REBEL Cast

Rational Evidence-Based Evaluation of Literature

14:40 2022-07-25
Background:  Some of the feared complications of endotracheal intubation include hypotension, cardiac arrest, and death (cardiovascular collapse).  These complications can result from numerous causes including medication-induced vasodilation and decreas...
6:39 2022-07-20
Take Home Points SVT >5cm or ...
10:36 2022-07-06
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 o...
5:40 2022-06-22
Take Home Points Post dural-puncture headache affects up to 30% of patients after lumbar puncture. Suspect PDPH in all patients who recently underwent an LP or epidural anesthesia regardless of whether they meet the IHS criteria. The best way to treat PDP...
20:59 2022-06-20
Background: Early in the COVID-19 pandemic, clinicians were looking for practical, widely available, and low-cost interventions to help patients with hypoxemia.  One of those interventions was awake prone positioning.  Potential mechanisms of benefit in...
9:00 2022-06-08
Take Home Points Consider AAA in patients with acute onset of back or abdominal pain particularly in patients > 50 and in those with a history of hypertension Consider ruptured AAA in patients (especially those > 50 years of age) with unexplained hypotens...
22:20:15 2022-06-01
Take Home Points Emergency medicine revolves around the differential diagnosis History and physical exam should significantly narrow your differential diagnosis Have an idea of what specific diagnoses are being ruled out when ordering diagnostic tests Al...
22:12:30 2022-06-01
Take Home Points Emergency medicine revolves around the differential diagnosis History and physical exam should significantly narrow your differential diagnosis Have an idea of what specific diagnoses are being ruled out when ordering diagnostic tests Al...
25:23 2022-06-01
Take Home Points Break the differentials down into bad & painless, bad & painful, and other causes – WOMAN-PE Cardiac causes – mechanical or electrical – look for the obvious and 5 non-obvious causes (WPW, HCOM, ARVD, prolonged QT, and Brugada) Ask ...
21:28 2022-06-01
Take Home Points Be prepared to do everything with these cases, if they can’t provide information, dive into their medication list, history, contact whoever you have to to get more information Keep differentials wide – then approach these cases with t...
29:21 2022-06-01
Take Home Points Key point is to discern between central and peripheral causes – become familiar with the nuances of one and concentrate on that Assume central and convince yourself its peripheral in nature, if at the end of the evaluation, you can’t ...
22:01 2022-06-01
Take Home Points Examine all parts of the body, even inside the mouth – this can be the difference between benign and life threatening rashes Truly emergent causes: meningococcemia, TTP, DIC, TSS, SJS, TEN, and necrotizing fasciitis Toxic appearing pati...
14:41 2022-06-01
Take Home Points Look for the red flags – hypotension, environmental exposures, medications (SS, NMS), SIRS/qSOFA criteria Be on the lookout for neutropenic fever – isolate patients, administer abx early, and admit Sepsis definition is changing all th...
17:46 2022-06-01
Take Home Points Sprains need more support than just an ace wrap – place them in an aircast or a splint Perform a thorough physical exam – take off their shoes and socks Lisfranc and Maisonneuve injuries are often missed – make sure to exam the bott...
18:32 2022-06-01
Take Home Points Approach leg pain with the seconds, minutes, hours mindset – think about acute limb ischemia, compartment syndrome, and necrotizing fasciitis Do a thorough physical exam – get their shoes and socks off – you will find crazy stuff wh...
23:56 2022-06-01
Take Home Points Don’t make bite width to small – look at the curvature of the needle – start the bite at half the curvature of the needle Don’t pull too tight – this will pucker the skin and lead to poor healing due to ischemia at the wound bor...
21:55 2022-06-01
Take Home Points Ask about the red flags: cancer, fever, IVDA, FND, point tenderness, saddle/perianal anesthesia, trauma, urinary retention, bowel incontinence, weight loss Most don’t need XR’s – set this expectation and advise against bed rest Cons...
17:26 2022-06-01
Take Home Points Get a upreg on any childbearing age female with vaginal bleeding – this is an ectopic pregnancy until proven otherwise Confirm vaginal vs rectal bleeding – it can be hard for patients to tell, especially the elderly Quantify the amoun...
15:23 2022-06-01
Take Home Points Get a upreg on every female patient of child bearing age with lower abdominal pain – this is an ectopic pregnancy until proven otherwise Always consider ovarian/testicular pathology for lower abdominal pain Always have a chaperone when ...
15:54 2022-06-01
Take Home Points Diffuse abdominal pain can be anything – keep a broad differential and work from there Old patient and flank pain = aortic catastrophe – aortic dissections and aneurysms can knock off flow to the kidneys Appendicitis and diverticuliti...
18:52 2022-06-01
Take Home Points Patients don’t necessarily know what’s important – ask lots of questions, find out if they’ve been taking a ton of NSAID’s or Tylenol for their pain and now they have an ulcer or hepatitis Keep a broad differential – the kidne...
21:40 2022-06-01
Take Home Points Go in thinking sick vs not sick – this can take time to develop and that’s ok, this skill will come as you see more patients If you’re thinking about getting a scan or u/s – just get it! You don’t want to go home thinking you sh...
16:25 2022-06-01
Take Home Points Think about causes – is it the head, the belly, or something else leading to the vomiting Get a upreg on all females of childbearing age Peritoneal signs – look for rebound/guarding, consider surgery consult prior to imaging if unstab...
17:16 2022-06-01
Take Home Points Take chest pain seriously – ACS and PE patients don’t always appear ill – look for the silent killer cases Remember 4-2-1 approach to chest pain = 4 chambers, 2 lungs, 1 esophagus EKG’s – get an old one to compare to for every ...
32:15 2022-06-01
Take Home Points Wheezing can be absent when severe – be wary of the silent chest = impending respiratory failure Not everything that wheezes is asthma! Beware of mimics – COPD, CHF, anaphylaxis, stridor Consider dexamethasone in those with poor compl...
19:19 2022-06-01
Take Home Points Keep a wide differential Think of the airway, lungs, heart, blood, kidneys, acid/base, brain Use Wells & PERC consecutively to stratify those who you think may have a PE Silent chest is asthma patients is a harbinger of impending airway c...
21:46 2022-06-01
Take Home Points Constantly evolving disease with various presentations Identify those that are hypoxic are deliver appropriate oxygen therapy Give steroids to those that are hypoxic Educate patients about the course of the disease and what to look out fo...
13:24 2022-06-01
Take Home Points Be aware of the red flags – fever, HIV, hemoptysis, TB risk factors Is the onset acute or chronic Characterize sputum production – spoon full, cup full, bucket full- Hemoptysis – most can have streaking and thats normal with bronchi...
13:43 2022-06-01
Take Home Points Look for the red flags – fever, drooling, neck stiffness, toxic ingestion, uvula deviation, voice changes Steroids help with swelling Obtain CT soft tissue neck for concerning presentations Don’t be a cowboy/cowgirl – get consultant...
19:07 2022-06-01
Take Home Message Do not ignore abnormal vital signs – they can be the harbinger of badness Watch out for developing withdrawal, treat early and aggressively These patients are a major fall risk – keep rails up, place on safety observation Obtain a CT...
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