recent articles

practice updates

R.E.B.E.L. EM – Is Apneic Oxygenation Overhyped? with Scott Weingart

ApOx is a concept that has been around for some time in the operating room literature, but only recently been gaining acceptance in the ED, especially after the publication of this concept by Scott and Richard Levitan in the Annals of Emergency Medicine in 2011 [1]. Many nay sayers will argue that the OR studies were in controlled settings with elective surgical patients who were not in critical condition. The believers would argue that ApOx makes sense, its low cost, and low complexity. To date there has been no randomized controlled trials (RCTs) on ApOx in the ED. There has been one ICU Trial (i.e. The FELLOW Trial) [2] and an even more recent observational trial in the ED [3] that have been published on the topic of ApOx. So the question remains: Is Apneic Oxygenation Overhyped?

practice updates

R.E.B.E.L. EM – Management and Disposition of Low Risk Chest Pain

Chest Pain (CP) is a very common complaint seen in emergency departments around the world. In the US specifically anywhere from 8 – 10 million patients present to the ED complaining of CP. Many use liberal testing strategies to prevent missing acute coronary syndrome (ACS) or other major adverse cardiac events (MACE), but this is not without increase in healthcare cost and false positive testing leading to more downstream testing.

practice updates

R.E.B.E.L. EM – How to Call a Consult

The Bottom Line Learning to call effective consults that will facilitate faster dispositions for our patients is an essential skill for every emergency physician to master Using the 5C framework is an effective way to both model, and teach effective consultation Leading your consult call with a specific question will make the call a lot easier. If you are about to deliver 20 data points, and your consultant only needs 5, they will be able to pick those 5 from the 20 you offer them, but only if they know the question up front. This will save you from having to repeat these data points to the consultant More attention needs to be paid to the way we arrange consultations, as they can be a significant source of frustration, conflict, and job dissatisfaction if not performed efficiently and correctly.

practice updates

R.E.B.E.L. EM – Is Too Much Supplemental O2 Harmful in COPD Exacerbations?

Does hyperoxia suppress a COPD patient’s respiratory drive? Does it cause V/Q mismatch? Does it change the chemistry of the patient’s blood through the Haldane effect? It’s enough to make you want to give up and page respiratory therapy. Well lucky for you we sifted through the primary literature to bring you the myths and facts, and the short answer is… it’s complicated.

practice updates

R.E.B.E.L. EM – Should We Give Fingertip Amputations with Exposed Bone Prophylactic Antibiotics?

Fingertip amputations are not an uncommon injury seen in the emergency department. Treatment options range from healing by secondary intention to flap coverage or replantation. Selection of the appropriate treatment modality depends on the nature of the injury, the physical demands of the patient, and the patient’s co-morbidities. Prophylactic antibiotic use in patients with fingertip amputations is controversial.

practice updates

R.E.B.E.L. EM – More Dogma: Epi in Digital Nerve Blocks

You are working as an EM resident and have just evaluated a patient with a right long finger DIP joint dislocation. You perform a digital nerve block with 1% lidocaine with 1:100,000 epinephrine, and go to present to your attending before attempting the reduction. Your attending, on hearing about the epinephrine use goes berserk, and says “don’t you know that you shouldn’t use epi in fingers, noses, ears and toes?”.