REBEL Cast

🧭 REBEL Rundown 🗝️ Key Points 🛏️ Fewer ICU AdmissionsOnly 5 patients in the SQuID group required ICU care vs 99 in the traditional insulin drip group.⏱️ Shorter ED StaysED length of stay dropped by ~3 hours in the SQuID group—an operational win in crowded departments.💉 No Drop in Nursing WorkloadDespite using subQ insulin, nurses still performed hourly glucose checks and frequent injections.🧪 Focus on the Anion GapDKA resolution = closing the anion gap, not just normalizing blood sugar—critical concept for trainees and nurses alike.👶 Peds Has the EdgePediatric 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, MDShow 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 REBEL Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol Mechanical ventilation can feel overwhelming, especially when faced with a ... 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 Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol appeared first on REBEL EM - Emergency Medicine Blog.

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 Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain In this special episode of Rebel Cast, we spotlight the ... Read More 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 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 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 The post Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain appeared first on REBEL EM - Emergency Medicine Blog.

Dive into the fundamentals of mechanical ventilation with an engaging breakdown of the three types of breaths: Control, Assist, and Spontaneous. Discover how each breath type influences patient involvement and care. The discussion also highlights breath delivery methods—Volume vs. Pressure—unpacking their implications for lung compliance. Use fun sports analogies to make these concepts more relatable and easier to grasp, ensuring that even the most complex ventilator modes become manageable!

Discover the life-saving benefits of intraosseous lines in emergency medicine, especially during cardiac arrest. Fast placement and reliable access can deliver critical medications. Learn about the optimal locations for inserting these lines, and the differences in flow rates across various sites. Also discussed are key limitations, like potential dislodgement and the unreliability of lab results drawn from these lines. Not just for trauma, IO lines are vital in medical emergencies and challenging IV situations, particularly in pediatric patients.

Dive into the world of pneumothorax decompression with insights on recognizing tension pneumothorax, especially in critical scenarios. Learn why traditional needle decompression might not cut it and why finger thoracostomy takes the crown for effectiveness and reliability. Discover how ultrasound can quickly confirm diagnoses and the importance of swift action in emergency medicine. This discussion highlights the need to think beyond classic techniques and emphasizes better practices for patient care.

Discover the intriguing nature of shock as a clinical diagnosis, emphasizing that it's more than just a number. Learn to assess patients rapidly using the 'four L's' — mental status, limb temperature, urine output, and lactate levels. Find out how pulse pressure can reveal shock type, from narrow pressures indicating cardiogenic issues to wide pressures pointing towards distributive shock. The hosts stress the importance of systematic bedside evaluation, reinforcing that even basic techniques can uncover critical insights.

The podcast dives into the intricacies of sinus tachycardia, emphasizing it as a crucial clinical sign rather than just a number. It discusses how elevated heart rates can indicate underlying physiologic stress such as anemia or shock. The importance of a systematic evaluation and understanding the oxygen delivery equation is highlighted. Listeners learn to rethink reflexive treatments like beta blockers and the significance of addressing root causes before managing symptoms. Insights on fever, glucose levels, and pain-driven tachycardia are also explored.

Tachypnea can signal serious health issues, requiring swift bedside evaluation. Short, shallow breathing often indicates underlying neuromuscular problems or respiratory failure. Key signs to watch for include poor chest rise and symptoms like diaphoresis and tachycardia. Understanding lung compliance is crucial, especially in cases of pulmonary edema. The podcast emphasizes using all senses for a thorough assessment, combining clinical observations with urgent interventions to improve patient outcomes.