REBEL Cast

Background Information: Central venous catheterization is a common procedure performed in the ICU for the purposes of drug administration and resuscitation. The subclavian vein is the more preferred access site given its fixed puncture location, ease for nursing access and low incidence of infections.1 Landmark guided catheterization has a widely variable success rate and has been ... Read more

Background Information: Ultrasound guided peripheral and central venous access has become more common while simultaneously decreasing complications and increasing first pass success. Landmark guided palpation has historically been considered the standard of care when placing arterial lines, however the use of ultrasound is challenging that notion as anatomic landmarks are not helpful in 30% of ... Read more

Background: The well-established, standard treatment for acute appendicitis is surgical appendectomy.  However, recent research has challenged the dominance of the surgical approach in looking at antibiotics alone. The available literature on non-operative treatment of appendicitis (NOTA) has important limitations: exclusion of patients with appendicoliths, small sample size and predominance of open appendectomy over laparoscopic appendectomy. ... Read more

Take Home Points Watch for continued bleeding in excess of 500 ml or bleeding that is “more than normal.” Call it postpartum hemorrhage and start resuscitation Call your obstetric and/or surgical consultants early as operative intervention is often required Replace intravascular volume with blood products Uterine atony is the most common cause of postpartum hemorrhage. ... Read more

Background: ICU discharge is often delayed due to intravenous vasopressor requirements to maintain clinically indicated blood pressure goals. In some patients without impairment of tissue oxygenation, the use of oral agents could facilitate weaning from IV vasopressors and lead to earlier ICU discharge. Midodrine is an oral alpha1 adrenergic agonist that may facilitate liberation from ... Read more

Take Home Points Measles is highly infective: One infected person can infect approximately 10-20 unvaccinated people 2 doses of MMR is 97% protective Unvaccinated people can acquire measles from travel to endemic areas with low vaccination rates There is a large amount of misinformation on the internet Misinformation uses fear based messaging and the power ... Read more

Take Home Points Trauma resulting in a retrobulbar hemorrhage can lead to orbital compartment syndrome which is a vision threatening injury Diagnosis is made clinically based on the presence of an afferent pupillary defect, vision loss and an intraocular pressure > 40 mm Hg Treatment is with a lateral canthotomy – a simple but mentally ... Read more

Background information: There are two popular blade shapes for video laryngoscopy, a standard-geometry blade comparable to a Macintosh blade and a hyperangulated blade. The standard-geometry blade permits both direct and indirect visualization during intubation, whereas the hyperangulated blade permits only indirect visualization. The hyperangulated blade is used with a rigid stylet, whereas the standard-geometry blade ... Read more

Take Home Points 100k people in US have sickle cell, the majority will at some point develop acute chest syndrome (ACS) The mortality rate per episode is 3-9%, similar to those of STEMI ACS is a syndrome – CXR infiltrate + respiratory symptoms Treat it aggressively and early (antibiotics, respiratory support) If you’re considering exchange ... Read more

Background: Baloxavir (trade name Xofluza) was approved for the treatment of acute, uncomplicated influenza in patients > 12 years of age in October 2018. However, high-quality data has been underwhelming at best for its efficacy in treatment. Back in November of 2018, REBEL EM concluded: Clinical Take Home Point: Consistent with every other study on anti-viral ... Read more