recent articles

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?”.

practice updates

R.E.B.E.L. EM – Diagnosis of RV Strain with TTE

Abnormal vital signs are poor predictors of mortality associated with pulmonary embolism (PE). Diagnosis of PE and right ventricular (RV) strain with transthoracic echocardiography (TTE) however, has been well documented as a predictor for pending shock and significant in-hospital mortality.

practice updates

R.E.B.E.L. EM – Mythbuster: Administration of Vasopressors Through PIV

Vasopressors are frequently used in critically ill patients with hemodynamic instability both in the emergency department (ED) as well as intensive care units (ICUs). Typically, vasopressors are given through central venous catheters (CVCs) as opposed to peripheral intravenous (PIV) access due to the concerns about adverse events (i.e. tissue ischemia/necrosis) associated with extravasation through PIVs.