Published 05/16/22
Take Home Points Classically, herpes zoster will present with rash and pain in a dermatomal distribution Immunocompromised patients are at greater risk for significant complications of zoster, including visceral dissemination and zoster ophthalmicus Appropriate therapy includes antiviral therapy within 72 hours of onset of symptoms and analgesia for acute neuritis Disseminated zoster and zoster ophthalmicus ... Read more
Published 04/06/22
Take Home Points Think about flexor tenosynovitis in a patient with atraumatic finger pain.  They may have any combination of these signs: Tenderness along the course of the flexor tendon Symmetrical swelling of the finger – often called the sausage digit Pain on passive extension of the finger and Patient holds the finger in a ... Read more
Published 03/23/22
Background: In the past few years there has been a growing debate between  the use of balanced multielectrolyte solutions (BMES) and saline in the critically ill (See the “for more about this topic” section below). Recent research has yielded inconsistent results with RCTs showing improved mortality (SMART), no change in mortality (BaSICS), and decreased acute ... Read more
Published 03/10/22
REBEL Core Cast 76.0 – Zoom Better Click here for Direct Download of the Podcast Read More P Cubed Presentations: Zoom, Zoom, Zoom P Cubed Presentations: Online Presentation Setup P Cubed Presentations: How To Do An Online Presentation YouTube Tutorials: Link is HERE Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)
Published 03/09/22
Take Home Points: Newer data suggests that the infection and DVT rates for femoral lines are similar to that for internal jugular central lines. In a resuscitation situation, there are likely faster ways to obtain access than a femoral line (ie IO, Peripheral IV). If you are going to place a femoral line, use ultrasound ... Read more
Published 02/23/22
Background: Emergency endotracheal intubation is a potentially life-saving procedure in the management of critically-ill patients. The inherent risks associated with the procedure challenge us to refine our skills and adopt new techniques that can improve our performance. The bougie is an inexpensive device that has gained considerable traction in the last ten years. In 2018, ... Read more
Published 02/17/22
Take Home Points: Cauda equina syndrome is a rare emergency with devastating consequences Early recognition is paramount as the presence of bladder dysfunction portends bad functional outcomes The presence of bilateral lower extremity weakness or sensory changes should alert clinicians to the diagnosis. Saddle anesthesia (or change in sensation) and any bladder/bowel changes in function ... Read more
Published 02/09/22
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. Airway management ... Read more
Published 01/31/22
Take Home Points: First line treatment for asthma exacerbations is inhaled beta agonists, inhaled anticholinergics and systemic corticosteroids. The majority of patients presenting to the ED with asthma exacerbations should be started on short-burst corticosteroids to control inflammation and prevent admission and relapse. Diagnostic testing is not required for the majority of patients with asthma ... Read more
Published 01/26/22
Take Home Points: Lung ultrasound is simple, quick and accurate for real time, bedside assessment of your patient with acute undifferentiated dyspnea PTX: least dependent area, shallow depth, lung sliding, lung point CHF: scan across the 4 zones of the chest, look for B lines Bringing this to the bedside can give you diagnostic closure ... Read more
Published 01/12/22
Background: The utility of pharmacological interventions for patients with OHCA are rather limited with no robust evidence that they improve outcomes.  Calcium, one of the pharmacological options has both inotropic and vasopressor effects. Additionally, calcium plays an important role in the management of hyperkalemia  which is a significant cause of cardiac arrest. There have been ... Read more
Published 01/03/22
In this episode of REBEL Cast, Anand Swaminathan and I sit down to discuss the utility of thrombolysis prior to Endovascular therapy for LVO acute ischemic stroke.  The discussion is broken up into two potential scenarios: Not all facilities are comprehensive stroke centers In comprehensive stroke center, time from door to groin puncture will be ... Read more
Published 12/30/21
Take Home Points: DOPES is not just a memory tool. It give you a structured approach to taking care of vented patients with vital sign changes. Check for dislodgement of the tube, obstruction of the tube, pneumothorax, equipment failure, breath stacking and dyssynchrony. Don’t forget that the patient can have more than one issue; always ... Read more
Published 12/22/21
Take Home Points: Prioritize ABCs and systematic evaluation of the trauma patient with an open fracture as one third of these patients have multiple injuries Assess neurovascular status and immediately reduce and immobilize if compromised Give appropriate antibiotics as soon as possible Consult orthopedics for operative management as soon as possible REBEL Core Cast 70.0 ... Read more
Published 12/08/21
There are generally 3 main congenital heart diseases presentations that young children between ages of 0 days to about 3 months will present with.  Often times you will see experts split these congenital heart lesions into 2 categories: Cyanotic vs Acyanotic lesions. Either is an acceptable approach as long as you split the acyanotic lesions ... Read more
Published 12/02/21
Background: Two prior trials compared the addition of vasopressin 20 IU (for each dose of epinephrine) and methylprednisolone 40mg to placebo for in hospital cardiac arrest. The 1st trial was published in 2009 [2] and the second in 2013 [3].  In the 2009 study, the combination of vasopressin-epinephrine and methylprednisolone improved survival.  In the 2013 ... Read more
Published 11/29/21
Take home points: Epiglottitis has demonstrated a resurgence in the adult population. It is no longer a pediatric only disease. The classic presentation of epiglottitis (3Ds of drooling, dysphagia and distress) is uncommon Epiglottitis should be high on your differential for the bounce-back patient who continues to complain of worsening sore throat Definitive diagnosis is ... Read more
Published 11/24/21
I was fortunate enough to record a podcast on Rob Orman’s, Stimulus podcast on Oct 14th, 2021.  We both felt it was an important enough topic that we should post it on both his and my site.  The treatment of non-hospitalized patients suffering from COVID-19 is a hot topic and constantly changing.  In this podcast ... Read more
Published 11/15/21
Take-Home Points Always consider STEMI as the diagnosis prior to diagnosing pericarditis. If the EKG shows convex ST elevations, reciprocal ST depressions, or dynamic changes, the patient is much more likely to have a STEMI. Patients with pericarditis should be treated with a combination of NSAID/Aspirin and Colchicine Patients with large pericardial effusions, tachycardia out ... Read more
Published 11/10/21