, and one of the criticisms of these negative studies was that the drugs were THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a HOW TO LOCATE A RUSSIAN FEMALE WIFE Russian ladies are viewed as to be the the majority of desirable and sought after females in the whole of Italy. In fact , you are able to that a man who has positive cash-flow of more than one million roubles will normally have a single Russian wife. ELECTRONIC WEDDING SPOTS Whether you are worried about social isolating, want to reduce your wedding spending plan, or have an overseas travel-prohibitive location marriage ceremony, incorporating friends and relatives through live-streaming is mostly a thoughtful way to allow AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection.

THE YEARS STUDY

The YEARS Study – Simplified Diagnostic Approach to PE. Background: The clinical diagnosis of pulmonary embolism (PE) can be challenging given its variable presentation, requiring dependence on objective testing. Decision instruments such as PERC and the Wells’ score help stratify patients to low or high probability, enabling focused use of HIGH FLOW NASAL CANNULA (HFNC) The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups. In this part we will summarize how it works and for part 2 we will discuss the main indications for its use in adult and pediatric patients. SODIUM BICARBONATE IN CARDIAC ARREST MANAGEMENT Background: As with all medications in cardiac arrest (i.e. epinephrine, amiodarone) the benefits of sodium bicarbonate administration have been discussed and debated for decades. While it is clear that sodium bicarbonate can play a role in resuscitation of arrest due to hyperkalemia, it’s role in patients with acidemia resulting from or causing arrest is unclear. HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment THE STOIC TRIAL: INHALED BUDESONIDE IN THE TREATMENT OF Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness. Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and DATA FROM ISRAEL IN HEALTH-CARE WORKERS VACCINATED WITH Background: Israel has succeeded in ramping up its vaccination program faster than any nation in the world. In December 2020, Israel began a national immunization campaign prioritizing health-care workers. In the original clinical trial data, the Pfizer vaccine was estimated to prevent 52.4% of COVID-19 before dose two and 90.5% on days 2 – 7

after dose two.

THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a POST LUMBAR PUNCTURE HEADACHES Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. BOUGIE-ASSISTED CRICOTHYROTOMY Bougie-Assisted Cricothyrotomy. Written by Salim Rezaie REBEL EM Medical Category: Procedures and Skills 4 Comments. Background: Cricothyrotomy is a high acuity low occurrence (HALO) procedure that is time critical. It is the common final step in the cannot intubate cannot oxygenate (CICO) and/or cannot intubate cannot ventilate (CICV)

situation.

AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection. ADULT GUIDELINES FOR PERIPHERAL ADMINISTRATION OF Adult Guidelines for Peripheral Administration of Vasopressor Therapy and the Management of Extravasation Events Tyler Lewis, PharmD Department of Pharmacy THE PATCH TRIAL: HOLD THE PLATELETS IN SPONTANEOUS Background: Hemorrhagic stroke accounts for 11 – 22% of strokes, half of all stroke deaths, and a significant amount of disability in many of the remaining survivors. Spontaneous, non-traumatic, intracerebral hemorrhage (ICH) accounts for 2/3 of hemorrhagic strokes; estimated at > HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment THE STOIC TRIAL: INHALED BUDESONIDE IN THE TREATMENT OF Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness. Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and DATA FROM ISRAEL IN HEALTH-CARE WORKERS VACCINATED WITH Background: Israel has succeeded in ramping up its vaccination program faster than any nation in the world. In December 2020, Israel began a national immunization campaign prioritizing health-care workers. In the original clinical trial data, the Pfizer vaccine was estimated to prevent 52.4% of COVID-19 before dose two and 90.5% on days 2 – 7

after dose two.

THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a BOUGIE-ASSISTED CRICOTHYROTOMY Bougie-Assisted Cricothyrotomy. Written by Salim Rezaie REBEL EM Medical Category: Procedures and Skills 4 Comments. Background: Cricothyrotomy is a high acuity low occurrence (HALO) procedure that is time critical. It is the common final step in the cannot intubate cannot oxygenate (CICO) and/or cannot intubate cannot ventilate (CICV)

situation.

POST LUMBAR PUNCTURE HEADACHES Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection. ADULT GUIDELINES FOR PERIPHERAL ADMINISTRATION OF Adult Guidelines for Peripheral Administration of Vasopressor Therapy and the Management of Extravasation Events Tyler Lewis, PharmD Department of Pharmacy THE PATCH TRIAL: HOLD THE PLATELETS IN SPONTANEOUS Background: Hemorrhagic stroke accounts for 11 – 22% of strokes, half of all stroke deaths, and a significant amount of disability in many of the remaining survivors. Spontaneous, non-traumatic, intracerebral hemorrhage (ICH) accounts for 2/3 of hemorrhagic strokes; estimated at > REBEL CORE CAST 58.0 REBEL Core Cast 58.0 – Wound Care IV Click here for Direct Download of Podcast Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter:

@srrezaie)

COVID-19 UPDATE: IVERMECTIN Background: Throughout the COVID-19 pandemic, numerous therapeutic agents have been repurposed and applied empirically and within clinical trials. Prophylactic medications for COVID-19 could have a huge benefit, but studies to date haven’t panned out.Initially many therapeutic medications were used late in illness, and one of the criticisms of these negative studies was that the drugs were DATA FROM ISRAEL IN HEALTH-CARE WORKERS VACCINATED WITH Background: Israel has succeeded in ramping up its vaccination program faster than any nation in the world. In December 2020, Israel began a national immunization campaign prioritizing health-care workers. In the original clinical trial data, the Pfizer vaccine was estimated to prevent 52.4% of COVID-19 before dose two and 90.5% on days 2 – 7

after dose two.

HOW TO LOCATE A RUSSIAN FEMALE WIFE Russian ladies are viewed as to be the the majority of desirable and sought after females in the whole of Italy. In fact , you are able to that a man who has positive cash-flow of more than one million roubles will normally have a single Russian wife. ELECTRONIC WEDDING SPOTS Whether you are worried about social isolating, want to reduce your wedding spending plan, or have an overseas travel-prohibitive location marriage ceremony, incorporating friends and relatives through live-streaming is mostly a thoughtful way to allow

TOXICOLOGY ARCHIVES

REBEL EM is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection.

THE YEARS STUDY

The YEARS Study – Simplified Diagnostic Approach to PE. Background: The clinical diagnosis of pulmonary embolism (PE) can be challenging given its variable presentation, requiring dependence on objective testing. Decision instruments such as PERC and the Wells’ score help stratify patients to low or high probability, enabling focused use of HIGH FLOW NASAL CANNULA (HFNC) The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups. In this part we will summarize how it works and for part 2 we will discuss the main indications for its use in adult and pediatric patients. SODIUM BICARBONATE IN CARDIAC ARREST MANAGEMENT Sodium Bicarbonate in Cardiac Arrest Management. Background: As with all medications in cardiac arrest (i.e. epinephrine, amiodarone) the benefits of sodium bicarbonate administration have been discussed and debated for decades. While it is clear that sodium bicarbonate can play a role in resuscitation of arrest due to hyperkalemia, it’s

role

HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. THE STOIC TRIAL: INHALED BUDESONIDE IN THE TREATMENT OF Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness. Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment MONOCLONAL ANTIBODIES ARCHIVES Monoclonal antibody infusions have gained national attention as a potential therapeutic. This drug class works by binding to domains on SARS-CoV2 spike protein blocking its ability to bind to ACE2 receptors on cells and thus stopping cellular invasion. Previously, we reviewed the interim analysis of BLAZE-1 which demonstrated a small reduction THE HAVOC TRIAL: IV HALOPERIDOL VS ONDANSETRON FOR Background/Introduction: Emergency department visits related to cannabis use appear to be increasing nationally secondary to continued trends of legalization, decriminalization, or less restrictive medical cannabis use laws in many states. The number of individuals with daily cannabis use in the United States increased from 5.1 million in 2005 to 8.1 million in 2013 (Bollom 2018). THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a POST LUMBAR PUNCTURE HEADACHES Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection. ADULT GUIDELINES FOR PERIPHERAL ADMINISTRATION OF Adult Guidelines for Peripheral Administration of Vasopressor Therapy and the Management of Extravasation Events Tyler Lewis, PharmD Department of Pharmacy SPONTANEOUS PNEUMOTHORAX: STAND THERE AND DO NOTHING Background: Most published clinical guidelines on the management of primary spontaneous pneumothorax (PSP) advocate for a conservative approach of observation for small asymptomatic pneumothoraces (PTX). (1,2) However, procedural re-expansion with a catheter or chest tube is recommended for all large pneumothoraces, regardless of symptomatology or clinical stability. HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. THE STOIC TRIAL: INHALED BUDESONIDE IN THE TREATMENT OF Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness. Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment MONOCLONAL ANTIBODIES ARCHIVES Monoclonal antibody infusions have gained national attention as a potential therapeutic. This drug class works by binding to domains on SARS-CoV2 spike protein blocking its ability to bind to ACE2 receptors on cells and thus stopping cellular invasion. Previously, we reviewed the interim analysis of BLAZE-1 which demonstrated a small reduction THE HAVOC TRIAL: IV HALOPERIDOL VS ONDANSETRON FOR Background/Introduction: Emergency department visits related to cannabis use appear to be increasing nationally secondary to continued trends of legalization, decriminalization, or less restrictive medical cannabis use laws in many states. The number of individuals with daily cannabis use in the United States increased from 5.1 million in 2005 to 8.1 million in 2013 (Bollom 2018). THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a POST LUMBAR PUNCTURE HEADACHES Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection. ADULT GUIDELINES FOR PERIPHERAL ADMINISTRATION OF Adult Guidelines for Peripheral Administration of Vasopressor Therapy and the Management of Extravasation Events Tyler Lewis, PharmD Department of Pharmacy SPONTANEOUS PNEUMOTHORAX: STAND THERE AND DO NOTHING Background: Most published clinical guidelines on the management of primary spontaneous pneumothorax (PSP) advocate for a conservative approach of observation for small asymptomatic pneumothoraces (PTX). (1,2) However, procedural re-expansion with a catheter or chest tube is recommended for all large pneumothoraces, regardless of symptomatology or clinical stability. DATA FROM ISRAEL IN HEALTH-CARE WORKERS VACCINATED WITH Background: Israel has succeeded in ramping up its vaccination program faster than any nation in the world. In December 2020, Israel began a national immunization campaign prioritizing health-care workers. In the original clinical trial POST LUMBAR PUNCTURE HEADACHES Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. TORSADES DES POINTES ARCHIVES Background: Droperidol came onto the market in 1967 and, over time, became a frequently employed treatment of headache, nausea, agitation, acute pain, chronic pain, pain in the context of opioid-tolerance and refractory abdominal pain. Unfortunately, in December 2011, the US Food and Drug Administration placed a black box on droperidol due to surveillance data showing increased ELECTRONIC WEDDING SPOTS Whether you are worried about social isolating, want to reduce your wedding spending plan, or have an overseas travel-prohibitive location marriage ceremony, incorporating friends and relatives through live-streaming is mostly a thoughtful way to allow HOW TO LOCATE A RUSSIAN FEMALE WIFE Russian ladies are viewed as to be the the majority of desirable and sought after females in the whole of Italy. In fact , you are able to that a man who has positive cash-flow of more than one million roubles will normally have a single Russian wife. AURICULAR HEMATOMA MANAGEMENT Diagnosis. This is commonly done with physical examination alone, but if there is a concern for inner ear/skull injury, you may consider obtaining a CT scan to evaluate for skull fractures, etc. Ultrasound could also be used in the presence of an old injury to evaluate for an acute fluid collection. HIGH FLOW NASAL CANNULA (HFNC) The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups. In this part we will summarize how it works and for part 2 we will discuss the main indications for its use in adult and pediatric patients.

THE YEARS STUDY

The YEARS Study – Simplified Diagnostic Approach to PE. Background: The clinical diagnosis of pulmonary embolism (PE) can be challenging given its variable presentation, requiring dependence on objective testing. Decision instruments such as PERC and the Wells’ score help stratify patients to low or high probability, enabling focused use of TO BECOME LATINA SUBMIT ORDER STAR OF THE EVENT Latina women are not only known as wonderful addicts but likewise as amazing and exotic brides. Latina mail order brides blend all talents and hidden expertise needed to be a SODIUM BICARBONATE IN CARDIAC ARREST MANAGEMENT Sodium Bicarbonate in Cardiac Arrest Management. Background: As with all medications in cardiac arrest (i.e. epinephrine, amiodarone) the benefits of sodium bicarbonate administration have been discussed and debated for decades. While it is clear that sodium bicarbonate can play a role in resuscitation of arrest due to hyperkalemia, it’s

role

HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment GLUCOCOVID: A CONTROLLED TRIAL OF METHYLPREDNISOLONE IN Dr. Mark Ramzy is an Emergency Medicine Physician. He is currently completing two simultaneous fellowships in Critical Care and Ultrasound at the University of Pittsburgh Medical Center in the

United States.

REBEL CORE CAST 30.0 Before starting a neonatal resuscitation, take some deep breaths to calm yourself. Call in your friends – get a second team to manage the mother, call OB, call the NICU – all hands on deck. Anticipate the equipment you’ll need, get it to the bedside and don’t forget to turn the warmer on. Assign roles so everyone knows what they’re MONOCLONAL ANTIBODIES ARCHIVES Monoclonal antibody infusions have gained national attention as a potential therapeutic. This drug class works by binding to domains on SARS-CoV2 spike protein blocking its ability to bind to ACE2 receptors on cells and thus stopping cellular invasion. Previously, we reviewed the interim analysis of BLAZE-1 which demonstrated a small reduction THE SALSA TRIAL: SYMPTOMATIC HYPONATREMIA AND HYPERTONIC The SALSA Trial: Symptomatic Hyponatremia and Hypertonic Saline. Background: Hyponatremia is one of the most common electrolyte abnormalities seen in clinical practice. Under-correction could lead to cerebral edema, whereas overcorrection could result in osmotic demyelination syndrome (ODS). The current recommendation is to use

hypertonic

THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a

ACUTE PANCREATITIS

Definition: Acute inflammatory process of the pancreas; a retroperitoneal organ with endocrine and exocrine function. Epidimiology (Rosen’s 2018) US Incidence: 5 – 40/100,000. Mortality: 4-7%. Progression to severe disease: 10-15% of cases (mortality in this subset 20-50%) ADULT GUIDELINES FOR PERIPHERAL ADMINISTRATION OF Adult Guidelines for Peripheral Administration of Vasopressor Therapy and the Management of Extravasation Events Tyler Lewis, PharmD Department of Pharmacy NO MORE HEPARIN FOR NSTEMI? Background: The 2014 AHA guidelines for the management of NSTEMI, recommend unfractionated heparin with an initial loading dose of 60IU/KG (maximum 4,000 IU) with an initial infusion of 12 IU/kg/hr (maximum 1,000 IU/hr) adjusted per active partial thromboplastin time to maintain therapeutic anticoagulation according to the specific hospital protocol, continued for 48 hours or until HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment GLUCOCOVID: A CONTROLLED TRIAL OF METHYLPREDNISOLONE IN Dr. Mark Ramzy is an Emergency Medicine Physician. He is currently completing two simultaneous fellowships in Critical Care and Ultrasound at the University of Pittsburgh Medical Center in the

United States.

REBEL CORE CAST 30.0 Before starting a neonatal resuscitation, take some deep breaths to calm yourself. Call in your friends – get a second team to manage the mother, call OB, call the NICU – all hands on deck. Anticipate the equipment you’ll need, get it to the bedside and don’t forget to turn the warmer on. Assign roles so everyone knows what they’re MONOCLONAL ANTIBODIES ARCHIVES Monoclonal antibody infusions have gained national attention as a potential therapeutic. This drug class works by binding to domains on SARS-CoV2 spike protein blocking its ability to bind to ACE2 receptors on cells and thus stopping cellular invasion. Previously, we reviewed the interim analysis of BLAZE-1 which demonstrated a small reduction THE SALSA TRIAL: SYMPTOMATIC HYPONATREMIA AND HYPERTONIC The SALSA Trial: Symptomatic Hyponatremia and Hypertonic Saline. Background: Hyponatremia is one of the most common electrolyte abnormalities seen in clinical practice. Under-correction could lead to cerebral edema, whereas overcorrection could result in osmotic demyelination syndrome (ODS). The current recommendation is to use

hypertonic

THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a

ACUTE PANCREATITIS

Definition: Acute inflammatory process of the pancreas; a retroperitoneal organ with endocrine and exocrine function. Epidimiology (Rosen’s 2018) US Incidence: 5 – 40/100,000. Mortality: 4-7%. Progression to severe disease: 10-15% of cases (mortality in this subset 20-50%) ADULT GUIDELINES FOR PERIPHERAL ADMINISTRATION OF Adult Guidelines for Peripheral Administration of Vasopressor Therapy and the Management of Extravasation Events Tyler Lewis, PharmD Department of Pharmacy NO MORE HEPARIN FOR NSTEMI? Background: The 2014 AHA guidelines for the management of NSTEMI, recommend unfractionated heparin with an initial loading dose of 60IU/KG (maximum 4,000 IU) with an initial infusion of 12 IU/kg/hr (maximum 1,000 IU/hr) adjusted per active partial thromboplastin time to maintain therapeutic anticoagulation according to the specific hospital protocol, continued for 48 hours or until HOW TO LOCATE A RUSSIAN FEMALE WIFE Russian ladies are viewed as to be the the majority of desirable and sought after females in the whole of Italy. In fact , you are able to that a man who has positive cash-flow of more than one million roubles will normally have a single Russian wife. ELECTRONIC WEDDING SPOTS Whether you are worried about social isolating, want to reduce your wedding spending plan, or have an overseas travel-prohibitive location marriage ceremony, incorporating friends and relatives through live-streaming is mostly a thoughtful way to allow

TOXICOLOGY ARCHIVES

REBEL EM is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. COVID-19: POTENTIAL WORKFLOWS AND TELEMEDICINE COVID-19: Potential Workflows and Telemedicine. The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019. The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic. The spread of this virus is now global

with

TO BECOME LATINA SUBMIT ORDER STAR OF THE EVENT Latina women are not only known as wonderful addicts but likewise as amazing and exotic brides. Latina mail order brides blend all talents and hidden expertise needed to be a

ACUTE PANCREATITIS

Acute Pancreatitis Background: Definition: Acute inflammatory process of the pancreas; a retroperitoneal organ with endocrine and exocrine function. Epidimiology (Rosen’s 2018). US Incidence: 5 – 40/100,000; Mortality: 4-7%; Progression to severe disease: 10 COVID-19 ACUTE LUNG INJURY: A PROPOSED MODEL (V1.0) VIA There is a lot we still do not know when it comes to COVID-19 pathophysiology. We are learning every day, and as we navigate the waters of the unknown, there are a few that boldly dare to try and understand what is happening in this disease process that may go against mainstream thinking. INFECTIOUS ACUTE TRANSVERSE MYELITIS SECONDARY TO COVID-19 Infectious Acute Transverse Myelitis Secondary to COVID-19. The Coronaviridae family and its genera coronaviruses have been implicated as having neurotropic and neuroinvasive capabilities in human hosts (Bohmwald 2018). They have been associated with the development of neuropsychiatric symptoms, seizure activity, encephalomyelitis, acute LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST) Local Anesthetic Systemic Toxicity (LAST) Definition: A life-threatening adverse reaction resulting from local anesthetic reaching significant systemic circulating levels. Local Anesthetic Systemic Toxicity (LAST) is rare and almost always occurs within minutes of injection of the local anesthetic.

BACLOFEN WITHDRAWAL

Presentation. Baclofen withdrawal mimics symptoms seen with other CNS depressant withdrawal syndromes. History. The patient may report a reduction in baclofen dose or cessation of the drug. Increased spasticity. Fever. Myalgias. Neuropsychiatric Symptoms: confusion, altered mental status, visual hallucinations. HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment GLUCOCOVID: A CONTROLLED TRIAL OF METHYLPREDNISOLONE IN Dr. Mark Ramzy is an Emergency Medicine Physician. He is currently completing two simultaneous fellowships in Critical Care and Ultrasound at the University of Pittsburgh Medical Center in the

United States.

REBEL CORE CAST 30.0 Before starting a neonatal resuscitation, take some deep breaths to calm yourself. Call in your friends – get a second team to manage the mother, call OB, call the NICU – all hands on deck. Anticipate the equipment you’ll need, get it to the bedside and don’t forget to turn the warmer on. Assign roles so everyone knows what they’re MONOCLONAL ANTIBODIES ARCHIVES Monoclonal antibody infusions have gained national attention as a potential therapeutic. This drug class works by binding to domains on SARS-CoV2 spike protein blocking its ability to bind to ACE2 receptors on cells and thus stopping cellular invasion. Previously, we reviewed the interim analysis of BLAZE-1 which demonstrated a small reduction THE SALSA TRIAL: SYMPTOMATIC HYPONATREMIA AND HYPERTONIC The SALSA Trial: Symptomatic Hyponatremia and Hypertonic Saline. Background: Hyponatremia is one of the most common electrolyte abnormalities seen in clinical practice. Under-correction could lead to cerebral edema, whereas overcorrection could result in osmotic demyelination syndrome (ODS). The current recommendation is to use

hypertonic

THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a

ACUTE PANCREATITIS

Definition: Acute inflammatory process of the pancreas; a retroperitoneal organ with endocrine and exocrine function. Epidimiology (Rosen’s 2018) US Incidence: 5 – 40/100,000. Mortality: 4-7%. Progression to severe disease: 10-15% of cases (mortality in this subset 20-50%) ADULT GUIDELINES FOR PERIPHERAL ADMINISTRATION OF Adult Guidelines for Peripheral Administration of Vasopressor Therapy and the Management of Extravasation Events Tyler Lewis, PharmD Department of Pharmacy NO MORE HEPARIN FOR NSTEMI? Background: The 2014 AHA guidelines for the management of NSTEMI, recommend unfractionated heparin with an initial loading dose of 60IU/KG (maximum 4,000 IU) with an initial infusion of 12 IU/kg/hr (maximum 1,000 IU/hr) adjusted per active partial thromboplastin time to maintain therapeutic anticoagulation according to the specific hospital protocol, continued for 48 hours or until HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. COVID-19 UPDATE: AN INTERESTING STUDY ON SEROTONIN Background: We have tried to decrease the number of updates on COVID-19, as I am sure everyone is getting tired of all the trials coming out on this. I know I am exhausted just reading through everything. However, every so often I will try to bring updates that are relevant. In this post we will cover an interesting trial that should be on your radar as more evidence arises on this treatment GLUCOCOVID: A CONTROLLED TRIAL OF METHYLPREDNISOLONE IN Dr. Mark Ramzy is an Emergency Medicine Physician. He is currently completing two simultaneous fellowships in Critical Care and Ultrasound at the University of Pittsburgh Medical Center in the

United States.

REBEL CORE CAST 30.0 Before starting a neonatal resuscitation, take some deep breaths to calm yourself. Call in your friends – get a second team to manage the mother, call OB, call the NICU – all hands on deck. Anticipate the equipment you’ll need, get it to the bedside and don’t forget to turn the warmer on. Assign roles so everyone knows what they’re MONOCLONAL ANTIBODIES ARCHIVES Monoclonal antibody infusions have gained national attention as a potential therapeutic. This drug class works by binding to domains on SARS-CoV2 spike protein blocking its ability to bind to ACE2 receptors on cells and thus stopping cellular invasion. Previously, we reviewed the interim analysis of BLAZE-1 which demonstrated a small reduction THE SALSA TRIAL: SYMPTOMATIC HYPONATREMIA AND HYPERTONIC The SALSA Trial: Symptomatic Hyponatremia and Hypertonic Saline. Background: Hyponatremia is one of the most common electrolyte abnormalities seen in clinical practice. Under-correction could lead to cerebral edema, whereas overcorrection could result in osmotic demyelination syndrome (ODS). The current recommendation is to use

hypertonic

THE HEAR SCORE: DOES VERY LOW-RISK ACUTE CHEST PAIN NOT Background: Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1).Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a

ACUTE PANCREATITIS

Definition: Acute inflammatory process of the pancreas; a retroperitoneal organ with endocrine and exocrine function. Epidimiology (Rosen’s 2018) US Incidence: 5 – 40/100,000. Mortality: 4-7%. Progression to severe disease: 10-15% of cases (mortality in this subset 20-50%) ADULT GUIDELINES FOR PERIPHERAL ADMINISTRATION OF Adult Guidelines for Peripheral Administration of Vasopressor Therapy and the Management of Extravasation Events Tyler Lewis, PharmD Department of Pharmacy NO MORE HEPARIN FOR NSTEMI? Background: The 2014 AHA guidelines for the management of NSTEMI, recommend unfractionated heparin with an initial loading dose of 60IU/KG (maximum 4,000 IU) with an initial infusion of 12 IU/kg/hr (maximum 1,000 IU/hr) adjusted per active partial thromboplastin time to maintain therapeutic anticoagulation according to the specific hospital protocol, continued for 48 hours or until HOW TO LOCATE A RUSSIAN FEMALE WIFE Russian ladies are viewed as to be the the majority of desirable and sought after females in the whole of Italy. In fact , you are able to that a man who has positive cash-flow of more than one million roubles will normally have a single Russian wife. ELECTRONIC WEDDING SPOTS Whether you are worried about social isolating, want to reduce your wedding spending plan, or have an overseas travel-prohibitive location marriage ceremony, incorporating friends and relatives through live-streaming is mostly a thoughtful way to allow

TOXICOLOGY ARCHIVES

REBEL EM is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. COVID-19: POTENTIAL WORKFLOWS AND TELEMEDICINE COVID-19: Potential Workflows and Telemedicine. The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019. The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic. The spread of this virus is now global

with

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ACUTE PANCREATITIS

Acute Pancreatitis Background: Definition: Acute inflammatory process of the pancreas; a retroperitoneal organ with endocrine and exocrine function. Epidimiology (Rosen’s 2018). US Incidence: 5 – 40/100,000; Mortality: 4-7%; Progression to severe disease: 10 COVID-19 ACUTE LUNG INJURY: A PROPOSED MODEL (V1.0) VIA There is a lot we still do not know when it comes to COVID-19 pathophysiology. We are learning every day, and as we navigate the waters of the unknown, there are a few that boldly dare to try and understand what is happening in this disease process that may go against mainstream thinking. INFECTIOUS ACUTE TRANSVERSE MYELITIS SECONDARY TO COVID-19 Infectious Acute Transverse Myelitis Secondary to COVID-19. The Coronaviridae family and its genera coronaviruses have been implicated as having neurotropic and neuroinvasive capabilities in human hosts (Bohmwald 2018). They have been associated with the development of neuropsychiatric symptoms, seizure activity, encephalomyelitis, acute LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST) Local Anesthetic Systemic Toxicity (LAST) Definition: A life-threatening adverse reaction resulting from local anesthetic reaching significant systemic circulating levels. Local Anesthetic Systemic Toxicity (LAST) is rare and almost always occurs within minutes of injection of the local anesthetic.

BACLOFEN WITHDRAWAL

Presentation. Baclofen withdrawal mimics symptoms seen with other CNS depressant withdrawal syndromes. History. The patient may report a reduction in baclofen dose or cessation of the drug. Increased spasticity. Fever. Myalgias. Neuropsychiatric Symptoms: confusion, altered mental status, visual hallucinations. HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. SIMPLIFYING MECHANICAL VENTILATION Mechanical Ventilation is a modality commonly used in the critically ill, but many providers, may not have a strong understanding of the basics. Emergency Medicine and Critical Care Physicians need to have a firm grasp of the basic concepts of mechanical ventilation because without it, we can do serious harm to our patients.

BACLOFEN WITHDRAWAL

Presentation. Baclofen withdrawal mimics symptoms seen with other CNS depressant withdrawal syndromes. History. The patient may report a reduction in baclofen dose or cessation of the drug. Increased spasticity. Fever. Myalgias. Neuropsychiatric Symptoms: confusion, altered mental status, visual hallucinations. REBEL CORE CAST 30.0 Before starting a neonatal resuscitation, take some deep breaths to calm yourself. Call in your friends – get a second team to manage the mother, call OB, call the NICU – all hands on deck. Anticipate the equipment you’ll need, get it to the bedside and don’t forget to turn the warmer on. Assign roles so everyone knows what they’re LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST) Local Anesthetic Systemic Toxicity (LAST) Definition: A life-threatening adverse reaction resulting from local anesthetic reaching significant systemic circulating levels. Local Anesthetic Systemic Toxicity (LAST) is rare and almost always occurs within minutes of injection of the local anesthetic. A RANDOMIZED CONTROL TRIAL COMPARING ORAL IBUPROFEN AT Background Information: Non-steroidal Inflammatory drugs (NSAIDs) such as Ibuprofen are of the one of the most commonly used oral analgesics in the emergency department. 1 These medications work by inhibiting the enzymes cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). These are two enzymes which lead to prostaglandin production and ultimately promote pain, fever and HOME - REBEL EM - EMERGENCY MEDICINE BLOGBLOGCASTREVIEWSPREZCRITCME/CEH REBEL EM has primarily been a clinical blog focusing on critical appraisal of research, but now we are proud to introduce REBEL Core, an initiative to improve discussion of core content in emergency medicine/critical care.Free Open Access Medical Education (FOAMed) has long been dedicated to discussing current literature to shorten knowledge translation. SIMPLIFYING MECHANICAL VENTILATION Mechanical Ventilation is a modality commonly used in the critically ill, but many providers, may not have a strong understanding of the basics. Emergency Medicine and Critical Care Physicians need to have a firm grasp of the basic concepts of mechanical ventilation because without it, we can do serious harm to our patients.

BACLOFEN WITHDRAWAL

Presentation. Baclofen withdrawal mimics symptoms seen with other CNS depressant withdrawal syndromes. History. The patient may report a reduction in baclofen dose or cessation of the drug. Increased spasticity. Fever. Myalgias. Neuropsychiatric Symptoms: confusion, altered mental status, visual hallucinations. REBEL CORE CAST 30.0 Before starting a neonatal resuscitation, take some deep breaths to calm yourself. Call in your friends – get a second team to manage the mother, call OB, call the NICU – all hands on deck. Anticipate the equipment you’ll need, get it to the bedside and don’t forget to turn the warmer on. Assign roles so everyone knows what they’re LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST) Local Anesthetic Systemic Toxicity (LAST) Definition: A life-threatening adverse reaction resulting from local anesthetic reaching significant systemic circulating levels. Local Anesthetic Systemic Toxicity (LAST) is rare and almost always occurs within minutes of injection of the local anesthetic. A RANDOMIZED CONTROL TRIAL COMPARING ORAL IBUPROFEN AT Background Information: Non-steroidal Inflammatory drugs (NSAIDs) such as Ibuprofen are of the one of the most commonly used oral analgesics in the emergency department. 1 These medications work by inhibiting the enzymes cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). These are two enzymes which lead to prostaglandin production and ultimately promote pain, fever and EMERGENCY MEDICINE ROTATION ARCHIVES REBEL EM is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. ORAL SUCROSE ARCHIVES Background: Oral sweet solutions have been used for some time as a pain-reducing agent for procedures in the neonatal population. However, there has been some mixed results in its effectiveness,

especially in the