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.

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.

This week we once again borrow audio from the Only in Staten Podcast and feature a discussion on cardiogenic shock with the director of the CCU at SIUH, Dr. Martin Amor.

We've got toxicologist Dr. Sanjay Mohan back on to chat about carbon monoxide toxicity in the ED.

This week, Swami sits down with director of the Staten Island University Hospital cardiac catheterization lab, Dr. Ruben Kandov, to discuss ACS management.

This week we chat with Dr. Danielle Langan, MedEd Fellow and Attending at Staten Island University Hospital, about awareness during paralysis post-RSI.

Simply put, flow is the peak of human performance, maximum focus with maximum responsiveness, an optimal state of consciousness. This state of mind is accessible to anyone under the right circumstances and has huge implications to how we live, work and train. 

In this podcast episode, three Emergency Medicine Physicians, Drs. Marco Propersi, Dan Wolf and Will Smith, discuss flow in relation to working in the ED, how it intersects with medical training, on shift performance and even in daily life outside the hospital. 

• Does the high stakes life or death environment in the ED allow us to access a flow state, even though our own lives are not at risk? 
• How can you set yourself up to achieve flow?
• While on shift how does being ‘in flow’ facilitate mastery of our profession?

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

The Rise of Superman on Amazon.com

From the Only in Staten Podcast - Swami sits down with cardiologist Dr. Samantha Lee to chat about cardiac testing.

This week, Swami shares some pearls from a recent critical care shift.

Toxicologist Sanjay Mohan is back to discuss sodium channel blocker poisoning management.

This week, we discuss angioedema focusing on treatment.

This week we chat about an uncommon, but potentially lethal, cause of back pain.

This week we sit down with Dr. Billy Caputo, Associate Professor of EM and residency director at SIUH to chat about nerve blocks.

Toxicologist and ED doc Sanjay Mohan is back talking methylxanthines.

This week, we chat with toxicologist Sanjay Mohan about caustic ingestions.

This week, Swami sits down with Dr. Mike Cooper, Director of the Staten Island University Hospital Burn Center, to talk emergency burn management.

This week, we discuss the indications for imaging in renal colic.

This week, Swami sits down with EM doc and toxicologist Sanjay Mohan to chat about alcoholic ketoacidosis.

This week we discuss RBBB, LBBB as well as LPFB and LAFB.

This week we chat about AVNRT - diagnosis, management and why we shouldn't be getting troponins on the vast majority of cases.

Swami explores some common causes of non-traumatic, acute, monocular vision loss including retinal detachment and CRAO.

Swami explores some common causes of non-traumatic, acute, monocular vision loss including glaucoma and giant cell arteritis.

This week, Swami sits down with Dr. Danielle Langan to chat about lithium toxicity.

This week we discuss testicular torsion focusing on some pearls and pitfalls.

This week we discuss the diagnosis and management of Methemoglobinemia.

This week we discuss the diagnosis and management of SBP.

This week we dive into diagnosis and management of hypocalcemia.

This week, we review the median, ulnar and radial nerve blocks and how they can be useful in clinical practice.

This week we discuss the diagnosis and management of superficial venous thrombosis.

This week, we discuss the ins and outs of management of AVNRT.

This week we discuss the diagnosis and management of post-LP headache.

This week we discuss AAA presentations and diagnosis.