This week we're featuring a cross post from the Only in Staten podcast on peds hem onc emergencies.

This week we dive into hyperkalemia management.

This week we sit down with our in house toxicologist Dr. Sanjay Mohan to chat about HIET.

The REVERT Randomized Controlled Trial demonstrated the superiority of the modified valsalva maneuver (MVM) over the standard valsalva maneuver in re-establishing normal sinus rhythm in patients with Paroxysmal SVT. MVM exaggerates venous return to the heart and increases vagal outflow by elevating the patient's legs. However, the success rate of the MVM is still significantly lower than that of intravenous adenosine, the first-line pharmacological therapy for treating PSVT, which establishes NSR by transiently slowing electrical conduction through the AV node. 

Given that these two treatment options operate via different physiologic mechanisms, could MVM and IV adenosine be combined synergistically to convert PSVT with better success rates than either treatment individually and with better safety profiles?

This week we discuss the management of posterior epistaxis.

This week we dive into neutropenic fever

This week, we discuss acute sinusitis and identifying patients who will benefit from antibiotics.

Resuscitationists have debated the choice of induction agents in rapid sequence intubation (RSI) for decades. Critics of etomidate will highlight its link to adrenal suppression in critically ill patients (Albert 2011), while critics of ketamine will highlight the higher incidence of post-intubation hypotension (Mohr 2020). Amidst the debate, the Ketased Trial (Jabre 2009), a large multicenter prospective, single-blind randomized clinical trial (RCT), reported no significant difference in SOFA scores or 28-day mortality between the two induction agents. However, the EvK trial (Matchett 2022) identified a statistically significant difference in 7-day mortality but not 28-day mortality in favor of ketamine. However, methodological concerns from the EvK Trial warrant a cautious interpretation of the data. In light of these and several other recent high-quality clinical trials comparing ketamine and etomidate, this meta-analysis aims to provide a point estimate of the mortality rate.

https://rebelem.com/from-debate-to-data-emerging-insights-into-rsi-induction-with-ketamine-vs-etomidate/

Swami sits down with Emergency Physicians and the authors of the soon to be released book MicroSkills Drs. Adaira Landy and Resa Lewiss.

Swami sits down with Drs. Dara Kass and Monica Saxena to discuss the EMTALA law and current challenges in the area of reproductive health.

Annie Duke, a former World Series of Poker champion, details some of the psychology of decision making in the high-risk gambling in her book, Thinking in Bets. In poker, important decisions must be made quickly in the midst of extreme uncertainty and repeated in rapid succession with each new hand. To learn and improve in this environment, these players learn to embrace uncertainty, tease the luck out of their outcomes and avoid common biases when reviewing their prior performance.  As doctors working in Emergency Medicine we often have do the same thing and the wrong decision could potentially be fatal.

In this episode of Rebel Reflections, four Emergency Medicine Physicians, Jacob White, Marco Propersi, Dan Wolf and Will Smith, discuss how thinking in bets while dealing with levels of uncertainty can benefit our performance and learning in the Emergency Department.

• • How does “resulting” or the tendency to equate a decision’s quality with its outcome affect learning in and after residency?
  • How does thinking on the spectrum of more or less right impact our utilization of new research or of implementing a consultant’s recommendations?
  • How do you avoid decision fatigue during a long shift?

We will discuss these topics and many more on this episode of REBEL Reflections!

Thinking in Bets on Amazon.com

Swami chats with Brendan Freeman, Emergency doc and medical education fellow at Staten Island University Hospital about improving our sleep hygiene.

There is a shifting paradigm towards shorter durations of antibiotics in pediatric infections. Conflicting international guidelines recommend treatment of urinary tract infection (UTI) with antibiotic courses ranging from just 3 days to 7–14 days. Antimicrobial resistance is a global health crisis, underscoring the importance of antibiotic stewardship. Investigators in the SCOUT Trial examine the impact of short-course (5 day) antibiotic therapy in UTI, with potentially far reaching implications.

https://rebelem.com/pediatric-utis-short-course-vs-standard-course-antibiotics-is-it-time-for-a-change/

Community-acquired pneumonia (CAP) can lead to pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and an increased risk of death. Corticosteroids have excellent anti-inflammatory and immunomodulatory effects that could mitigate some of the inflammation caused by pneumonia. There have been several randomized trials that have shown glucocorticoids have positive effects in patients with CAP. However, except for one trial, none showed a between-group difference regarding mortality.  We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial.

https://rebelem.com/corticosteroids-in-severe-community-acquired-pneumonia-could-cape-cod-catalyze-a-change-in-critical-care-management/

Should we give oral ibuprofen or intramuscular ketorolac in the ED in patients who can take PO?

This week we discuss some of the serious infectious processes of pregnancy.

This week we discuss the diagnosis and management of Achilles tendon ruptures.