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

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

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

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

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

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

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

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

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

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