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REBEL Cast — Government & Organizations
REBEL Cast

Rational Evidence-Based Evaluation of Literature

Latest Episodes:

REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy Oct 23, 2025

🧭 REBEL Rundown

📝Introduction

In this exciting episode of REBEL Cast, host Dr. Mark Ramzy joins forces with renowned educator and speaker, Dr. George Willis. Broadcasting straight from the ACEP 25 in Salt Lake City, the duo talk about bringing together the international emergency medicine community, as they reflect on their experiences at the Increment Conference in Murcia, Spain, and preview the upcoming event this spring.

Click here for Direct Download of the Podcast.

🤔What's IncrEMentuM?

A new conference and a pivotal gathering for emergency medicine professionals worldwide, has become an essential platform for education, collaboration, and advocacy, especially in light of emergency medicine’s recent recognition as a specialty in Spain. The conference is praised for its outstanding production quality, engaging speakers, and its capacity to foster a global community of emergency care professionals.

🦪Pearls from George's IncrEMentuM 2025 Lectures:Pearls from George's IncrEMentuM 2025 Lectures:

Sodium Bicarbonate Use:
Appropriate Use: Focus on specific instances like metabolic acidosis with renal failure or severe metabolic cases with tox patients (e.g., salicylate or TCA overdose).
Emphasis on Patient-Centric Care: Treat the patient, not the number; avoid harmful overreliance on bicarb based solely on lab results
Diabetic Ketoacidosis (DKA):
Balanced Solutions: Preferenced over normal saline to prevent hyperchloremic acidosis.
Potassium Management: Oral potassium is effective and should be utilized, challenging the myth of impaired gastric absorption in DKA.
Squid Protocol: Usage of ultra-rapid insulin subcutaneously as an alternative to insulin drips in mild to moderate DKA cases.
We covered this topic before on REBEL EM. Check out the post here and the podcast here
Crashing Aortic Dissection:
Hypotension Insights: Do not attribute sudden hypotension solely to medication; prioritize ruling out tamponade or cardiogenic shock.
Ultrasound Utilization: Essential tool for detecting complications like tamponade or low EF due to myocardial infarction or aortic valve regurgitation.
Controlled Pericardial Drainage: Crucial technique to stabilize hemodynamics without increasing mortality, avoiding extensive fluid removal.
Here’s a helpful algorithmic infographic to reference for aortic dissection patients:
Image Courtesy of Dr. Mark Ramzy, DO (@MRamzyDO)
Hyperkalemia
Not every patient needs calcium. Dont just give it prophylatically, only those with EKG changes should get it and get enough of it.
Give an appropriate dose of your other medications. That includes giving 10 units of insulin and 2 amps of dextrose 50. One when they get the 10 units of insulin and the other 30 minutes later
Patients may be dehydrated, dont give them furosemide or diuretics. Those patients need fluid to help perfuse their kidneys and eliminate potassium
Here’s the Algorithm George mentioned in the episode
Here’s a REBEL REVIEW breaking down the different electrolytes in each of the types of fluids:

🫣Teasers from George's IncrEMentuM 2026 Lectures:

Severe Thyroid Storm:
Diagnosis Reminder: Consider thyroid storm in febrile patients with altered mental status; order TSH tests.
Beta Blocker Administration: Use ultrasound to assess heart function before administering propranolol to prevent low output heart failure.
Medication Timing: Administer iodine after antithyroid drugs.
Refractory Hypoglycemia:
Early Use of Octreotide: Beneficial in sulfonylurea-induced cases; initiate treatment promptly for better efficacy.
Broadened Perspective: Consider other endocrine disorders as potential causes beyond typical measures.
Modern Management of SCAPE:
Bolus Dose Nitroglycerin: A recommended practice for quick patient stabilization and improved outcomes in SCAPE scenarios.
We covered this topic before on REBEL EM, see Dr. Marco Propersi’s post here

See you in Spain!

The upcoming conference aims to gather world-class educators once more and promises an enriching experience for all attendees. George Willis, along with many others, will bring significant discourse to the event. For more information on the IncrEMentuM Conference and to register, visit their website! See you there!

Mark Ramzy, DO
Co-Editor-in-Chief RWJBH / Rutgers Health, Newark NJ

George Willis, MD
Vice Chair and Assistant Program Director UT Health, San Antonio, TX

🔎 Your Deep-Dive Starts Here

REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy

🧭 REBEL Rundown 📝Introduction In this exciting episode of REBEL ...
Endocrine, Metabolic, Fluid, and Electrolytes Read More
REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial

Managing diabetic ketoacidosis (DKA) requires careful consideration of fluid therapy, ...
Endocrine, Metabolic, Fluid, and Electrolytes Read More
REBEL Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol

In this episode of REBEL Cast, we dive into part ...
Endocrine, Metabolic, Fluid, and Electrolytes Read More
REBEL Core Cast 18.0 – DKA Tips and Tricks

Take Home Points When looking at pH and bicarb, the ...
Endocrine, Metabolic, Fluid, and Electrolytes Read More
The post REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy appeared first on REBEL EM - Emergency Medicine Blog.

REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy Oct 23, 2025

🧭 REBEL Rundown

📝Introduction

In this exciting episode of REBEL Cast, host Dr. Mark Ramzy joins forces with renowned educator and speaker, Dr. George Willis. Broadcasting straight from the ACEP 25 in Salt Lake City, the duo talk about bringing together the international emergency medicine community, as they reflect on their experiences at the Increment Conference in Murcia, Spain, and preview the upcoming event this spring.

Click here for Direct Download of the Podcast.

🤔What's IncrEMentuM?

A new conference and a pivotal gathering for emergency medicine professionals worldwide, has become an essential platform for education, collaboration, and advocacy, especially in light of emergency medicine’s recent recognition as a specialty in Spain. The conference is praised for its outstanding production quality, engaging speakers, and its capacity to foster a global community of emergency care professionals.

🦪Pearls from George's IncrEMentuM 2025 Lectures:Pearls from George's IncrEMentuM 2025 Lectures:

Sodium Bicarbonate Use:
Appropriate Use: Focus on specific instances like metabolic acidosis with renal failure or severe metabolic cases with tox patients (e.g., salicylate or TCA overdose).
Emphasis on Patient-Centric Care: Treat the patient, not the number; avoid harmful overreliance on bicarb based solely on lab results
Diabetic Ketoacidosis (DKA):
Balanced Solutions: Preferenced over normal saline to prevent hyperchloremic acidosis.
Potassium Management: Oral potassium is effective and should be utilized, challenging the myth of impaired gastric absorption in DKA.
Squid Protocol: Usage of ultra-rapid insulin subcutaneously as an alternative to insulin drips in mild to moderate DKA cases.
We covered this topic before on REBEL EM. Check out the post here and the podcast here
Crashing Aortic Dissection:
Hypotension Insights: Do not attribute sudden hypotension solely to medication; prioritize ruling out tamponade or cardiogenic shock.
Ultrasound Utilization: Essential tool for detecting complications like tamponade or low EF due to myocardial infarction or aortic valve regurgitation.
Controlled Pericardial Drainage: Crucial technique to stabilize hemodynamics without increasing mortality, avoiding extensive fluid removal.
Here’s a helpful algorithmic infographic to reference for aortic dissection patients:
Image Courtesy of Dr. Mark Ramzy, DO (@MRamzyDO)
Hyperkalemia
Not every patient needs calcium. Dont just give it prophylatically, only those with EKG changes should get it and get enough of it.
Give an appropriate dose of your other medications. That includes giving 10 units of insulin and 2 amps of dextrose 50. One when they get the 10 units of insulin and the other 30 minutes later
Patients may be dehydrated, dont give them furosemide or diuretics. Those patients need fluid to help perfuse their kidneys and eliminate potassium
Here’s the Algorithm George mentioned in the episode
Here’s a REBEL REVIEW breaking down the different electrolytes in each of the types of fluids:

🫣Teasers from George's IncrEMentuM 2026 Lectures:

Severe Thyroid Storm:
Diagnosis Reminder: Consider thyroid storm in febrile patients with altered mental status; order TSH tests.
Beta Blocker Administration: Use ultrasound to assess heart function before administering propranolol to prevent low output heart failure.
Medication Timing: Administer iodine after antithyroid drugs.
Refractory Hypoglycemia:
Early Use of Octreotide: Beneficial in sulfonylurea-induced cases; initiate treatment promptly for better efficacy.
Broadened Perspective: Consider other endocrine disorders as potential causes beyond typical measures.
Modern Management of SCAPE:
Bolus Dose Nitroglycerin: A recommended practice for quick patient stabilization and improved outcomes in SCAPE scenarios.
We covered this topic before on REBEL EM, see Dr. Marco Propersi’s post here

See you in Spain!

The upcoming conference aims to gather world-class educators once more and promises an enriching experience for all attendees. George Willis, along with many others, will bring significant discourse to the event. For more information on the IncrEMentuM Conference and to register, visit their website! See you there!

Mark Ramzy, DO
Co-Editor-in-Chief RWJBH / Rutgers Health, Newark NJ

George Willis, MD
Vice Chair and Assistant Program Director UT Health, San Antonio, TX

🔎 Your Deep-Dive Starts Here

REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy

🧭 REBEL Rundown 📝Introduction In this exciting episode of REBEL ...
Endocrine, Metabolic, Fluid, and Electrolytes Read More
REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial

Managing diabetic ketoacidosis (DKA) requires careful consideration of fluid therapy, ...
Endocrine, Metabolic, Fluid, and Electrolytes Read More
REBEL Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol

In this episode of REBEL Cast, we dive into part ...
Endocrine, Metabolic, Fluid, and Electrolytes Read More
REBEL Core Cast 18.0 – DKA Tips and Tricks

Take Home Points When looking at pH and bicarb, the ...
Endocrine, Metabolic, Fluid, and Electrolytes Read More
The post REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial Oct 21, 2025

🧭 REBEL Rundown

🔑Key Points

💧 Fluid Choice Matters: Plasma-Lyte, a balanced crystalloid, corrected acidosis faster than normal saline in severe DKA patients, with no increase in adverse events.
🧪 Chloride Load Concerns: Normal saline’s high chloride content can worsen acidosis, potentially slowing bicarb recovery even after the anion gap closes.
🔬 Study Design Strengths: The SCOPE-DKA trial was a cluster crossover, open-label RCT, protocolizing all variables except fluid type, enhancing the reliability of its findings.
🧮 Base Excess & Strong Ion Difference: Base excess/deficit and strong ion difference are valuable but underutilized tools for assessing acid-base status—don’t rely solely on pH or bicarb.
⚠️ Limitations & Next Steps: The study did not include lactated Ringer’s, and fluid rates were left to clinical discretion. More research, including three-arm trials, is needed for definitive guidance.

Click here for Direct Download of the Podcast.

📝 Introduction

Managing diabetic ketoacidosis (DKA) requires careful consideration of fluid therapy, especially in severe cases. In part two of our REBEL Cast DKA series, we shifted from insulin strategies to fluid choice in severe DKA, diving into the SCOPE-DKA trial—a cluster, crossover, open-label RCT from Australia. While normal saline (NS) is commonly used, concerns about its high chloride content and impact on acidosis have sparked growing interest in balanced solutions like Plasma-Lyte.

Clinical Question

Does the fluid you choose affect how quickly acidosis resolves in DKA?

IV Fluid Composition

🚨 Clinical Bottom Line

Plasma-Lyte showed a modest but meaningful benefit over normal saline in resolving metabolic acidosis in patients with severe DKA. Though safety profiles were similar, the more balanced electrolyte composition of Plasma-Lyte helped normalize acid-base status slightly faster—without worsening ketosis. While this won’t revolutionize care overnight, it’s one more step toward physiologic resuscitation in DKA. Understanding fluid composition and its impact on acid-base balance is crucial for optimal patient care.

Post Peer Reviewed By: Marco Propersi (Twitter/X: @Marco_propersi), and Kim Bambach, MD
Show Notes By: Mark Ramzy, DO

Authors

Mark Ramzy, DO
Co-Editor-in-Chief RWJBH / Rutgers Health, Newark, NJ
Frank Lodeserto
Associate Editor Cape Fear Valley Medical Center, Fayetteville NC
🔎 Your Deep-Dive Starts Here

It seems we can't find what you're looking for.

REBEL Cast
is the blogs audio version. The podcast typically starts by setting a clinical stage with a pertinent clinical question, followed by a discussion of the paper with pertinent results, strengths, limitations, and further discussion. Finally, we end every podcast with clinical take home points from the papers being reviewed. If there are papers you think we should evaluate, email them to srrezaie@gmail.com.

REBEL EM stands for Rational Evidence Based Evaluation of Literature in Emergency Medicine. We cover a myriad of topics, primarily focusing on evidence-based clinical topics.
At its core, evidence-based medicine (EBM) incorporates clinical judgment, relevant scientific evidence, and patient values/preferences. Research and scientific evidence help inform care but should not dictate care of patients.
With the constant influx of new published research, it makes it difficult to stay current with the latest and greatest. REBEL EM was created October 2013 in an effort to cut down knowledge translation of research to clinical application (Bench to Bedside), using a structured critical appraisal method of evaluation.

REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial
Mark Ramzy October 21, 2025 No Comments
Managing diabetic ketoacidosis (DKA) requires careful consideration of fluid therapy, especially in severe cases. In part two of our REBEL Cast DKA series, we shifted from insulin strategies to fluid choice in severe DKA, diving into the SCOPE-DKA trial—a cluster, crossover, open-label RCT from Australia. While normal saline (NS) is commonly used, concerns about its high chloride content and impact on acidosis have sparked growing interest in balanced solutions like Plasma-Lyte.
Read More » « Page1 Page2 Page3 Page4 Page5 »
The post REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial Oct 21, 2025

🧭 REBEL Rundown

🔑Key Points

💧 Fluid Choice Matters: Plasma-Lyte, a balanced crystalloid, corrected acidosis faster than normal saline in severe DKA patients, with no increase in adverse events.
🧪 Chloride Load Concerns: Normal saline’s high chloride content can worsen acidosis, potentially slowing bicarb recovery even after the anion gap closes.
🔬 Study Design Strengths: The SCOPE-DKA trial was a cluster crossover, open-label RCT, protocolizing all variables except fluid type, enhancing the reliability of its findings.
🧮 Base Excess & Strong Ion Difference: Base excess/deficit and strong ion difference are valuable but underutilized tools for assessing acid-base status—don’t rely solely on pH or bicarb.
⚠️ Limitations & Next Steps: The study did not include lactated Ringer’s, and fluid rates were left to clinical discretion. More research, including three-arm trials, is needed for definitive guidance.

Click here for Direct Download of the Podcast.

📝 Introduction

Managing diabetic ketoacidosis (DKA) requires careful consideration of fluid therapy, especially in severe cases. In part two of our REBEL Cast DKA series, we shifted from insulin strategies to fluid choice in severe DKA, diving into the SCOPE-DKA trial—a cluster, crossover, open-label RCT from Australia. While normal saline (NS) is commonly used, concerns about its high chloride content and impact on acidosis have sparked growing interest in balanced solutions like Plasma-Lyte.

Clinical Question

Does the fluid you choose affect how quickly acidosis resolves in DKA?

IV Fluid Composition

🚨 Clinical Bottom Line

Plasma-Lyte showed a modest but meaningful benefit over normal saline in resolving metabolic acidosis in patients with severe DKA. Though safety profiles were similar, the more balanced electrolyte composition of Plasma-Lyte helped normalize acid-base status slightly faster—without worsening ketosis. While this won’t revolutionize care overnight, it’s one more step toward physiologic resuscitation in DKA. Understanding fluid composition and its impact on acid-base balance is crucial for optimal patient care.

Post Peer Reviewed By: Marco Propersi (Twitter/X: @Marco_propersi), and Kim Bambach, MD
Show Notes By: Mark Ramzy, DO

Authors

Mark Ramzy, DO
Co-Editor-in-Chief RWJBH / Rutgers Health, Newark, NJ
Frank Lodeserto
Associate Editor Cape Fear Valley Medical Center, Fayetteville NC
🔎 Your Deep-Dive Starts Here

It seems we can't find what you're looking for.

REBEL Cast
is the blogs audio version. The podcast typically starts by setting a clinical stage with a pertinent clinical question, followed by a discussion of the paper with pertinent results, strengths, limitations, and further discussion. Finally, we end every podcast with clinical take home points from the papers being reviewed. If there are papers you think we should evaluate, email them to srrezaie@gmail.com.

REBEL EM stands for Rational Evidence Based Evaluation of Literature in Emergency Medicine. We cover a myriad of topics, primarily focusing on evidence-based clinical topics.
At its core, evidence-based medicine (EBM) incorporates clinical judgment, relevant scientific evidence, and patient values/preferences. Research and scientific evidence help inform care but should not dictate care of patients.
With the constant influx of new published research, it makes it difficult to stay current with the latest and greatest. REBEL EM was created October 2013 in an effort to cut down knowledge translation of research to clinical application (Bench to Bedside), using a structured critical appraisal method of evaluation.

REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial
Mark Ramzy October 21, 2025 No Comments
Managing diabetic ketoacidosis (DKA) requires careful consideration of fluid therapy, especially in severe cases. In part two of our REBEL Cast DKA series, we shifted from insulin strategies to fluid choice in severe DKA, diving into the SCOPE-DKA trial—a cluster, crossover, open-label RCT from Australia. While normal saline (NS) is commonly used, concerns about its high chloride content and impact on acidosis have sparked growing interest in balanced solutions like Plasma-Lyte.
Read More » « Page1 Page2 Page3 Page4 Page5 »
The post REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol Oct 17, 2025

🧭 REBEL Rundown

🗝️ Key Points

🛏️ Fewer ICU Admissions
Only 5 patients in the SQuID group required ICU care vs 99 in the traditional insulin drip group.
⏱️ Shorter ED Stays
ED length of stay dropped by ~3 hours in the SQuID group—an operational win in crowded departments.
💉 No Drop in Nursing Workload
Despite using subQ insulin, nurses still performed hourly glucose checks and frequent injections.
🧪 Focus on the Anion Gap
DKA resolution = closing the anion gap, not just normalizing blood sugar—critical concept for trainees and nurses alike.
👶 Peds Has the Edge
Pediatric ICUs routinely use a 2-bag system (D10 + electrolytes vs electrolytes alone) to safely continue insulin while managing glucose—adult medicine should take note.

Click here for Direct Download of the Podcast.

📝 Introduction

In this episode of REBEL Cast, we dive into part one of our Diabetic Ketoacidosis (DKA) series with a twist—subcutaneous insulin instead of the traditional IV drip. We explore the SQuID Protocol (Subcutaneous Insulin in DKA), which could potentially shift how we manage mild to moderate DKA—from the ICU to the general floor.
With ICU bed shortages, ED boarding, and nursing resource challenges, it’s time to ask: Do all DKA patients really need a drip and an ICU bed?
We reviewed a quasi-experimental study comparing traditional insulin drips versus subcutaneous insulin (lispro q4h + glargine at time zero) in a busy urban ED. The results? Promising—but not without caveats.

🦑 SQuID Protocol

🚨 Clinical Bottom Line

The SQuID Protocol appears safe and effective for carefully selected patients with mild to moderate DKA. It may reduce ICU admissions and shorten ED stays. But implementation requires thoughtful coordination, nursing comfort, and institutional buy-in. This isn’t ready for prime time everywhere—but it’s worth knowing and considering when ICU resources are tight.

Post Peer Reviewed By: Marco Propersi (Twitter/X: @Marco_propersi), and Kim Bambach, MD
Show Notes By: Mark Ramzy, DO

Authors

Mark Ramzy, DO
Co-Editor-in-Chief RWJBH / Rutgers Health, Newark, NJ
Frank Lodeserto
Associate Editor Cape Fear Valley Medical Center, Fayetteville NC
🔎 Your Deep-Dive Starts Here

It seems we can't find what you're looking for.

The post REBEL Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol Oct 17, 2025

🧭 REBEL Rundown

🗝️ Key Points

🛏️ Fewer ICU Admissions
Only 5 patients in the SQuID group required ICU care vs 99 in the traditional insulin drip group.
⏱️ Shorter ED Stays
ED length of stay dropped by ~3 hours in the SQuID group—an operational win in crowded departments.
💉 No Drop in Nursing Workload
Despite using subQ insulin, nurses still performed hourly glucose checks and frequent injections.
🧪 Focus on the Anion Gap
DKA resolution = closing the anion gap, not just normalizing blood sugar—critical concept for trainees and nurses alike.
👶 Peds Has the Edge
Pediatric ICUs routinely use a 2-bag system (D10 + electrolytes vs electrolytes alone) to safely continue insulin while managing glucose—adult medicine should take note.

Click here for Direct Download of the Podcast.

📝 Introduction

In this episode of REBEL Cast, we dive into part one of our Diabetic Ketoacidosis (DKA) series with a twist—subcutaneous insulin instead of the traditional IV drip. We explore the SQuID Protocol (Subcutaneous Insulin in DKA), which could potentially shift how we manage mild to moderate DKA—from the ICU to the general floor.
With ICU bed shortages, ED boarding, and nursing resource challenges, it’s time to ask: Do all DKA patients really need a drip and an ICU bed?
We reviewed a quasi-experimental study comparing traditional insulin drips versus subcutaneous insulin (lispro q4h + glargine at time zero) in a busy urban ED. The results? Promising—but not without caveats.

🦑 SQuID Protocol

🚨 Clinical Bottom Line

The SQuID Protocol appears safe and effective for carefully selected patients with mild to moderate DKA. It may reduce ICU admissions and shorten ED stays. But implementation requires thoughtful coordination, nursing comfort, and institutional buy-in. This isn’t ready for prime time everywhere—but it’s worth knowing and considering when ICU resources are tight.

Post Peer Reviewed By: Marco Propersi (Twitter/X: @Marco_propersi), and Kim Bambach, MD
Show Notes By: Mark Ramzy, DO

Authors

Mark Ramzy, DO
Co-Editor-in-Chief RWJBH / Rutgers Health, Newark, NJ
Frank Lodeserto
Associate Editor Cape Fear Valley Medical Center, Fayetteville NC
🔎 Your Deep-Dive Starts Here

It seems we can't find what you're looking for.

The post REBEL Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator Oct 02, 2025

🧭 REBEL Rundown

🗝️ Key Points

❌ Don’t chase perfect numbers: Adequate and safe is often better than “perfect but harmful.”
💨 Oxygenation levers: Start with FiO₂ and PEEP, but remember MAP is the true driver.
🫁 Ventilation levers: Adjust RR and TV, tailored to underlying physiology.
🚫 Watch your obstructive patients: Sometimes less RR is more.

Click here for Direct Download of the Podcast.

📝 Introduction

When you take the airway, you take the wheel and you now control the patient’s oxygenation and ventilation. In this REBEL Crit episode, Dr. Lodeserto and Dr. Acker walk through the physiology, ventilator strategies, and clinical curveballs that separate calm control from chaos at the bedside.

️ The Two Pillars of Vent Management

1. Oxygenation — Getting O₂ In
Primary levers: FiO₂ (fraction of inspired oxygen) and PEEP (positive end-expiratory pressure).
Real driver: Mean Airway Pressure (MAP) : the average pressure applied to the lungs across the entire respiratory cycle.
Key physiology:
Oxygen enters blood by diffusion down a concentration gradient.
Adequate alveolar surface area is critical → PEEP keeps alveoli open, prevents collapse/reopen injury, and ensures FiO₂ delivery actually translates into effective oxygenation.
MAP analogy: Just as mean arterial pressure drives perfusion, mean airway pressure drives oxygenation. Prolonged inspiratory time or sustained pressure (e.g., APRV, inverse I:E) can raise MAP.
Risks: Excessive pressure/volume can cause barotrauma or volutrauma.
2. Ventilation — Getting CO₂ Out
Primary levers: Tidal Volume (TV) and Respiratory Rate (RR).
Minute Ventilation = RR × TV.
Mechanism: Ventilation removes CO₂ through bulk convection (movement of air in and out).
Disease-specific strategies:
Obstructive Disease (COPD / Asthma)
RR ↓ to allow more time for exhalation.
Ensure expiratory flow = inspiratory flow → prevents air trapping.
If not equal → auto-PEEP → increased intrathoracic pressure → ↓ preload, risk of hypotension, cardiac arrest, or pneumothorax.
Metabolic Acidosis
RR ↑ to blow off CO₂ and buffer acidosis.
ARDS
Tidal volume limited to 4–6 mL/kg IBW to minimize ventilator-induced lung injury.
RR becomes the main adjustment knob.
Exception: in obstructive lung disease, patients need extra time to exhale (I:E may be 1:4–1:6).

💡 Why This Matters

Ventilator management is part science, part art. Understanding the physiology and knowing when to bend or break the rules helps protect patients from ventilator-induced injury and improves outcomes.

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)
Show Notes By: Rubén Tapia-Bucheli, M.D.

👤 Guest Contributors

Rubén Tapia-Bucheli, M.D.
3rd Year Internal Medicine Resident Cape Fear Valley Internal Medicine Residency Program Fayetteville NC Aspiring Pulmonary Critical Care Fellow
🔎 Your Deep-Dive Starts Here

REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator

When you take the airway, you take the wheel and ...
Thoracic and Respiratory Read More
REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes

Mechanical ventilation can feel overwhelming, especially when faced with a ...
Thoracic and Respiratory Read More
REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes

For many medical residents, the ICU can feel like stepping ...
Thoracic and Respiratory Read More
REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine

The sicker the patient, the more likely an IO line ...
Procedures and Skills Read More
REBEL Core Cast 139.0: Pneumothorax Decompression

On this episode of the Rebel Core Cast, Swami takes ...
Procedures and Skills Read More
REBEL Core Cast 137.0: A Simple Approach to Sinus Tachycardia

Sinus tachycardia is the most prevalent cardiac dysrhythmia in critically ...
Cardiovascular Read More
The post REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator Oct 02, 2025

🧭 REBEL Rundown

🗝️ Key Points

❌ Don’t chase perfect numbers: Adequate and safe is often better than “perfect but harmful.”
💨 Oxygenation levers: Start with FiO₂ and PEEP, but remember MAP is the true driver.
🫁 Ventilation levers: Adjust RR and TV, tailored to underlying physiology.
🚫 Watch your obstructive patients: Sometimes less RR is more.

Click here for Direct Download of the Podcast.

📝 Introduction

When you take the airway, you take the wheel and you now control the patient’s oxygenation and ventilation. In this REBEL Crit episode, Dr. Lodeserto and Dr. Acker walk through the physiology, ventilator strategies, and clinical curveballs that separate calm control from chaos at the bedside.

️ The Two Pillars of Vent Management

1. Oxygenation — Getting O₂ In
Primary levers: FiO₂ (fraction of inspired oxygen) and PEEP (positive end-expiratory pressure).
Real driver: Mean Airway Pressure (MAP) : the average pressure applied to the lungs across the entire respiratory cycle.
Key physiology:
Oxygen enters blood by diffusion down a concentration gradient.
Adequate alveolar surface area is critical → PEEP keeps alveoli open, prevents collapse/reopen injury, and ensures FiO₂ delivery actually translates into effective oxygenation.
MAP analogy: Just as mean arterial pressure drives perfusion, mean airway pressure drives oxygenation. Prolonged inspiratory time or sustained pressure (e.g., APRV, inverse I:E) can raise MAP.
Risks: Excessive pressure/volume can cause barotrauma or volutrauma.
2. Ventilation — Getting CO₂ Out
Primary levers: Tidal Volume (TV) and Respiratory Rate (RR).
Minute Ventilation = RR × TV.
Mechanism: Ventilation removes CO₂ through bulk convection (movement of air in and out).
Disease-specific strategies:
Obstructive Disease (COPD / Asthma)
RR ↓ to allow more time for exhalation.
Ensure expiratory flow = inspiratory flow → prevents air trapping.
If not equal → auto-PEEP → increased intrathoracic pressure → ↓ preload, risk of hypotension, cardiac arrest, or pneumothorax.
Metabolic Acidosis
RR ↑ to blow off CO₂ and buffer acidosis.
ARDS
Tidal volume limited to 4–6 mL/kg IBW to minimize ventilator-induced lung injury.
RR becomes the main adjustment knob.
Exception: in obstructive lung disease, patients need extra time to exhale (I:E may be 1:4–1:6).

💡 Why This Matters

Ventilator management is part science, part art. Understanding the physiology and knowing when to bend or break the rules helps protect patients from ventilator-induced injury and improves outcomes.

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)
Show Notes By: Rubén Tapia-Bucheli, M.D.

👤 Guest Contributors

Rubén Tapia-Bucheli, M.D.
3rd Year Internal Medicine Resident Cape Fear Valley Internal Medicine Residency Program Fayetteville NC Aspiring Pulmonary Critical Care Fellow
🔎 Your Deep-Dive Starts Here

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The post REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes Sep 22, 2025

🧭 REBEL Rundown

🗝️ Key Points

💨 Start with Breath Types: Controlled, assisted, and supported breaths are the foundation of all modes.
🛌 Comfort Over “Best Mode”: No mode improves mortality — focus on patient synchrony and comfort.
Know the Big 5 Modes: AC: All controlled or assisted (volume or pressure). PS: Fully spontaneous, great for SBTs. PRVC: Pressure-delivered, volume-targeted hybrid. SIMV: Mixed mode, less favored in adults. VS: Spontaneous mode with adaptive pressure.
⚠️ Watch for Pitfalls: PRVC may under-ventilate in agitation. SIMV often causes dyssynchrony.
🎯 Bottom Line: Master mode mechanics and match the vent to the patient — not the other way around.

Click here for Direct Download of the Podcast.

📝 Introduction

Mechanical ventilation can feel overwhelming, especially when faced with a sea of ventilator modes and unfamiliar terminology. In Part 2 of the series, we go beyond breath types and delivery mechanics to explore the most used modes in the ICU. We will break down each one; explaining how it works, when to use it, and why the goal isn’t the “best mode” but the most comfortable one for the patient.

️ Ventilator Modes Explained

Assist Control (AC)
Commonly mislabeled as “volume control” or “pressure control.”
Two main types:
AC Volume: Delivers a preset tidal volume with each breath, whether machine-initiated (controlled) or patient-initiated (assisted).
AC Pressure: Delivers a preset pressure; tidal volume varies based on compliance.
All breaths are either controlled or assisted.
Pressure Support (PS)
All breaths are spontaneous initiated by the patient.
The ventilator provides a preset level of pressure support, like a resistance band during a pull-up.
No set rate, but a backup mode (often AC) activates during apnea.
Commonly used for spontaneous breathing trials (SBTs) to assess extubation readiness.
Typical goal: Patient breathing comfortably with PS ~5 cmH₂O and reasonable rate.
Pressure Regulated Volume Control (PRVC)
Also called autoflow or adaptive pressure ventilation.
A hybrid mode: Pressure-delivered, volume-targeted.
Delivers breaths with a decelerating flow waveform, mimicking physiologic breathing.
Adjusts pressure breath-to-breath to meet a target tidal volume with minimal required pressure.
Safety feature: Pressure limit (e.g., 30–35 cm H₂O). If exceeded, volume delivery stops early.
Pitfall: In agitated patients, rapid breathing may trick the ventilator into reducing pressure, causing under-ventilation.
Synchronized Intermittent Mandatory Ventilation (SIMV)
Less common in adult ICU but still commonly used in pediatrics.
Delivers a set number of mandatory (controlled or assisted) breaths.
Allows spontaneous, pressure-supported breaths between mandatory ones.
Example: SIMV 10 = 10 guaranteed AC breaths; additional breaths are spontaneous + supported.
Why it’s less popular: Found to be less effective than daily SBTs for weaning and frequent dyssynchrony from not giving enough PS (PS should target at least 2/3 of the AC breath volumes) .
Volume Support (VS)
A newer, fully spontaneous mode (like PS + PRVC).
Patient initiates all breaths.
The ventilator automatically adjusts pressure support to achieve a target tidal volume.
Think of it as the spontaneous cousin of PRVC—adaptive and volume-driven.

🚨 Clinical Bottom Line

Understanding ventilator modes starts with knowing breath types, delivery mechanics, and clinical goals. When it comes to choosing the right mode:
Focus less on the “best” mode and more on patient comfort and synchrony.
Recognize the strengths, limitations, and pitfalls of each mode.
Stay tuned for future episodes that dive into ventilator troubleshooting and advanced respiratory strategies.

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)
Show Notes By: Nicole Ebalo, DO

👤 Guest Contributors

Eric Acker, MD
Internal Medicine, Chief Resident, Cape Fear Valley Medical Center, Fayetteville NC
Nicole Ebalo, DO
Internal Medicine, Chief Resident, Cape Fear Valley Medical Center, Fayetteville NC
🔎 Your Deep-Dive Starts Here

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The post REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes Sep 22, 2025

🧭 REBEL Rundown

🗝️ Key Points

💨 Start with Breath Types: Controlled, assisted, and supported breaths are the foundation of all modes.
🛌 Comfort Over “Best Mode”: No mode improves mortality — focus on patient synchrony and comfort.
Know the Big 5 Modes: AC: All controlled or assisted (volume or pressure). PS: Fully spontaneous, great for SBTs. PRVC: Pressure-delivered, volume-targeted hybrid. SIMV: Mixed mode, less favored in adults. VS: Spontaneous mode with adaptive pressure.
⚠️ Watch for Pitfalls: PRVC may under-ventilate in agitation. SIMV often causes dyssynchrony.
🎯 Bottom Line: Master mode mechanics and match the vent to the patient — not the other way around.

Click here for Direct Download of the Podcast.

📝 Introduction

Mechanical ventilation can feel overwhelming, especially when faced with a sea of ventilator modes and unfamiliar terminology. In Part 2 of the series, we go beyond breath types and delivery mechanics to explore the most used modes in the ICU. We will break down each one; explaining how it works, when to use it, and why the goal isn’t the “best mode” but the most comfortable one for the patient.

️ Ventilator Modes Explained

Assist Control (AC)
Commonly mislabeled as “volume control” or “pressure control.”
Two main types:
AC Volume: Delivers a preset tidal volume with each breath, whether machine-initiated (controlled) or patient-initiated (assisted).
AC Pressure: Delivers a preset pressure; tidal volume varies based on compliance.
All breaths are either controlled or assisted.
Pressure Support (PS)
All breaths are spontaneous initiated by the patient.
The ventilator provides a preset level of pressure support, like a resistance band during a pull-up.
No set rate, but a backup mode (often AC) activates during apnea.
Commonly used for spontaneous breathing trials (SBTs) to assess extubation readiness.
Typical goal: Patient breathing comfortably with PS ~5 cmH₂O and reasonable rate.
Pressure Regulated Volume Control (PRVC)
Also called autoflow or adaptive pressure ventilation.
A hybrid mode: Pressure-delivered, volume-targeted.
Delivers breaths with a decelerating flow waveform, mimicking physiologic breathing.
Adjusts pressure breath-to-breath to meet a target tidal volume with minimal required pressure.
Safety feature: Pressure limit (e.g., 30–35 cm H₂O). If exceeded, volume delivery stops early.
Pitfall: In agitated patients, rapid breathing may trick the ventilator into reducing pressure, causing under-ventilation.
Synchronized Intermittent Mandatory Ventilation (SIMV)
Less common in adult ICU but still commonly used in pediatrics.
Delivers a set number of mandatory (controlled or assisted) breaths.
Allows spontaneous, pressure-supported breaths between mandatory ones.
Example: SIMV 10 = 10 guaranteed AC breaths; additional breaths are spontaneous + supported.
Why it’s less popular: Found to be less effective than daily SBTs for weaning and frequent dyssynchrony from not giving enough PS (PS should target at least 2/3 of the AC breath volumes) .
Volume Support (VS)
A newer, fully spontaneous mode (like PS + PRVC).
Patient initiates all breaths.
The ventilator automatically adjusts pressure support to achieve a target tidal volume.
Think of it as the spontaneous cousin of PRVC—adaptive and volume-driven.

🚨 Clinical Bottom Line

Understanding ventilator modes starts with knowing breath types, delivery mechanics, and clinical goals. When it comes to choosing the right mode:
Focus less on the “best” mode and more on patient comfort and synchrony.
Recognize the strengths, limitations, and pitfalls of each mode.
Stay tuned for future episodes that dive into ventilator troubleshooting and advanced respiratory strategies.

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)
Show Notes By: Nicole Ebalo, DO

👤 Guest Contributors

Eric Acker, MD
Internal Medicine, Chief Resident, Cape Fear Valley Medical Center, Fayetteville NC
Nicole Ebalo, DO
Internal Medicine, Chief Resident, Cape Fear Valley Medical Center, Fayetteville NC
🔎 Your Deep-Dive Starts Here

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The post REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes appeared first on REBEL EM - Emergency Medicine Blog.

Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain Sep 18, 2025

🧭 REBEL Rundown

Click here for Direct Download of the Podcast.

⏰ Highlights

00:00 Introduction to Rebel Cast
00:10 Highlighting the Incrementum Conference 2026
00:34 Meet the Founders of Incrementum
01:21 The Journey to Incrementum
04:27 The Recognition of Emergency Medicine in Spain
06:04 What is Incrementum?
08:14 Bringing Together Top Emergency Medicine Experts
11:38 Exciting Sessions to Look Forward To
15:54 Conclusion and Invitation to Incrementum 2026

📝 Introduction

In this special episode of Rebel Cast, we spotlight the Incrementum Conference in Spain, a significant event in emergency medicine. Hosts welcome Dr. Francisco ‘Paco’ Campillo Palma and Dr. Carmen Maria Cano, founders of Incrementum, to discuss the recognition of emergency medicine as a specialty in Spain. They share their journey of creating the conference, emphasizing the importance of education, collaboration, and growth. The discussion also touches on this year’s conference highlights, including sessions on mental health and evidence-based medicine, and the exceptional lineup of speakers. Listeners are encouraged to attend the conference in April 2026 for an enriching experience.

📌 Bottom Line

Join us in Spain this April for the Increment Conference!
👉 Register now at incrementum-conference.com

Post Peer Reviewed By: Mark Ramzy, DO (X: @MRamzyDO)

👤 Co-Editor-In-Chief

Marco Propersi

DO

All Things REBEL EM
Meet The Team
🔎 Your Deep-Dive Starts Here

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The post Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain appeared first on REBEL EM - Emergency Medicine Blog.

Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain Sep 18, 2025

🧭 REBEL Rundown

Click here for Direct Download of the Podcast.

⏰ Highlights

00:00 Introduction to Rebel Cast
00:10 Highlighting the Incrementum Conference 2026
00:34 Meet the Founders of Incrementum
01:21 The Journey to Incrementum
04:27 The Recognition of Emergency Medicine in Spain
06:04 What is Incrementum?
08:14 Bringing Together Top Emergency Medicine Experts
11:38 Exciting Sessions to Look Forward To
15:54 Conclusion and Invitation to Incrementum 2026

📝 Introduction

In this special episode of Rebel Cast, we spotlight the Incrementum Conference in Spain, a significant event in emergency medicine. Hosts welcome Dr. Francisco ‘Paco’ Campillo Palma and Dr. Carmen Maria Cano, founders of Incrementum, to discuss the recognition of emergency medicine as a specialty in Spain. They share their journey of creating the conference, emphasizing the importance of education, collaboration, and growth. The discussion also touches on this year’s conference highlights, including sessions on mental health and evidence-based medicine, and the exceptional lineup of speakers. Listeners are encouraged to attend the conference in April 2026 for an enriching experience.

📌 Bottom Line

Join us in Spain this April for the Increment Conference!
👉 Register now at incrementum-conference.com

Post Peer Reviewed By: Mark Ramzy, DO (X: @MRamzyDO)

👤 Co-Editor-In-Chief

Marco Propersi

DO

All Things REBEL EM
Meet The Team
🔎 Your Deep-Dive Starts Here

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The post Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes Sep 15, 2025

🧭 REBEL Rundown

🗝️ Key Points

💨 Master the 3 Types of Breaths
Control, Assist, and Spontaneous — know the difference before tackling ventilator modes.
📦 Breath Delivery: Volume vs. Pressure
Volume-Targeted = fixed volume → monitor pressure
📈 Pressure-Targeted = fixed pressure → monitor volume
🫁 Lung Compliance = Pressure-Volume Relationship
Volume mode: ↑ pressure = ↓ compliance (stiff lungs)
Pressure mode: ↓ tidal volume = ↓ compliance

Click here for Direct Download of the Podcast.

📝 Introduction

For many medical residents, the ICU can feel like stepping into a pressure cooker. At the heart of that stress often lies one intimidating machine: the ventilator. Rather than diving headfirst into complex ventilator modes, this episode lays a critical foundation by breaking down the basic building blocks of mechanical ventilation, something every clinician should master before moving on to more advanced concepts. Once you know the 3 types of breaths and how those breaths are delivered, you can more easily understand most of the mechanical ventilator modes.

🧮 The 3 Types of Breaths

To simplify things, we use a pull-up analogy to explain the types of ventilator breaths:

🫁 The 3 Types of Breaths…It's Like

😮‍💨 Breath Delivery: Volume vs. Pressure

Once you know the type of breath, the next key concept is how it’s delivered:
1. Volume-Targeted Delivery
The ventilator delivers a fixed tidal volume (e.g., 400 mL) with each control or assist breath.
What to monitor: Pressure. As lung compliance worsens, pressure increases.
Risk: Barotrauma if the pressure becomes too high.
2. Pressure-Targeted Delivery
The ventilator delivers air to a preset pressure (e.g., 15 cm H₂O).
What to monitor: Tidal volume. As compliance drops, so does delivered volume.
Adjustment: Modify pressure to maintain appropriate ventilation.

🧱 Putting It All Together: Lung Compliance

The relationship between pressure and volume is described by compliance:
📐 Compliance = Δ Volume / Δ Pressure
In volume mode:
Rising pressure to achieve the same volume = decreased compliance (stiff)
Decreasing pressure to achieve the same volume = increased compliance (loose)
In pressure mode:
Dropping tidal volume at a constant pressure = decreased compliance (stiff)
Rising tidal volume at a constant pressure = increased compliance (loose)

🚨 Clinical Bottom Line

Before tackling advanced ventilator modes, master these foundational concepts:
The three breath types
The two delivery methods
The role of lung compliance
Once you’ve got these down, the rest of mechanical ventilation becomes far easier to understand.
Stay tuned for Part 2, where we’ll build on this foundation and unpack the most commonly used ventilator modes.

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)
Show Notes By: Nicole Ebalo, DO

👤 Guest Contributors

Eric Acker, MD
Internal Medicine, Chief Resident, Cape Fear Valley Medical Center, Fayetteville NC
Nicole Ebalo, DO
Internal Medicine, Chief Resident, Cape Fear Valley Medical Center, Fayetteville NC
🔎 Your Deep-Dive Starts Here

It seems we can't find what you're looking for.

The post REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes Sep 15, 2025

🧭 REBEL Rundown

🗝️ Key Points

💨 Master the 3 Types of Breaths
Control, Assist, and Spontaneous — know the difference before tackling ventilator modes.
📦 Breath Delivery: Volume vs. Pressure
Volume-Targeted = fixed volume → monitor pressure
📈 Pressure-Targeted = fixed pressure → monitor volume
🫁 Lung Compliance = Pressure-Volume Relationship
Volume mode: ↑ pressure = ↓ compliance (stiff lungs)
Pressure mode: ↓ tidal volume = ↓ compliance

Click here for Direct Download of the Podcast.

📝 Introduction

For many medical residents, the ICU can feel like stepping into a pressure cooker. At the heart of that stress often lies one intimidating machine: the ventilator. Rather than diving headfirst into complex ventilator modes, this episode lays a critical foundation by breaking down the basic building blocks of mechanical ventilation, something every clinician should master before moving on to more advanced concepts. Once you know the 3 types of breaths and how those breaths are delivered, you can more easily understand most of the mechanical ventilator modes.

🧮 The 3 Types of Breaths

To simplify things, we use a pull-up analogy to explain the types of ventilator breaths:

🫁 The 3 Types of Breaths…It's Like

😮‍💨 Breath Delivery: Volume vs. Pressure

Once you know the type of breath, the next key concept is how it’s delivered:
1. Volume-Targeted Delivery
The ventilator delivers a fixed tidal volume (e.g., 400 mL) with each control or assist breath.
What to monitor: Pressure. As lung compliance worsens, pressure increases.
Risk: Barotrauma if the pressure becomes too high.
2. Pressure-Targeted Delivery
The ventilator delivers air to a preset pressure (e.g., 15 cm H₂O).
What to monitor: Tidal volume. As compliance drops, so does delivered volume.
Adjustment: Modify pressure to maintain appropriate ventilation.

🧱 Putting It All Together: Lung Compliance

The relationship between pressure and volume is described by compliance:
📐 Compliance = Δ Volume / Δ Pressure
In volume mode:
Rising pressure to achieve the same volume = decreased compliance (stiff)
Decreasing pressure to achieve the same volume = increased compliance (loose)
In pressure mode:
Dropping tidal volume at a constant pressure = decreased compliance (stiff)
Rising tidal volume at a constant pressure = increased compliance (loose)

🚨 Clinical Bottom Line

Before tackling advanced ventilator modes, master these foundational concepts:
The three breath types
The two delivery methods
The role of lung compliance
Once you’ve got these down, the rest of mechanical ventilation becomes far easier to understand.
Stay tuned for Part 2, where we’ll build on this foundation and unpack the most commonly used ventilator modes.

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)
Show Notes By: Nicole Ebalo, DO

👤 Guest Contributors

Eric Acker, MD
Internal Medicine, Chief Resident, Cape Fear Valley Medical Center, Fayetteville NC
Nicole Ebalo, DO
Internal Medicine, Chief Resident, Cape Fear Valley Medical Center, Fayetteville NC
🔎 Your Deep-Dive Starts Here

It seems we can't find what you're looking for.

The post REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine Sep 01, 2025

🧭 REBEL Rundown

📌 Key Points

💉 IO Lines Are Life-Saving in Extremis: IO access is fast, reliable, and can deliver nearly any resuscitative medication or fluid during cardiac arrest or hemorrhagic shock.
🧭 Location Matters for Flow. Sternal IO: 💨 Fastest (up to 500cc/5 min). Humerus IO: ⚡ Faster than tibia (300cc/5 min). Tibial IO: 🐢 Slower (200cc/5 min) but easier to place during CPR
⚠️ Watch for Contraindications: Avoid IO placement in bones with fractures, prior IO attempts, or compromised circulation proximal to the site.
🩸 Labs From IO = ❌: Labs drawn from IO lines are generally unreliable. Once stabilized, obtain bloodwork through IV access.
🎯 Stabilize or Lose It: IO dislodgement is common—always use a stabilizer or secure with gauze and tape if none is provided.
🧠 Don’t Forget Non-Trauma Uses: IO isn’t just for trauma—think about it in medical arrests, shocked pediatric patients, and patients with difficult IV access.

Click here for Direct Download of the Podcast.

⏰ Highlights

00:00 Introduction to the Podcast
00:07 First Encounter with Intraosseous Lines
01:09 Advantages of Intraosseous Lines
02:42 Intraosseous Lines in Pediatric Patients
03:34 Optimal Locations for Intraosseous Lines
06:17 Limitations and Considerations
07:34 Conclusion and Final Thoughts

📝 Introduction

Welcome to the Rebel Core Content blog, your go-to source for core medical concepts applicable to practitioners anywhere, anytime. Today, we delve into the world of Intraosseous (IO) lines—a crucial tool in emergency medicine. Swami shares insights into the effectiveness and limitations of IO usage in diverse clinical scenarios.

🧠 Background

The sicker the patient, the more likely an IO line is the right choice. In emergencies such as cardiac arrest or hemorrhagic shock, the speed and reliability of IO access outshine traditional intravenous (IV) or central line placements. There’s virtually no resuscitation medication or blood product that cannot be administered through an IO, making it indispensable in life-threatening situations.

🧭 Location

While proximal humerus site portents faster infusion rates than proximal tibia site, the main limitation of the proximal humerus site is that the arm must be held in internal rotation to avoid dislodgement of the IO
Proximal tibia may be easier to landmark than proximal humerus
Other sites include distal tibia, distal femur and sternum but are uncommonly employed in EDs

🚰 Flow Rates

Proximal Humerus IO
~300cc over 5 minutes
Faster than tibia
May be harder to access in some trauma or positioning scenarios
Tibial IO
~200cc over 5 minutes
Slower flow compared to humerus
Easier to access, especially during CPR or transport
Sternal IO
Up to 500cc over 5 minutes
Highest flow rate
Best for rapid volume resuscitation
Risk of dislodgement or interfering with CPR compressions

⚠️ Limitations

Placing an IO in a bone with a proximal fracture, a previous IO placement attempt or any circulatory compromise proximal to the site is contraindicated
Blood work drawn from an IO are generally not accurate, so once the patient has been resuscitated with the IO, intravenous blood draws are recommended
Dislodgement is common; it is best to use the stabilizer that comes with the IO kit; if the kit does not have a stabilizer, stack lots of gauze on both sides of the IO needle and tape it down

🚨 Clinical Bottom Line

Intraosseous lines are a powerful tool, particularly in acute resuscitation scenarios involving cardiac arrest or severe trauma. While they offer quick and effective access, Clinicians must remain vigilant about their limitations and be prepared to switch to more stable options as patients stabilize.

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)

👤 Associate Editor

Anand Swaminathan

MD, MPH

All Things REBEL EM
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The post REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 139.0: Pneumothorax Decompression Aug 18, 2025

🧭 REBEL Rundown

📌 Key Points

🧠 Think Beyond Trauma: Don’t forget to suspect tension pneumothorax in ventilated patients who suddenly crash or after a central line placement! 🫁⚠️
🔍 Confirm with Ultrasound: If the patient is stable enough, grab the probe! 🖐️📟Ultrasound can rapidly confirm tension PTX and avoid unnecessary delays.
💉🚫 Needles Are Out: Needle decompression? Meh. Finger thoracostomy is faster, more reliable, and more definitive. 🖐️🫁

Click here for Direct Download of the Podcast.

📝 Introduction

On this episode of the Rebel Core Cast, Swami takes a deep dive into pneumothorax decompression, focusing on the need for improvements beyond the classic teachings. Covering scenarios where immediate decompression is critical, particularly in tension pneumothorax, Swami discusses the limitations of needle decompression, especially in the second intercostal space at the midclavicular line. He highlights the importance of using POCUS for diagnosis and recommends skipping needle decompression in favor of finger thoracostomy for a more reliable and effective treatment. Key takeaways emphasize recognizing tension pneumothorax in various clinical situations and the advantages of finger thoracostomy over traditional techniques.

⏰ Highlights

00:00 Introduction to Pneumothorax Decompression
00:17 Recognizing Tension Pneumothorax
01:00 Common Scenarios for Pneumothorax
01:34 Confirming Diagnosis with POCUS
01:50 Issues with Needle Decompression
03:21 Advantages of Finger Thoracostomy
04:11 Key Takeaways and Conclusion

📚 References

Ferrie EP et al. The right place in the right space? Awareness of site for needle thoracentesis. Emerg Med J 2005; 22: 788-9 PMID: 16244336
Laan DV et al. Chest wall thickness and decompression failure: a systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury; 2016; 47(4): 797-804 PMID: 26724173
Terboven T et al. Chest wall thickness and depth to vital structures in paediatric patients – implications for prehospital needle decompression of tension pneumothorax. Scan J Trauma Resusc Emerg Med 2109; 27(1). PMID: 30992028

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)

👤 Associate Editor

Anand Swaminathan

MD, MPH

All Things REBEL EM
Meet The Team
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The post REBEL Core Cast 139.0: Pneumothorax Decompression appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 138.0: A Simple Bedside Approach to Shock Aug 04, 2025

🧭 REBEL Rundown

📌 Key Points

🧠 Shock is a Clinical Diagnosis — Not Just a Number
Patients can be in compensated shock with normal BP. Look for signs like AMS, cool extremities, ↓ UOP, and ↑ HR/RR.
🖐️ Start with the 4 L’s
Lucid (mental status), Limbs (warm/cold), Leak (urine output), and Lactate give you rapid bedside insight into perfusion status.
💡 Pulse Pressure Helps Pinpoint the Type
➡️ Narrow PP = Cardiogenic, Hypovolemic, or Obstructive shock
➡️ Wide PP = Distributive shock (Sepsis, Anaphylaxis, Neurogenic)
🚨 Be Systematic at the Bedside
Quick vitals, focused history, and targeted exam can reveal the etiology faster than invasive tools.

Click here for Direct Download of the Podcast.

📝 Introduction

In this episode, we will dive into a simple yet effective bedside approach to a patient in shock. By using quick physical exam findings and bedside vitals (particularly pulse pressure), you can form a quick assessment of the likely underlying etiology of a critically ill patient.

🔑 Key Concepts

What is Shock?

Supply vs. Demand mismatch:
Inadequate perfusion relative to metabolic demands
Leading to tissue hypoxia and cell death
DO2 = CO x (Hb x Sat + (0.003 x paO2))
CO = Heart Rate x Stroke Volume
Determinants of Stroke Volume: Preload, Contractility, and Afterload
4 L’s of Hypotension
Lucid: What’s their mental status?
Limbs: Are they cold vs. warm? What is the cap refill?
Leak: Are they taking a “leak”? What is the urine output?
Lactate
Remember:
Shock DOES NOT equal hypotension
A patient in shock can still have normotensive pressures in “Compensated Shock”
Signs of Shock
Increased HR, increased RR, AMS, decreased urine output, cool to touch, weak pulses, slow capillary refill

Defining Blood Pressure

Systolic Blood Pressure
Stroke Volume: Main contributor to SBP ➡️ SV ≈ SBP
Aortic/Arterial Compliance
Diastolic Blood Pressure
Systemic Vascular Resistance
Maintains end-organ perfusion in diastole
Pulse Pressure
SBP – DBP
Mean Arterial Pressure
MAP < 60-65 can lead to end-organ damage

Narrow Pulse Pressure

Cardiogenic: “Cold Shock”
Low contractility ➡️low SV ➡️ low SBP ➡️ increased HR + increased SVR due to catecholamine release leading to increased DBP
Cold limbs, weak pulses, poor capillary refill
Hypovolemic
Hemorrhagic vs. Dehydration
Decrease preload ➡️ decreased SV ➡️ decreased SBP ➡️ increased HR + increased SVR due to catecholamine release leading to increased DBP
Obstructive
“Obstruction of preload” ➡️ decreased SV➡️ low SBP ➡️ increased HR + increased SVR due to catecholamine release leading to increased DBP
Pneumothorax
Increased intrathoracic pressure ➡️ decrease IVC and SVC ➡️ decreased preload
Cardiac Tamponade
Fluid in pericardial space ➡️ decrease filling ➡️ decreased preload
Pulmonary Emboli: Obstruction of RV to LA flow ➡️ decreased preload

Wide Pulse Pressure: Distributive Shock

“Warm shock”: Vasodilatation ➡️ decreased SVR ➡️ Decreased DBP
Septic: Main cause of distributive shock
Neurogenic: Loss of sympathetic tone ➡️ unopposed parasympathetic / vagal tone ➡️ decreased SVR ➡️ decreased DBP
Anaphylaxis: histamine and other inflammatory mediators released ➡️ increased vascular permeability ➡️ decreased SVR ➡️ decreased DBP
Adrenal Crisis: Not secreting cortisol ➡️ not increasing vascular tone ➡️ decreased SVR ➡️ decreased DBP
Hepatic Failure: Increase in NOS ➡️ increases NO ➡️ vasodilatation

🛌 Practical Bedside Approach

When called to bedside:
Is the patient meeting any of the 4 “L’s” ?
Check the pulse pressure along with other vitals
Why are they here? What’s the brief history?
Narrow Pulse Pressure? Cardiogenic, hypovolemic, or obstructive shock
Wide Pulse Pressure? Distributive shock
Think: sepsis (most likely), neurogenic, anaphylaxis, adrenal crisis, hepatic failure

🚨 Clinical Bottom Line

A brief but thorough bedside exam remembering the 4 “L’s”, a quick history, and examining the pulse pressure can help a clinician form a quick differential into the underlying etiology for a critically ill patient in shock. Stay sharp, stay systematic!
💡 Shock is a clinical diagnosis based on bedside findings — not just blood pressure readings.
You don’t always need invasive monitoring to identify shock. Look at HR, RR, UOP, and mentation.

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)

👤 Guest Contributors

Eric Acker, MD
Internal Medicine Resident, Rising Chief Resident, Cape Fear Valley Medical Center, Fayetteville NC
Micheal Bass DO
Internal Medicine Resident, Rising Chief Resident Cape Fear Valley Medical Center, Fayetteville NC
Frank J. Lodeserto MD
Associate Professor and Internal Medicine Residency Program Director Adult & Pediatric Critical Care Medicine, Cape Fear Valley Medical Center, Fayetteville, NC
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The post REBEL Core Cast 138.0: A Simple Bedside Approach to Shock appeared first on REBEL EM - Emergency Medicine Blog.

Eric Acker MD — REBEL Core Cast 138.0: A Simple Bedside Approach to Shock Aug 04, 2025

🧭 REBEL Rundown

📌 Key Points

🧠 Shock is a Clinical Diagnosis — Not Just a Number
Patients can be in compensated shock with normal BP. Look for signs like AMS, cool extremities, ↓ UOP, and ↑ HR/RR.
🖐️ Start with the 4 L’s
Lucid (mental status), Limbs (warm/cold), Leak (urine output), and Lactate give you rapid bedside insight into perfusion status.
💡 Pulse Pressure Helps Pinpoint the Type
➡️ Narrow PP = Cardiogenic, Hypovolemic, or Obstructive shock
➡️ Wide PP = Distributive shock (Sepsis, Anaphylaxis, Neurogenic)
🚨 Be Systematic at the Bedside
Quick vitals, focused history, and targeted exam can reveal the etiology faster than invasive tools.

Click here for Direct Download of the Podcast.

📝 Introduction

In this episode, we will dive into a simple yet effective bedside approach to a patient in shock. By using quick physical exam findings and bedside vitals (particularly pulse pressure), you can form a quick assessment of the likely underlying etiology of a critically ill patient.

🔑 Key Concepts

What is Shock?

Supply vs. Demand mismatch:
Inadequate perfusion relative to metabolic demands
Leading to tissue hypoxia and cell death
DO2 = CO x (Hb x Sat + (0.003 x paO2))
CO = Heart Rate x Stroke Volume
Determinants of Stroke Volume: Preload, Contractility, and Afterload
4 L’s of Hypotension
Lucid: What’s their mental status?
Limbs: Are they cold vs. warm? What is the cap refill?
Leak: Are they taking a “leak”? What is the urine output?
Lactate
Remember:
Shock DOES NOT equal hypotension
A patient in shock can still have normotensive pressures in “Compensated Shock”
Signs of Shock
Increased HR, increased RR, AMS, decreased urine output, cool to touch, weak pulses, slow capillary refill

Defining Blood Pressure

Systolic Blood Pressure
Stroke Volume: Main contributor to SBP ➡️ SV ≈ SBP
Aortic/Arterial Compliance
Diastolic Blood Pressure
Systemic Vascular Resistance
Maintains end-organ perfusion in diastole
Pulse Pressure
SBP – DBP
Mean Arterial Pressure
MAP < 60-65 can lead to end-organ damage

Narrow Pulse Pressure

Cardiogenic: “Cold Shock”
Low contractility ➡️low SV ➡️ low SBP ➡️ increased HR + increased SVR due to catecholamine release leading to increased DBP
Cold limbs, weak pulses, poor capillary refill
Hypovolemic
Hemorrhagic vs. Dehydration
Decrease preload ➡️ decreased SV ➡️ decreased SBP ➡️ increased HR + increased SVR due to catecholamine release leading to increased DBP
Obstructive
“Obstruction of preload” ➡️ decreased SV➡️ low SBP ➡️ increased HR + increased SVR due to catecholamine release leading to increased DBP
Pneumothorax
Increased intrathoracic pressure ➡️ decrease IVC and SVC ➡️ decreased preload
Cardiac Tamponade
Fluid in pericardial space ➡️ decrease filling ➡️ decreased preload
Pulmonary Emboli: Obstruction of RV to LA flow ➡️ decreased preload

Wide Pulse Pressure: Distributive Shock

“Warm shock”: Vasodilatation ➡️ decreased SVR ➡️ Decreased DBP
Septic: Main cause of distributive shock
Neurogenic: Loss of sympathetic tone ➡️ unopposed parasympathetic / vagal tone ➡️ decreased SVR ➡️ decreased DBP
Anaphylaxis: histamine and other inflammatory mediators released ➡️ increased vascular permeability ➡️ decreased SVR ➡️ decreased DBP
Adrenal Crisis: Not secreting cortisol ➡️ not increasing vascular tone ➡️ decreased SVR ➡️ decreased DBP
Hepatic Failure: Increase in NOS ➡️ increases NO ➡️ vasodilatation

🛌 Practical Bedside Approach

When called to bedside:
Is the patient meeting any of the 4 “L’s” ?
Check the pulse pressure along with other vitals
Why are they here? What’s the brief history?
Narrow Pulse Pressure? Cardiogenic, hypovolemic, or obstructive shock
Wide Pulse Pressure? Distributive shock
Think: sepsis (most likely), neurogenic, anaphylaxis, adrenal crisis, hepatic failure

🚨 Clinical Bottom Line

A brief but thorough bedside exam remembering the 4 “L’s”, a quick history, and examining the pulse pressure can help a clinician form a quick differential into the underlying etiology for a critically ill patient in shock. Stay sharp, stay systematic!
💡 Shock is a clinical diagnosis based on bedside findings — not just blood pressure readings.
You don’t always need invasive monitoring to identify shock. Look at HR, RR, UOP, and mentation.

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)

👤 Guest Contributors

Eric Acker, MD
Internal Medicine Resident, Rising Chief Resident, Cape Fear Valley Medical Center, Fayetteville NC
Micheal Bass DO
Internal Medicine Resident, Rising Chief Resident Cape Fear Valley Medical Center, Fayetteville NC
Frank J. Lodeserto MD
Associate Professor and Internal Medicine Residency Program Director Adult & Pediatric Critical Care Medicine, Cape Fear Valley Medical Center, Fayetteville, NC
🔎 Your Deep-Dive Starts Here

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The post REBEL Core Cast 138.0: A Simple Bedside Approach to Shock appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 137.0: A Simple Approach to Sinus Tachycardia Jul 21, 2025
Sinus tachycardia is the most prevalent cardiac dysrhythmia in critically ill patients, yet it often receives less attention than it warrants. While the rhythm itself is not inherently dangerous, it serves as a crucial indicator of underlying physiological disturbances that require prompt evaluation and management.

The post REBEL Core Cast 137.0: A Simple Approach to Sinus Tachycardia appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 136.0: A Simple Approach to the Tachypneic Patient Jul 07, 2025
In this episode, we focus on the bedside evaluation of the tachypneic patient. Tachypnea (increased respiratory rate) can be an early indicator of serious illness, but not every tachypneic patient is on the verge of arrest. The key is honing your bedside assessment to recognize who is at risk for rapid deterioration and why. We break down a practical approach you can use immediately at the bedside.

The post REBEL Core Cast 136.0: A Simple Approach to the Tachypneic Patient appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 135.0: A Simple Approach to Hypoxemia (vs. Hypoxia) Jun 16, 2025
In this episode, we break down a practical bedside approach to hypoxemia. We clarify the difference between hypoxemia (low oxygen in the blood) and hypoxia (low oxygen at the tissue level), and walk through the major causes of hypoxemia that you need to recognize quickly at the bedside.

The post REBEL Core Cast 135.0: A Simple Approach to Hypoxemia (vs. Hypoxia) appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 134.0 – Acetaminophen Toxicity Jun 02, 2025
Acetaminophen (APAP) overdose remains one of the most common causes of acute liver failure in the United States. While its therapeutic use is widespread and generally safe, unintentional overdoses and delayed presentations can lead to devastating outcomes. In this episode of REBEL Cast, we break down the pathophysiology, clinical course, diagnostic approach, and evidence-based management ... Read more

The post REBEL Core Cast 134.0 – Acetaminophen Toxicity appeared first on REBEL EM - Emergency Medicine Blog.

Street Medicine: Compassionate Care for the Unhoused Apr 02, 2025
Introduction: In this episode of Rebel Cast, host Marco Propersi, along with co-hosts Steve Hochman and Kim Baldino, delve into the practice and importance of street medicine—the direct delivery of healthcare to homeless and unsheltered individuals. Special guests Dr. Jim O’Connell, a pioneer of street medicine, and Dr. Ed Egan, a recent street medicine fellowship ... Read more

The post Street Medicine: Compassionate Care for the Unhoused appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 131.0 – Traumatic Arthrotomy Nov 13, 2024
Take Home points: Always suspect an open joint if there is a laceration, regardless of size, the lies over joint CT scan of the affected joint is widely considered to be the standard approach to evaluation but the saline load test may be useful in certain circumstances. Obtain emergency orthopedics consultation for all open joints ... Read more

The post REBEL Core Cast 131.0 – Traumatic Arthrotomy appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 130.0 – Omphalitis Oct 30, 2024
Take Home Points Early diagnosis: erythema and warmth of the skin surrounding the umbilicus isn’t normal. Get labs, start abx and get the patient admitted Consult peds surgery on all of these patients as progression to nec fast, while uncommon, is devastating If the patient appears toxic or has systemic symptoms, the simply omphalitis has ... Read more

The post REBEL Core Cast 130.0 – Omphalitis appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 129.0 – Gastric Lavage Oct 16, 2024
Take Home Points Orogastric lavage may still play an important role in treatment of the overdose patient. Do not perform lavage if the ingestion has limited toxicity at any dose or the ingested dose is unlikely to cause significant toxicity. Strongly consider orogastric lavage in a patient who has taken an overdose of drugs that ... Read more

The post REBEL Core Cast 129.0 – Gastric Lavage appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 128.0 – Toxic Alcohols Oct 02, 2024
Take Home Points Toxic alcohols generally refer to methanol and ethylene glycol as these substances pose significant metabolic derangement and end-organ damage. Patient who present shortly after ingestion will simply look inebriated – no different than ethanol intoxication. At this point, patients will have an elevated osmolar gap and little to no anion gap. Patient ... Read more

The post REBEL Core Cast 128.0 – Toxic Alcohols appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 127.0 – Penetrating Neck Injuries Sep 18, 2024
Take Home Points Anticipate anatomically challenging airways and consider early intubation prior to loss of airway anatomy. Skip the zones of the neck and focus on hard signs of vascular (Shock w/o another source, Pulsatile bleeding, Expanding hematoma, Audible bruit, Signs of stroke) or aerodigestive (Airway compromise, Bubbling wound, Extensive SubQ air, Stridor, Significant hemoptysis/hematemesis). ... Read more

The post REBEL Core Cast 127.0 – Penetrating Neck Injuries appeared first on REBEL EM - Emergency Medicine Blog.

A Winning Hand in Cardiology: Queen of Hearts AI Model Enhances OMI Detection Jul 22, 2024
Background: Cath lab activation based on ST-elevation myocardial infarction (STEMI) criteria is founded on aging data and requires evolution. In the “Occlusive Myocardial Infarction (OMI) Manifesto,” emergency physicians Dr. Steve Smith, Dr. Pendell Meyers, and Dr. Scott Weingart introduced a new paradigm —OMI vs. non-occlusive myocardial infarction (NOMI). The OMI/NOMI paradigm focuses on the presence ... Read more

The post A Winning Hand in Cardiology: Queen of Hearts AI Model Enhances OMI Detection appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 126.0 – Peds Hem Onc Emergencies Jul 10, 2024
Take Home Points Early administration of antibiotics (within 60 min) in patients with fever and neutropenia is life saving. Fever in sickle cell is an emergency and always requires cultures and antibiotics even if the child appears well. Avoid sedation and lying supine and steroids in patients with mediastinal masses. Red flags in patients with ... Read more

The post REBEL Core Cast 126.0 – Peds Hem Onc Emergencies appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 125.0 – Hyperkalemia Jun 26, 2024
Take Home Points Always obtain an EKG in patients with ESRD upon presentation Always obtain an EKG in patients with hyperkalemia as pseudohyperkalemia is the number one cause If the patient with hyperkalemia is unstable or has significant EKG changes (wide QRS, sine wave) rapidly administer calcium salts In patients who are anuric, early mobilization ... Read more

The post REBEL Core Cast 125.0 – Hyperkalemia appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 124.0 – Hyperinsulinemia Euglycemia Therapy Jun 12, 2024
Take Home Points Management of severe beta-blocker and calcium-channel blocker toxicity should occur in a stepwise fashion: potential gastric decontamination, multiple lines of access, judicious fluids, calcium, glucagon, and vasopressors as needed. Initiation of high dose insulin therapy requires a tremendous amount of logistical and cognitive resources as it requires cross-disciplinary collaboration and is prone ... Read more

The post REBEL Core Cast 124.0 – Hyperinsulinemia Euglycemia Therapy appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 123.0 – Posterior Epistaxis May 29, 2024
Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. The key is in identifying and rapidly gaining control with a posterior pack or foley catheter. These patients often require surgical intervention so get ENT to the bedside and admit to a place with a higher level of monitoring. REBEL Core Cast 123.0 – Posterior ... Read more

The post REBEL Core Cast 123.0 – Posterior Epistaxis appeared first on REBEL EM - Emergency Medicine Blog.

ANNEXA-1: Andexanet Alfa Associated with Harm in DOAC Reversal May 23, 2024
Background: In May of 2018, Andexanet alfa gained accelerated approval by the FDA for the reversal direct oral anticoagulants (DOACs) despite a lack of robust evidence for use. The 2022 AHA/ASA guidelines give the drug a level 2A recommendation and recommend it over the use of 4F-PCC (Greenberg 2022). FDA approval alongside guideline endorsement has ... Read more

The post ANNEXA-1: Andexanet Alfa Associated with Harm in DOAC Reversal appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 122.0 – Neutropenic Fever May 15, 2024
Take Home Points: There are many causes of neutropenia, chemotherapy being by far the most dangerous. Febrile neutropenia is a condition conveying high mortality. Early administration of antibiotics is the only factor known to reduce this mortality. For a patient with neutropenic fever, remember that the body’s own flora is the greatest danger. Isolate, but ... Read more

The post REBEL Core Cast 122.0 – Neutropenic Fever appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Cast Ep126: Should We Not Be Recommending Small Adult BVMs in OHCA? May 13, 2024
Background: The holy grail of outcomes in OHCA is survival with good neurologic outcome. The only interventions proven to increase this outcome are high quality CPR and defibrillation in shockable rhythms. Ventilation is also an important component of resuscitation in OHCA. Excess minute ventilation can adversely affect hemodynamics due to increased intrathoracic pressure (i.e. decreased ... Read more

The post REBEL Cast Ep126: Should We Not Be Recommending Small Adult BVMs in OHCA? appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 121.0 – Acute Sinusitis May 01, 2024
Take Home Points Acute rhinosinusitis is a clinical diagnosis The vast majority of acute rhinosinusitis cases are viral in nature and do not require antibiotics Consider the use of antibiotics in select groups with severe disease or worsening symptoms after initial improvement. REBEL Core Cast 121.0 – Acute Sinusitis Click here for Direct Download of ... Read more

The post REBEL Core Cast 121.0 – Acute Sinusitis appeared first on REBEL EM - Emergency Medicine Blog.

REBEL EM Book Club – MicroSkills Apr 09, 2024
Podcast Direct Download: Link Release Date: April 16th, 2024 Show Notes The Visible Voices Podcast Dr. Glaucomflecken: Power of Ultrasound with Emergency Medicine Dr. Resa Lewiss Adaira I Landry MD Resa E Lewiss MD is a Professor of Emergency Medicine at the University of Alabama at Birmingham. A TEDMED speaker and TimesUp Healthcare founder, she’s ... Read more

The post REBEL EM Book Club – MicroSkills appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Cast – EMTALA + Reproductive Health Rights Apr 03, 2024
REBEL Cast – EMTALA + Reproductive Health Click here for Direct Download of the Podcast. Dr. Dara Kass is a practicing emergency medicine physician who was most recently as the Regional Director of Region 2 for the US Department of Health and Human Services. She currently works with organizations and institutions to advance and implement ... Read more

The post REBEL Cast – EMTALA + Reproductive Health Rights appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Cast Ep125: 1st 48 Hours of PE Management – How Good Is Unfractionated Heparin? Apr 01, 2024
Background: The mainstay of treatment for symptomatic pulmonary embolism (PE) is anticoagulation (AC). Patients with higher-risk PE may require advanced interventions such as thrombolytic therapy, surgical thrombectomy, or even extracorporeal membrane oxygenation (ECMO). Because of its short half-life and availability of a reversal agent, unfractionated heparin (UFH) is commonly used when percutaneous or surgical interventions ... Read more

The post REBEL Cast Ep125: 1st 48 Hours of PE Management – How Good Is Unfractionated Heparin? appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Cast Ep124: Nitrates in Right Sided MIs? Mar 18, 2024
Background: Nitrates can help improve symptoms and ischemia in the setting of acute myocardial infarction. Current teaching holds that nitrates should be avoided in patients with potential right ventricular myocardial infarction (RVMI), due to the risk of decreasing preload and precipitating hypotension. This belief is based on a single 1989 study of 40 patients with ... Read more

The post REBEL Cast Ep124: Nitrates in Right Sided MIs? appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 119.0 – Sleep Hygiene Mar 06, 2024
REBEL Core Cast 119.0 – Sleep Hygiene Click here for Direct Download of the Podcast Employ sleep strategies: Anchor sleep: a period of sleep that overlaps each day regardless of your night shift schedule to provide a guidepost for your body clock. Ideally would overlap with when you would normally be asleep if you were ... Read more

The post REBEL Core Cast 119.0 – Sleep Hygiene appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 118.0 – IM vs PO NSAIDs Feb 21, 2024
REBEL Core Cast 118.0 – IM vs PO NSAIDs Click here for Direct Download of the Podcast Bottom Line Up Top: There is no difference in analgesic efficacy between oral and intramuscular NSAIDs. Clinical Scenario: A 34-year-old woman presents to the ED with back pain. After your history and physical, you conclude that the patient’s ... Read more

The post REBEL Core Cast 118.0 – IM vs PO NSAIDs appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 117.0 – Infections of Pregnancy Feb 07, 2024
Take Home Points Infections are a leading cause of maternal mortality worldwide. Prompt recognition is critical in management. Most infectious processes will require admission and close observation for improvement or decompensation. REBEL Core Cast 117.0 – Infections of Pregnancy Click here for Direct Download of the Podcast Urinary Tract Infection/Pyelonephritis Epidemiology: Occurs in as many ... Read more

The post REBEL Core Cast 117.0 – Infections of Pregnancy appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE? Jan 29, 2024
Background: Massive pulmonary embolism defined as sustained hypotension (SBP Read more

The post REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE? appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 116.0 – Achilles Tendon Rupture Jan 24, 2024
Take Home Points Achilles tendon rupture is a clinical diagnosis. The Thompson Test should be applied in all suspected cases. Remember to brace or splint a rupture, even if suspected, in the resting equinus position for optimal healing and prevention of further injury. Schedule follow up with orthopedics within 1 week for discussion of operative ... Read more

The post REBEL Core Cast 116.0 – Achilles Tendon Rupture appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 115.0 – Cardiogenic Shock Dec 27, 2023
Take Home Points: Know clinical (cold extremities, oliguria, confusion, dizziness, narrow pulse pressure) and laboratory markers (metabolic acidosis, elevated creatinine, lactic acidosis) of hypoperfusion. An elevated lactate is a danger sign and requires explanation. Norepinephrine is a great first line vasopressor in Cardiogenic shock. Dobutamine is useful for inotropic support in Cardiogenic shock. Use POCUS ... Read more

The post REBEL Core Cast 115.0 – Cardiogenic Shock appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 114.0 – Carbon Monoxide Toxicity Dec 13, 2023
Take Home Points: Carbon monoxide is a colorless, odorless, and tasteless gas that results from incomplete combustion of any carbon containing product. Exposure often occur unintentionally from indoor use of gas powered generators, camp stoves, or faulty home heaters. The symptoms of mild, acute exposure are non-specific and can be confused with a variety of ... Read more

The post REBEL Core Cast 114.0 – Carbon Monoxide Toxicity appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 113.0 – ACS Therapies and Management Nov 29, 2023
Take Home Points: All STEMIs should be loaded with dual antiplatelet therapy. Prasugrel (Effient) is avoided as there is an increase in bleeding complications if the patient requires a CABG. NSTEMI cases can be challenging to manage. Consult Cardiology early and use all available data. The appropriate medical treatment for ACS patients is as important ... Read more

The post REBEL Core Cast 113.0 – ACS Therapies and Management appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 112.0 – Awareness During Paralysis Nov 15, 2023
Take Home Points: Dose your RSI meds correctly. Reach for post-intubation sedation at the same time you are asking for your induction agent and paralytic. Propofol is a great choice for post-intubation sedation, and if your patient becomes hypotensive do not be afraid of adding on a pressor! REBEL Core Cast 112.0 – Awareness During ... Read more

The post REBEL Core Cast 112.0 – Awareness During Paralysis appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 111.0 – Cardiac Testing Oct 25, 2023
Take Home Points: A CCTA is an anatomic test to determine if a patient has normal coronary arteries, non-obstructive disease, or obstructive disease. The warranty period for a CCTA is anywhere from 3-10 years depending on the characteristics of the plaque. A nuclear stress test is a functional study that allows for ischemia-driven management. The ... Read more

The post REBEL Core Cast 111.0 – Cardiac Testing appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 110.0 – On Shift Learning Pearls Oct 11, 2023
Take Home Points: Patients with recent onset atrial fibrillation can safely be cardioverted if they are 1) on anticoagulation 2) Low risk based on CHADS-VASC with onset Read more

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REBEL Core Cast 109.0 – Na Channel Blocker Poisoning Sep 27, 2023
Take Home Points: In the context of poisoning, a “wide QRS” is anything greater than 100 milliseconds. A newly “wide QRS”, especially with hemodynamic instability, should prompt consideration of sodium channel blockade and not ventricular tachycardia. Treatment is guided by administration of sodium-bicarbonate. Recall that the resultant alkalemia driven by sodium-bicarbonate will shift potassium intracellularly. ... Read more

The post REBEL Core Cast 109.0 – Na Channel Blocker Poisoning appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 108.0 – Angioedema Sep 13, 2023
Take Home Points: Airway management is paramount; expect a challenging intubation and consider controlling the airway early if there is apparent airway compromise. Understanding the cause of angioedema (mast cell vs. bradykinin mediated) helps dictate directed management. Urticaria and pruritus = MAST CELL mediated, which is treated like a standard allergic reaction. REBEL Core Cast ... Read more

The post REBEL Core Cast 108.0 – Angioedema appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 107.0 – Vertebral Osteomyelitis Aug 30, 2023
Take Home Points Clinical presentation is very nonspecific; evaluate all patients presenting with back pain for infectious risk factors. Baseline labs should not guide diagnosis, but may assist in later management. MRI is key to diagnosis, obtain this imaging in all patients who raise clinical suspicion Patients with hemodynamic instability and neurologic compromise warrant empiric ... Read more

The post REBEL Core Cast 107.0 – Vertebral Osteomyelitis appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Core Cast 106.0 – Nerve Block Basics Aug 16, 2023
Take Home Points REBEL Core Cast 106.0 – Nerve Block Basics Click here for Direct Download of the Podcast Resources REBEL EM: Local Anesthetic Systemic Toxicity Sono in Staten Blog: https://www.statenislandem.com/sono-in-staten Core Ultrasound: https://www.coreultrasound.com/ POCUS Atlas: https://www.thepocusatlas.com/ Highland Ultrasound: http://highlandultrasound.com/ Post Created By: Billy Caputo MD Post Peer Reviewed By: Anand Swaminathan MD, MPH (Twitter ... Read more

The post REBEL Core Cast 106.0 – Nerve Block Basics appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Cast Ep122 – Delayed vs Rapid Sequence Intubation in Agitated Trauma Patients Aug 07, 2023
Background: Getting a definitive airway in a critically ill trauma patient can be a stressful situation. The potential for soiled airways, cervical spine injuries, maxillofacial injuries and head injuries combined with agitation/delirium, altered mental status and hypoxemia can make securing a definitive airway both an anatomic and physiologic challenge. Traditional RSI entails preoxygenation followed by ... Read more

The post REBEL Cast Ep122 – Delayed vs Rapid Sequence Intubation in Agitated Trauma Patients appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Cast Ep121: The Battle of the Blades – Video Laryngoscopy vs. Direct Laryngoscopy Jul 31, 2023
Background: The ongoing debate between video laryngoscopy (VL) and direct laryngoscopy (DL) has ignited intense debate within the emergency medicine and critical care communities. A recent pragmatic, randomized, multicenter trial (The DEVICE Trial) compared the two techniques to determine if VL outperformed DL in first-pass success (FPS). In this blog post, we explore the study’s ... Read more

The post REBEL Cast Ep121: The Battle of the Blades – Video Laryngoscopy vs. Direct Laryngoscopy appeared first on REBEL EM - Emergency Medicine Blog.

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