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

Take Home Points Wernicke encephalopathy is characterized by ataxia, altered mental status and ophthalmoplegia but patients are unlikely to have all these components Suspect Wernicke encephalopathy in any patient that is at risk of malnutrition or malabsorption and has any one of the classic symptoms Prophylactic administration of thiamine 100 mg IV/IM to at risk ... Read more

Take Home Points Focus on resuscitating well by focusing on the basics Recognize Massive GIB (MGIB) with a thorough exam of the patient and vital signs (Shock index >0.7 is ABNORMAL and signals impending shock) Obtain large bore PIV access and prioritize transfusion over crystalloids for MGIB Get consultants on board early Give adjunctive medications ... Read more

REBEL Core Cast 38.0 – Productivity Click here for Direct Download of Podcast Resources EMCrit: Getting Shit Done EMCrit: GTD Redux David Allen: Getting Things Done Cal Newport: Deep Work McChesney, Covey, Huling: The 4 Disciplines of Execution Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)

Take Home Points Spinal Epidural Abscess may present insidiously and patients often lack the classic triad of fever, back pain and neurologic symptoms Empiric Antibiotics should cover Staphylococcus (including MRSA) and Gram negative Bacilli All patients with clinical suspicion require rapid evaluation with MRI as the diagnostic study of choice Although not all patients will ... Read more

Take Home Points When approaching the patient with uspected seizure, focus on questions that matter in determining if the event was a seizure or not Extensive lab work after a first time seizure is not necessary in patients who are back to baseline.  Focus on serum glucose, determining pregnancy/postpartum status, and in patients who continue ... Read more

Background: Acute gastrointestinal bleeding (GIB) is a common diagnosis dealt with by emergency clinicians.  Definitive therapy for acute GIB often includes endoscopy or surgery. However, there is a myriad of pharmaceutical options (i.e. PPI, Somatostatin Analogues, Antibiotics, etc.) as well as blood products that may be instituted as part of the acute resuscitation of these ... Read more

Take Home Points Heat stroke is a life-threatening disorder characterized by elevated core temperature, compromise to neurologic function and multi-system organ dysfunction The keystone of treatment is rapid cooling within 30 minutes of presentation preferably with ice water immersion Patients with heat stroke should be investigated for rhabdomyolysis, AKI, liver failure and concomitant infection REBEL ... Read more

Background: Here we go again with another “Time is Brain,” acute ischemic stroke study.  The authors start out by saying that earlier administration of intravenous tPA in acute ischemic stroke is associated with reduced mortality by the time of hospital discharge and better functional outcomes at 3 months.  These statements are based on flawed studies ... Read more