REBEL Cast

🧭 REBEL Rundown 📝 Introduction Welcome to the Rebel Core Content Blog, where we delve into crucial knowledge for emergency medicine. Today, we share insightful tips from PEM specialist Dr. Elise Perelman, shedding light on respiratory challenges in infants, toddlers, and young children during the viral season. Understanding that most cases involve typical viruses, we aim to equip you with diagnostic pearls to identify more serious pathologies. Click here for Direct Download of the Podcast. 🔍 Recognizing Respiratory Patterns Pearl #1: Look at Your PatientBegin exams from the doorway. Observing patterns such as accessory muscle usage can reveal a patient’s respiratory effort. Specify whether the work of breathing occurs during inspiration, expiration, or both. Inspiratory work indicates difficulty getting air in, while expiratory work suggests trouble pushing air out. Silent tachypnea may point to other issues, like acidemia or pneumothorax. 🩺 Localizing Sounds for Accurate Diagnosis Pearl #2: Localize the SoundBreathing noises signal varied respiratory issues. Stridor, often heard on inspiration, results from obstructions above the thoracic inlet. Conversely, wheezing, generally linked to exhalation, indicates obstructions in the lower airways. Watch for signs like ‘silent chest’—a dangerous, severe obstruction, and distinguish grunting as a bodily mechanism to prevent alveolar collapse. Correctly identifying the sound assists in determining the appropriate intervention. 💉 Tailoring Treatment for Effective Results Once a sound is localized, treatments vary. We explore Soder from nasal congestion, typically needing supportive care and suctioning. Stridor from conditions like croup is eased with interventions to reduce airway swelling, such as steroids or inhaled epinephrine. Conversely, wheezing in infants is often due to bronchiolitis—not bronchospasms—and over-treatment is to be avoided. Supportive measures including suction, hydration, and oxygen are preferred unless improvement warrants bronchodilators. 🌬️ Intervening with Severe Asthma In severe cases of asthma or bronchiolitis, where standard at-home treatments fail, immediate adjunct therapies like intramuscular epinephrine become essential. Administering this quickly can alleviate obstruction when inhalants aren’t effective due to low air movement. 🦓 Navigating the Zebras of Respiratory Cases When recognizing Zebras—uncommon cases overshadowed by routine diagnoses—remain vigilant for histories or presentations that don’t conform. Conditions like pneumonia, bacterial tracheitis, and even myocarditis may mimic more common issues. 📌 Conclusion As attending physicians, our role extends beyond conventional treatment—it’s about discerning the atypical from the typical. Dr. Perelman urges continual reassessment, emphasizing reliance on observational skills as much as technological aid. Keeping keen on respiratory nuances ensures we catch those outlier cases, paving the way for adept medical care despite the overwhelming prevalence of viral infections.Stay tuned for more pearls and insights in our future posts, as Dr. Perelman shares further strategies for effective pediatric emergency care. For more resources, continue exploring our faculty’s valuable contributions on our site. Until then, stay safe and perceptive in your practice. Post Peer Reviewed By: Mark Ramzy, DO (X: @MRamzyDO), and Marco Propersi, DO (X: @Marco_Propersi) 👤 Guest Elise Perlman MD Pediatric Emergency Medicine​ Assistant Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Meet The Team 🔎 Your Deep-Dive Starts Here REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season Welcome to the Rebel Core Content Blog, where we delve ... Pediatrics Read More REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Tarlan Hedayati, Jess Mason and Simon Carley Host Dr. Mark Ramzy shines a spotlight on three distinguished ... Resuscitation Read More REBEL Core Cast 145.0: Understanding QTc Prolongation: Causes, Risks, and Management The QT interval is a vital part of ECG interpretation, ... Procedures and Skills Read More REBEL Core Cast 144.0: Tourniquet Tips In this episode of the Rebel Core Content podcast, Swami ... Procedures and Skills Read More 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 The post REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season appeared first on REBEL EM - Emergency Medicine Blog.

🧭 REBEL Rundown 📝Introduction Welcome to this special edition of the REBEL Cast, where we unravel key highlights and educational insights from the IncrEMentuM Conference in Spain. This event is a cornerstone for advancing emergency medicine education, drawing esteemed speakers and participants from around the globe. As emergency medicine gains traction in Spain, this conference has become an essential platform for knowledge exchange and professional growth. Today, host Dr. Mark Ramzy shines a spotlight on three distinguished speakers: Dr. Jess Mason, Dr. Tarlan Hedayati, and Dr. Simon Carley, who shared their expertise and experiences at this transformative gathering last 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 Their IncrEMentuM 2025 Lectures Think about alternative diagnoses that could be driving the patient’s atrial fibrillationMaybe the atrial fibrillation is an adaptive response and slowing them down (whether chemically or electrically) may cause more harm than goodGet in the mental space before having to perform a High Acuity Low Occurrence (HALO) procedure and walk through each of the parts step by stepEMRAP has uploaded the video of the Resuscitative Hysterotomy here (Subscription required to watch)Like many things in critical care, a patient with a severe head injury requires you to do many little things very well (ie. reducing ICP increases by taking off the C-collar if able, positioning the patient appropriately, knowing when to use certain medications) See you in Spain! The upcoming conference aims to gather world-class educators once more and promises an enriching experience for all attendees. Drs. Tarlan Hedayati, Jess Mason and Simon Carley, along with many others, will be there at the event. For more information on the IncrEMentuM Conference and to register, visit their website! See you there! Tarlan Hedayati, MD Vice Chair of Education and Associate Program Director Cook County, Chicago, IL Jess Mason, MD Associate Professor of Emergency Medicine Vanderbilt University, Nashville, TN Simon Carley, MD, PhD Professor of Emergency and Dean of the Royal College of Emergency Medicine Manchester, England 🔎 Your Deep-Dive Starts Here Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain In this special episode of Rebel Cast, we spotlight the ... Read More REBEL Core Cast 110.0 – On Shift Learning Pearls Take Home Points: Patients with recent onset atrial fibrillation can ... Read More The post REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Tarlan Hedayati, Jess Mason and Simon Carley appeared first on REBEL EM - Emergency Medicine Blog.

🧭 REBEL Rundown 📌 Key Points 🫀 Prolonged QTc raises risk of torsades de pointes ⏱️ Correct for heart rate: QTc > 440 ms (men) or > 460 ms (women); > 500 ms = high TdP risk.💊 Common culprits: Methadone, ondansetron, macrolides, fluoroquinolones, antipsychotics.🧪 Prevention: Check & replete K, Mg, Ca and avoid QT-prolonging meds when possible.🚑 If TdP develops: Defibrillate + IV magnesium and stop offending agents. Click here for Direct Download of the Podcast. 📝 Introduction The QT interval is a vital part of ECG interpretation, reflecting the heart’s electrical recovery after each beat. When prolonged, it can set the stage for torsades de pointes. Understanding how to measure and correct the QT interval, identify high-risk medications, and act quickly when TdP occurs is essential for every clinician. This guide walks you through the physiology, interpretation, common causes, and emergency management of QTc prolongation to keep your patients safe. 🤔 Definition and Physiology QT evaluation is a fundamental component of EKG analysis. The QT interval reflects the time from ventricular depolarization and contraction through ventricular repolarization and relaxation.Clinically, QT prolongation increases the risk of torsades de pointes (TdP) – a form of polymorphic ventricular tachycardia (a non-perfusing rhythm) that is classically described as a pattern of “twisting points” or alternating amplitudes. This occurs when a premature ventricular contraction leads to an R on T phenomenon during the repolarization period.The differential for QT prolongation is long and varied: congenital long QT, electrolyte disturbances (hypoK, hypoMg, hypoCa), hypothermia, myocardial ischemia, and increased intracranial pressure. Moreover, a whole host of xenobiotics can prolong the QT interval: methadone, anti-microbials, anti-emetics, anti-psychotics, and anti-dysrhythmics. 🧮 ECG Interpretation The QT interval must be interpreted in conjunction with the patient’s heart rate. The QT interval with shorten in the context tachycardia and length in the context of bradycardia. In other words, tachycardia is protective when evaluating the patient with prolonged QT.With that in mind, many EKG machines will calculate a corrected QT interval or QTc. The QTc is a standardized way to account for variations in heart rate so clinicians are able to compared QT intervals at different heart rates over time and thus calculate risk.Generally, a QTc is considered prolonged if greater than 440ms in males or 460ms in females. Once the QTc > 500msec, the risk of TdP increases 2-3 fold.1A variety of different correction formulas exist: Bazett, Fridericia, Hodges, Framingham, Rautaharju.Manually, the QT interval should be measured from the beginning of the QRS complex to the end of the T wave – and thus should be measured in leads where all portions can be visualized, most frequently lead II or V5/V6. Ideally, the QT interval should be average over 3 or more beats.2 To determine the end of the T wave, a tangent line should be drawn through the maximum slope of the T wave – the point at which this line crosses the isoelectric line is the end of the T wave.3 💊 Commonly Used QTc Prolonging Medications Methadone: particularly concerning because not only does it inherently prolong QT but also induces a bradycardiaAntiemetics: OndansetronMacrolides: azithromycin, erythromycin, clarithromycinFluroquinolones: ciprofloxacin, levofloxacinAntipsychotics: Haloperidol, Olanzapine ️ Management Prevention is key!Assess electrolytes (Mg, Ca, K) and replete as neededTelemetry MonitoringIf patient happens to fall into TdP, initiate ACLS with immediate defibrillation and magnesium.Withdrawal of offending agents. 📚 References Drew BJ, Ackerman MJ, Funk M, Gibler WB, Kligfield P, Menon V, Philippides GJ, Roden DM, Zareba W. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation. 2010 Mar;121(8):1047-1060.Postema PG and Wilde AAM. The measurement of the QT interval. Curr Cardiol Rev. 2014 Aug;10(3): 287-294.https://litfl.com/qt-interval-ecg-library/ 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 🔎 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 145.0: Understanding QTc Prolongation: Causes, Risks, and Management appeared first on REBEL EM - Emergency Medicine Blog.

🧭 REBEL Rundown 📌 Key Points 🩸 Tourniquets save lives and limbs: Apply immediately when you’ve got arterial bleeding.📍 Placement matters: Position the tourniquet 5–6 cm proximal to the arterial bleed, or if you can’t identify the exact source, place it as high up on the limb as possible.🔧 Windlass technique: The windlass provides only a small amount of extra pressure. Tighten the velcro first, then twist the windlass 1–2 turns to complete compression. Click here for Direct Download of the Podcast. ⏰ Highlights 00:00 Introduction to Tourniquets00:40 Optimal Placement of Tourniquets01:21 Proper Tightening Techniques01:57 Importance of Timing and Application02:36 Summary and Conclusion 📝 Introduction In this episode of the Rebel Core Content podcast, Swami provides crucial tips on using tourniquets. Highlighting the significance of these life and limb-saving devices, the discussion focuses on the optimal placement of tourniquets, emphasizing placing them 2-3 inches (5-6 cm) above the bleeding source and avoiding joints. Swami also advises on the correct way to tighten the tourniquet using the Velcro strap first, followed by minimal use of the windless. The importance of noting the application time to avoid prolonged arterial flow interruption is also discussed. The episode concludes with a reminder to visit the podcast’s website for more valuable content. 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 🔎 Your Deep-Dive Starts Here REBEL Core Cast 136.0: A Simple Approach to the Tachypneic Patient In this episode, we focus on the bedside evaluation of ... Thoracic and Respiratory Read More REBEL Core Cast 135.0: A Simple Approach to Hypoxemia (vs. Hypoxia) In this episode, we break down a practical bedside approach ... Resuscitation Read More REBEL Core Cast 134.0 – Acetaminophen Toxicity Acetaminophen (APAP) overdose remains one of the most common causes ... Toxicology Read More Street Medicine: Compassionate Care for the Unhoused Introduction: In this episode of Rebel Cast, host Marco Propersi, ... Read More REBEL Cast Ep91: Static Ultrasound vs Landmark Placement of Subclavian Central Lines Background Information: Central venous catheterization is a common procedure performed in ... Procedures and Skills Read More REBEL Cast Ep82: Timing of Endoscopy for UGIB Background: Upper endoscopy allows for the identification of the source ... Abdominal and Gastroinstestinal Read More The post REBEL Core Cast 144.0: Tourniquet Tips appeared first on REBEL EM - Emergency Medicine Blog.

🧭 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: 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 resultsDiabetic 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 hereCrashing 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) HyperkalemiaNot 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 laterPatients may be dehydrated, dont give them furosemide or diuretics. Those patients need fluid to help perfuse their kidneys and eliminate potassiumHere’s the Algorithm George mentioned in the episodeHere’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 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.

Fluid choice is crucial in managing severe diabetic ketoacidosis. The SCOPE-DKA trial shows that Plasma-Lyte corrects acidosis faster than normal saline, which may worsen acidosis due to its chloride content. The trial's design strengthens its findings, but it highlights the need for more research comparing different fluid types. Important metrics like base excess and strong ion difference are often overlooked when assessing acid-base status. The podcast discusses ethical considerations and the impact of protocols on patient care and nursing workload.

Explore the innovative SQuID Protocol for managing mild-to-moderate DKA using subcutaneous insulin instead of IV drips. Discover the impressive results: fewer ICU admissions and shorter ED stays, while nursing workloads remain unchanged. Delve into critical concepts like focusing on closing the anion gap over just normalizing blood sugar. Learn why pediatric approaches can inform adult practices, and how the two-bag system effectively manages insulin without risking hypoglycemia, offering a fresh perspective on DKA treatment.

Explore the art of mechanical ventilation with insights on balancing oxygenation and ventilation. Discover why aiming for adequacy over perfection can prevent harm. Learn how Mean Airway Pressure (MAP) truly drives oxygenation, and understand the importance of PEEP in keeping alveoli open. The hosts discuss optimizing tidal volume and respiratory rate while managing patients with obstructive diseases, emphasizing the need for time to exhale. Tune in for practical strategies that transform chaos into calm control at the bedside!

Dive into the complexities of mechanical ventilation with an exploration of key modes used in the ICU. Discover the significance of controlled, assisted, and supported breaths. Learn that no single mode guarantees better outcomes; comfort for the patient is crucial. Examine the ins and outs of popular modes such as Assist Control and Pressure Support, along with potential pitfalls like the SIMV's tendency to create dyssynchrony. Get equipped to match ventilator settings to patient needs, ensuring optimal care.

🧭 REBEL Rundown Click here for Direct Download of the Podcast. ⏰ Highlights 00:00 Introduction to Rebel Cast00:10 Highlighting the Incrementum Conference 202600:34 Meet the Founders of Incrementum01:21 The Journey to Incrementum04:27 The Recognition of Emergency Medicine in Spain06:04 What is Incrementum?08:14 Bringing Together Top Emergency Medicine Experts11:38 Exciting Sessions to Look Forward To15:54 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 REBEL Core Cast 138.0: A Simple Bedside Approach to Shock In this episode, we will dive into a simple yet ... Cardiovascular Read More REBEL Core Cast 131.0 – Traumatic Arthrotomy Take Home points: Always suspect an open joint if there ... Trauma Read More REBEL Core Cast 130.0 – Omphalitis Take Home Points Early diagnosis: erythema and warmth of the ... Pediatrics Read More REBEL Core Cast 129.0 – Gastric Lavage Take Home Points Orogastric lavage may still play an important ... Toxicology Read More REBEL Core Cast 128.0 – Toxic Alcohols Take Home Points Toxic alcohols generally refer to methanol and ... Toxicology Read More REBEL Core Cast 127.0 – Penetrating Neck Injuries Take Home Points Anticipate anatomically challenging airways and consider early ... Trauma Read More The post Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain appeared first on REBEL EM - Emergency Medicine Blog.