Background information: Alcohol has potentiating effects on the inhibitory GABA neurotransmission system and inhibitory effects on the excitatory glutamate neurotransmission system. Chronic alcohol use causes changes to preserve homeostasis, and when the stimulus is removed, alcohol withdrawal results due to decreased inhibition via the GABA system and increased excitation via the glutamate system. Treatment options ... Read more

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Take Home Points AVNRT is a common tachydysrhythmia that results from a reentrant loop within the AV node. Unstable patients with AVNRT should be considered for immediate synchronized electrical cardioversion. Stable patients with AVNRT can have a trial of vagal maneuvers followed by chemical cardioversion with adenosine or verapamil and synchronized electrical cardioversion if that ... Read more

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Take Home Points: Assess patients with floaters or flashers for retinal or vitreous detachment. Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. REBEL Core Cast 97.0 – Acute Vision Loss II Click here for Direct Download ... Read more

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Background: Historically, we have treated acute coronary syndrome with supplemental oxygen regardless of the patient’s oxygen saturation.  This intervention was based on the belief that pushing the patient’s PaO2 to supra therapeutic levels would increase O2 delivery to ischemic myocardium and help reduce myocardial injury.  More recent evidence, however, demonstrates that too much oxygen could ... Read more

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Take Home Points: Suspect glaucoma in any patient with an acute change in vision and get an intraocular pressure measurement First line treatment in acute angle closure glaucoma is a topical beta blocker Consider giant cell arteritis in patients with unilateral headache, jaw claudication and change in vision Don’t wait for the biopsy to start ... Read more

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Take Home Points: Fluorescein is an essential tool in the diagnosis of HSV keratitis Identifying the type of HSV keratitis is crucial, as it will guide treatment Update tetanus vaccination Consult ophthalmology if there is concern for HSV keratitis as these patients require close and frequent follow-up REBEL Core Cast 95.0 – Herpetic Keratitis Click ... Read more

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Take Home Points SBO should be considered in all patients presenting with abdominal pain particularly if they have a prior abdominal surgical history Patients with SBO often have non-specific signs and symptoms. There is no history or physical exam feature that rules out the disease Lactate elevation is a late finding in SBO. A normal ... Read more

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Take Home Points Lithium toxicity comes in a three flavors: acute, chronic and acute on chronic. Each form will have a different presentation as well as management. Lithium levels are often unreliable in terms of guiding management and must be taken in context with symptoms and time of ingestion (in acute overdose). IV fluids are ... Read more

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Background Information:  Double external defibrillation (DED) is an intervention often used to treat refractory ventricular fibrillation (RVF). This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. At REBEL EM, we’ve done an extensive write up that details some of ... Read more

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Take Home Points Perichondritis is an infection of the cartilage and connective tissue of the ear Perichondritis can be recognized clinically by erythema, swelling and tenderness of the auricle. The most common organism in perichondritis is P. aeruginosa and antibiotics should be tailored to cover this organism REBEL Core Cast 92.0 – Perichondritis Click here ... Read more

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