recent articles

R.E.B.E.L. EM

R.E.B.E.L. EM – Mythbuster: Glucose Levels Must be Below a “Safe” Threshold Before Discharge

Anyone who works in the Emergency Department has seen patients brought in by EMS or sent from the clinic with a chief complaint of “high blood sugar.” Now, we are not talking about patients with diabetic ketoacidosis, but just simple hyperglycemia. This is a common complaint with no real consensus on optimal blood glucose levels before safe discharge.

practice updates

R.E.B.E.L. EM – Is ST-Segment Elevation in Lead aVR Getting Too Much Respect? with Amal Mattu

Lead aVR is a commonly ignored lead and I have even heard of it referred to as the Rodney Dangerfield of ECG leads as it gets no respect. I have anecdotally heard many EM physicians activate the cath lab for STE in lead aVR and many cardiologists say that these are not STEMI patients. So is lead aVR now getting too much respect? Well, I thought it would be a great idea to bring the great Amal Mattu on to the show to answer a few questions for us regarding STE in lead aVR.

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.