REBEL Cast

🧭 REBEL Rundown 🔑Key Points 🌱 Growth mindset transforms learning – Residents and students who believe skills can be developed are more open to feedback, more resilient after failure, and more engaged in practice.🧠 Language matters in feedback – Simple reframes such as “You’re developing procedural skills” instead of “You’re not strong at procedures” encourage persistence and normalize the learning curve.🤝 Mindset shapes team culture – Growth mindset leaders foster psychological safety, invite input, and create collaborative teams. Fixed mindset hierarchies, on the other hand, silence voices and can compromise patient care.🔥 Growth mindset protects against burnout – By reframing mistakes as part of the process, clinicians reduce perfectionism and shame, bolstering resilience and wellness.🔍 Practical steps start with self-talk – Add the word “yet” to limiting beliefs (“I’m not good at X…yet”) and shift feedback questions toward improvement (“What’s one thing I can do better next time?”).🛠️ Embracing mistakes with a growth mindset – Leads to more effective feedback loops and improvement do this by building a culture of psychological safety is crucial for growth and reducing medical errors. Click here for Direct Download of the Podcast. 👀Previously Covered and Related Content: REBEL EM: The EM MindsetREBEL EM: Titles Dont Make LeadersREBEL EM: Mind of the Resuscitationist with Scott WeingartEM Crit: Making Things Happen with Cliff Reid 📝 Introduction Welcome to this episode of REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Mindset shapes everything we do in medicine—from how we teach and learn to how we show up for patients at the bedside. Drawing from Carol Dweck’s influential book Mindset, this episode of REBEL MIND explores the critical difference between a fixed mindset (believing abilities are innate and static) and a growth mindset (seeing skills as things that can be developed through effort and feedback). We sat down with Dr. Kim Bambach, an emergency medicine physician and medical educator, and Dr. Frank Lodeserto, a dual-trained intensivist and internal medicine program director, to unpack how mindset influences medical education, bedside performance, and physician wellness. In this episode, we delve into how the mindset of clinicians can profoundly influence their performance, professional growth, and ultimately patient care Cognitive Question How does adopting a growth versus a fixed mindset influence clinical performance, medical education and patient outcomes? 🌱What is Growth vs Fixed Mindset? In Carol Dweck’s research, two primary mindsets are highlighted: Fixed mindset: Which sees intelligence and skills as staticIn the medical field, adopting a fixed mindset might lead a clinician to avoid complex cases due to fear of failure.Growth mindset: Which views abilities as improvable through dedication and effort. In contrast, a growth mindset encourages embracing challenges as opportunities for learning and development. 🏥How This Applies to the Emergency Department or ICU? In high-stakes environments like the ICU or the ED, the mindset adopted by healthcare providers can distinctly shape patient care and team dynamics. A fixed mindset might lead to defensive behaviors and a reluctance to engage in challenging cases, potentially stunting personal and professional growth. Conversely, a growth mindset not only fosters resilience and adaptability but also enhances team collaboration and patient outcomes by encouraging open communication, continuous learning, and acceptance of constructive feedback. ⏩Immediate Action Steps for Your Next Shift  **Monitor Self-Talk**: Notice your internal narrative when faced with challenges. Replace negative, fixed-mindset thoughts with growth-oriented ones like “Not yet” or “What can I learn from this?”**Promote a Culture of Inquiry**: Challenge yourself and your team to engage in constructive questioning and explore alternative diagnoses or treatment plans to encourage a growth-centered environment.**Model Vulnerability**: Share personal learning experiences and mistakes with colleagues to normalize the growth process and reduce the stigma of imperfection.**Reframe Feedback**: Instead of broadly asking, “How did I do?” inquire, “What’s one thing I can improve on next time?” This shift helps maintain focus on growth rather than performance validationFeedback is a whole another topic that we plan t

🧭 REBEL Rundown 🔑Key Points Try the coffee nap! Where you combine caffeine and a 30-minute nap to then have that boost energy and alertness by the time it kicks in.💤 Sleep isn’t optional—it’s crucial for memory, mood regulation, and physical recovery. It is fundamentally different from rest❌ Replacing sleep with caffeine isn’t effective and can have negative health impacts. Make getting enough sleep a priority🌞 Sunlight exposure is important for maintaining circadian rhythms and sleep quality. This applies even if you work as a nocturnist💡 Creating a personalized sleep system enhances quality and consistency. It gives you back control of a schedule that you may feel like is out of your hands.🧩 If you’ve tried these strategies and you’re still struggling, consider true sleep pathology (insomnia, shift work disorder, sleep apnea) and get help—this is not a “be tougher” problem.🩺 Better sleep isn’t just about feeling good; it’s directly tied to error reduction, patient safety, and longevity in EM/ICU careers. Click here for Direct Download of the Podcast. 👀Previously Covered and Related Content: REBEL Core Cast: Sleep HygieneREBEL MIND: Rest Is Not Sleep: The Seven Dimensions of True RecoveryRebellion in EM: Care For Yourself – Sleep HygieneFirst10EM: Some Evidence For Working Night ShiftsREBEL MIND: Dunning Kruger Effect 📝 Introduction Welcome to this episode of REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Today we are exploring the imperative topic of rest and why it’s not just about sleeping. The second of a two part series, hosted by Dr. Mark Ramzy with guests Dr. Maureen Aiad and Dr. Amil Badoolah, continue our discussion but this time on the multifaceted nature of sleep, how it serves as medicine and how we can use our tools deliberately to get more of it! Cognitive Question How would your clinical performance, patience with families, and long-term career sustainability change if you treated sleep as a non-negotiable clinical intervention rather than a flexible “nice-to-have”? 💤How is Sleep Different From Rest? 1. Rest reduces load; sleep repairs systemsWe previously talked about the 7 types of rest and you can check that out hereExamples of physical rest include: pausing tasks, stepping away from the monitor, taking a walk, stretching, breathing, journaling, connecting with a colleague. This lightens your cognitive/emotional burden.Sleep is fundamentally different in that it’s an active biologic process that helps:Consolidates memory and learning (yes, including the tough cases from last night).Regulates mood, impulse control, and emotional reactivity.Supports immunity, metabolic health, and cardiovascular function.Repairs tissue, replenishes neurotransmitters, and fine-tunes neural networks.You can have “rested but underslept” days (you took breaks but got 4 hours in bed), and “slept but unrested” days (you got hours, but all junk sleep). Both matter, but they are not interchangeable.2. Sleep architecture vs. “knocking out”True restorative sleep cycles through NREM and REM in predictable patterns.Alcohol, late caffeine, and fragmented nights may help you fall asleep faster but:Suppress REM.Shorten deep sleep.Increase awakenings and light sleep.The result: you technically slept, but your brain didn’t get the “software updates” it needed.Biology isn’t built for your scheduleCircadian rhythms were designed for light-day / dark-night cycles, not:10 pm–7 am ED shifts.24-hour calls.6 nights in a row followed by days.Your body can adapt partially, but not instantly and not perfectly. That’s why:You can feel “jet-lagged” even when you haven’t traveled.Sleep before and after nights feels odd and fragile.Recognizing that “this is biologically unnatural” is key: you’re not weak; you’re fighting physiology. 🏥How This Applies to the Emergency Department or ICU? Performance & safetySleep deprivation:Slows reaction time and increases error rate.Impairs risk assessment and complex decision-making.Drops your frustration tolerance with consultants, families, and staff.In both emergency medicine and critical care, that translates into:Anchoring on the wrong diagnosis.Missing subtle clinical changes.Snapping at a tech, nurse or resident and damaging team culture. Chronic health for chronic shift workLong-term sleep disruption is associated with:Hypertension, diabetes, obesity.Depression, anxiety, burnout.Arrhythmias (e.g., AFib) and increased stroke r

🧭 REBEL Rundown 📌 Key Points 🔍 Understanding the Why: The significance of understanding underlying causes, beyond initial diagnoses, in both sports and emergency medicine is explored. ⏱️ Recovery Focus: Emphasizing the importance of recovery time and small daily choices in optimizing performance for both athletes and emergency physicians. 📊 Data-Driven Insights: The Arena Labs approach uses personalized data, leveraging wearable technology and expert coaching to tackle burnout and enhance well-being. 🤝 Personalization and Partnership: Arena Labs’ collaboration with emergency clinicians sheds light on personalized performance solutions rooted in scientific evidence. Click here for Direct Download of the Podcast. 📝 Introduction Welcome back to REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. In this episode, we’re excited to continue collaboration with Arena Labs, where host Dr. Mark Ramzy interviews Allyn Abadie, Arena Labs’ Principal Scientist on how we can apply performance science in and out of the emergency department. Arena Labs is helping us measure healthcare performance through innovative programs designed to combat burnout and enhance personal wellness using data-driven strategies. 🔙Previously Covered on REBEL MIND: Performance Under Pressure – What Medicine Can Learn from Elite TeamsThe Power of Performance Coaching in MedicineRest Is Not Sleep: The Seven Dimensions of True Recovery 🤔Cognitive Question How can emergency department clinicians utilize techniques inspired by athletic performance to better manage stress, prevent burnout, and optimize recovery? 💭 Why This is Important Burnout among healthcare workers is a growing concern, especially in such high-pressure environments as emergency and intensive care units. The collaboration with Arena Labs brings forth a vital focus on using data and coaching to build resilience among medical professionals. 🏥How This Applies to the Emergency Department or ICU? Emergency medicine, akin to high-performance sports, demands intense energy and quick decision-making under pressure, often leading to stress and burnout. By applying principles from athletic recovery and personalized data tracking, clinicians can moderate their performance intensity, enhance their recovery even in short breaks, and prevent long-term burnout. This approach allows emergency physicians to maintain endurance and clarity, improving patient care and team dynamics. ⏩ Things You Can Do on Your Next Shift Measure and Reflect: Start tracking your vital health metrics like heart rate with wearable sensors. Reflect on how daily activities impact these measurements to identify stress patterns.Implement Quick Recovery Techniques: Use short, actionable exercises such as deep breathing or the de-stress breath method between patient encounters to moderate stress levels.Invest in Self-Care: Dedicate brief time slots for essential self-care activities like hydration or quick reflection journaling, aiming to enhance mental resilience throughout your shift.Utilize Coaching Tools: Engage with personalized coaching apps or resources that offer science-backed recovery strategies tailored to your personal and professional needs. 👀 Where to Learn More Intrigued by the possibilities this partnership offers? You can explore more by visiting Arena Labs’ website here. Also, check out the comprehensive coaching program available, designed specifically for healthcare providers looking to enhance their well-being and performance. 🚨 Clinical Bottom Line In an era where burnout is pervasive, our collaboration with Arena Labs offers a beacon of hope for healthcare workers. By leveraging cutting-edge data insights and practical coaching, this partnership aims to redefine healthcare wellness, fostering a sustainable, resilient workforce that’s equipped to navigate the pressures of modern medicine. Join us in this journey towards enhanced well-being and workforce empowerment, ensuring that those who care for us are also cared for. Meet the Authors Mark Ramzy, DO Co-Editor-in-Chief RWJBH / Rutgers Health, Newark NJ Allyn Abadie Principal Scientist Arena Labs REBEL MIND – Growth vs Fixed Mindset in Medicine Mindset shapes everything we do in medicine—from how we teach and learn to ... Human Behavior Read More REBEL MIND – How to Sleep When the World Says You Can’t Today we are exploring the imperative topic of rest and why it’s not ... Human Behavior Read More REBEL MIND: Applying Performance Science In and Out of the Emergency Department In this episode, we're excited to continue collaboration with Arena L

🧭 REBEL Rundown 📌 Key Points The 4 Steps of an ED Consult:👋 Introduce yourself and your role🎯 Lead with the outcome (the ask)🧾 Give a focused case summary (why it’s theirs + what you’ve done)🔁 Close the loop (timeline, next steps, contingencies) Click here for Direct Download of the Podcast. 📝 Introduction Today we’re tackling one of the most important (and most under-taught) skills in emergency medicine: how to call a consult in the ED and what to do when a consultant pushes back.To call a consult in the ED, start with a brief introduction, lead with the outcome you need (“the ask”), give a focused decision-relevant summary, and close the loop with timeline and next steps. If the consultant resists, clarify the “why,” restate the ask, offer alternatives, and escalate when patient safety or disposition is at risk.After two decades in emergency medicine and countless consult calls, here’s a simple framework—plus copy/paste scripts—to make your consults faster, clearer, and easier to say “yes” to. 🤔 Why Consult Skills Matter in Emergency Medicine Consults aren’t a formality—they’re a patient-care intervention. Strong consult communication:Reduces delays in time-sensitive careImproves ED throughput and dispositionDecreases conflict and miscommunicationClarifies ownership and next stepsProtects the patient (and the team) when plans are unclear 🪜 The 4-Step ED Consult Framework (Introduction → Ask → Summary → Close the Loop) Most consult friction comes from one of two problems: unclear expectations or excessive noise. This four-step structure solves both.1) Introduce yourself and your roleA simple intro sets a professional tone and removes ambiguity.Script: “Hey, this is Swami, one of the ED attendings. I’m calling for an ortho consult.” 2) Lead with the outcome (the ask)Don’t bury the lede. The consultant wants to know what you need—immediately.Script: “I’m calling about a patient with a suspected septic knee. I need you to evaluate for operative management.” 3) Give a focused, decision-relevant summaryYour summary should answer:Why this is your service’s problemWhat’s already been doneWhat I’m worried about / what decision is needed nowScript: “43-year-old man with no major PMH, 3 days of knee pain and swelling. XR negative. Febrile. Aspiration yielded purulent fluid—cultures sent. We started antibiotics after the tap. He’s hemodynamically stable.” High-yield pearl: Add quick “stability anchors” when relevant:“Airway stable, pain controlled.”“Neurovascularly intact.”“No signs of compartment syndrome.”“No hypotension or escalating oxygen requirement.” 4) Close the loop (timeline + next steps)This prevents the consult from floating in limbo and protects patient flow.Script: “When do you expect to see the patient, and do you want anything done before you arrive—NPO, repeat labs, additional imaging?” 📝 ED Consult Script General ED Consult Script “Hi, this is Dr. ___ in the ED. I’m calling for a ___ consult. The reason is ___. Briefly: ___ year-old with ___. We’ve done ___ and started ___. I’m concerned about ___. Can you see them today, and what’s your preferred next step?” Septic joint / Ortho Example “Hi, this is Swami in the ED. I need an ortho consult for suspected septic arthritis. 43-year-old with 3 days of atraumatic knee swelling and fever. XR negative. Tap produced purulent fluid—cultures sent. Antibiotics started after aspiration. Can you evaluate for operative management, and when can you see the patient?” Neurology example (time-sensitive) “Hi, this is Dr. ___ in the ED. I need neurology for suspected acute stroke. Last known well ___. NIHSS ___. CT/CTA completed (or pending). I’m calling to discuss candidacy for thrombolysis/thrombectomy and next steps. When can you evaluate and what additional workup do you want now?” ⛓️‍💥 Common ED Consult Mistakes (and Fixes) Mistake: Long story before the askFix: Lead with the outcome in the first sentenceMistake: Unfiltered data dumpFix: Provide only decision-relevant detailsMistake: No timelineFix: Ask explicitly when they’ll see the patient and what they need firstMistake: Implicit “ownership”Fix: Clarify who is admitting, who is following, and what happens if the patient worsens ✋ What to Do When a Consultant Pushes Back Even a perfect consult can meet resistance. Your job is to stay calm, keep it professional, and protect the patient.1) Ask “why?”Don’t argue first—diagnose the refusal.Script: &#x201

🧭 REBEL Rundown 📌 Key Points 💨 HFNC met criteria for non-inferiority to BPAP for preventing intubation or death within 7 days in four of the five ARF subgroups.🧪 Bayesian dynamic borrowing increased power across subgroups but created variable certainty, especially in smaller groups such as COPD.🫁 The immunocompromised hypoxemia subgroup did not meet non-inferiority, leading to early trial stopping for futility.️ Rescue BPAP use, subgroup-specific exclusion criteria, and non-standardized BPAP delivery are important contextual factors that influence how subgroup results should be interpreted. Click here for Direct Download of the Podcast. 📝 Introduction Bilevel Positive Airway Pressure (BPAP) has long been a foundational modality in the management of acute respiratory failure (ARF), particularly in COPD exacerbations and cardiogenic pulmonary edema, where it can rapidly reduce work of breathing and improve gas exchange. It remains a core tool in our respiratory support arsenal.High-flow nasal cannula (HFNC), however, has expanded what we can offer patients by delivering many of the same physiologic benefits through a far more comfortable interface. With high flows, modest PEEP, and effective dead-space washout, HFNC can improve oxygenation and decrease work of breathing while preserving the ability to talk, cough, eat, and interact with staff and family. This combination of physiologic support and tolerability makes HFNC especially attractive in patients where comfort, anxiety, or cardiovascular stability are key considerations, and in settings where prolonged noninvasive support may be needed. Rather than competing with BPAP, HFNC broadens our options in ARF and allows us to better match the modality to the patient and their underlying disease process.The RENOVATE trial set out to answer a high-impact question across five distinct etiologic groups: Is HFNC non-inferior to BPAP (NIV) for preventing intubation or death in acute respiratory failure? 🧾 Paper Azoulay É, et al. High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial. JAMA. 2025 PMID: 39657981 🔙Previously Covered On REBEL: HFNC: Part 1 – How It WorksHFNC: Part 2 – Adult and Pediatric IndicationsFLORALI and AVOID TrialFLORALI-2: NIV vs HFNC as Pre-Oxygenation Prior to IntubationThe Pre-AeRATE Trial – HFNC vs NC for RSI ️ What They Did CLINICAL QUESTION Is HFNC non-inferior to BPAP for rate of endotracheal intubation or death at 7 days in patients with acute respiratory failure due to a variety of causes? STUDY DESIGN Multicenter, randomized non-inferiority trial33 Brazilian hospitalsNov 2019 – Nov 2023Adaptive Bayesian hierarchical modeling with dynamic borrowingOpen label, outcome adjudicators blindedPatients were classified into 5 subgroups SUBGROUPS 1. Non-immunocompromised hypoxemiaSpO₂ < 90% on room air orPaO₂ < 60 mm Hg on room air plusIncreased respiratory effort (accessory muscle use, paradoxical breathing, thoracoabdominal asynchrony) orRespiratory rate > 25 breaths/min2. Immunocompromised hypoxemiaDefined as:Use of immunosuppressive drugs for >3 monthsOR high-dose steroids >0.5 mg/kg/dayOR solid organ transplantOR solid tumors or hematologic malignancies (past 5 years)OR HIV with AIDS / primary immunodeficiency3. COPD exacerbation with acidosisHigh clinical suspicion of COPD as primary diagnosisRR >25 with accessory muscle use, paradoxical breathing, and/or thoracoabdominal asynchronyABG: pH <7.35 AND PaCO₂ >454. Acute cardiogenic pulmonary edema (ACPE)Sudden onset dyspnea and rales± S3 heart soundNo evidence of aspiration, infection, or pulmonary fibrosisCXR consistent with pulmonary edema5. Hypoxemic COVID-19 (added June 2023)Added due to deviations between expected and observed outcome proportionsAny patient across the other 4 groups with PCR-confirmed SARS-CoV-2 infection in any of the above groups POPULATION Inclusion Criteria:≥18 yrs with ARF* in one of 5 pre-defined subgroups excluding COPD was defined by the following:Hypoxemia with SpO₂ <90 or PaO₂ <60Accessory muscle use, paradoxical breathing, and/or thoracoabdominal asynchronyRR >25 BPMExclusion Criteria:Need for emergency intubationProlonged apneic episodesCardiorespiratory arrestGCS <12HR <50 with decreased consciousnessABG pH <7.15Severe agitation requiring heavy sedationHemodynamic instability (MAP <65, SBP <90 despite fluids or requiring high-dose pressors)Contraindications to BPAP (facial trauma, recent esophageal surgery, copious secretions, vomiting, aspiration risk)Pneumothorax or large pleural effusionSevere arrhythmiaThoracic trauma as primary ARF causeAsthma attackCardiogenic shockACS requiring urgent cathARF within 72h post-extubationPost-surgical ARF within 72hHypercapnic ARF due to neuro

🧭 REBEL Rundown 🔑Key Points 🛌 Rest isn’t a luxury; it’s a necessity and differs significantly from sleep in terms of mental and physical recovery needs.🧠 Uncovering the seven types of rest can highlight diverse needs: physical, mental, sensory, creative, emotional, social, and spiritual.🏃‍️ Rest from high-stress environments such as the ED is crucial for reducing exhaustion, enhancing decision-making, and maintaining empathy.🔄 The necessity for intentional rest: tailor your rest strategies to meet personal recharge needs effectively.🧐 Rest should be deserved, not earned—it’s a vital component of overall health and wellness, on par with nutrition and hydration. Click here for Direct Download of the Podcast. 👀Previously Covered and Related Content: REBEL Core Cast: Sleep HygieneRebellion in EM: Care For Yourself – Sleep HygieneFirst10EM: Some Evidence For Working Night ShiftsREBEL MIND: Dunning Kruger Effect 📝 Introduction Welcome to this episode of REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Today we are exploring the imperative topic of rest and why it’s not just about sleeping. The first of a two part series, hosted by Dr. Mark Ramzy with guests Dr. Maureen Aiad and Dr. Amil Badoolah, our discussion sheds light on the multifaceted nature of rest, especially in the demanding field of emergency medicine. If you’re a clinician striving to perform at your best under pressure, this episode offers valuable insights into achieving the rest you deserve. Cognitive Question How do healthcare professionals in high-stress environments distinguish between rest and sleep, and how can they effectively incorporate various types of rest into their routines to manage stress and improve performance? 💤How is Rest Different From Sleep? Sleep is biological. It’s essential—but it’s only one form of recovery.Rest, on the other hand, is intentional, multifaceted, and active. You can sleep for 8 hours and still feel depleted—because what you needed wasn’t sleep, it was rest—in a different dimension. 🏥How This Applies to the Emergency Department or ICU? In the fast-paced, high-pressure world of the ED or ICU, medical professionals often overlook the importance of rest, perceiving it as unproductive. Yet, rest is crucial for maintaining cognitive function and emotional resilience. The unique concept of rest outlined in the ‘seven types of rest’ can be particularly beneficial. Understanding and implementing these can help practitioners handle the rigors of patient care and decision-making more effectively. 7️⃣The Seven Types of Rest 1️⃣Physical Rest: Passive (like sleep) and active (like stretching, massage, gentle movement).2️⃣Mental Rest: Reducing decision fatigue. Tools like brain dumping, meditation, or taking real breaks during work.3️⃣Sensory Rest: This involves reducing the input from your senses, such as limiting screen time, turning off the lights, or enjoying quiet time.4️⃣Creative Rest: Reconnecting with awe. Nature, art, music—things that refill your inspiration tank5️⃣Emotional Rest: Being around people you don’t have to perform for. Saying “I’m not okay.” spaces and people where you can be your authentic self and be at peace6️⃣Social Rest: Taking space from draining interactions; spending time with life-giving people. 7️⃣Spiritual Rest: Connection to a greater purpose—faith, community, reflection, meditation ⏩Immediate Action Steps for Your Next Shift **Identify Your Rest Needs**: Reflect on what kind of fatigue you’re experiencing and tailor rest activities accordingly, whether it’s sensory detox or emotional unwinding.**Practice Sensory Rest**: Take brief moments to close your eyes, or step outside for fresh air to manage overstimulation during shifts.**Plan Intentional Breaks**: Schedule specific times for rest that focus on particular dimensions you identify as lacking.**Engage in Active Rest**: Incorporate activities like stretching or meditation during your breaks to enhance mental clarity and reduce physical exhaustion.**Connect with Supportive Colleagues**: Seek interactions with peers who offer emotional and social support, promoting a healthy work-life balance. 🛌🏽The Many Aspects of What Makes Up Rest Rest is multifaceted – it comes in more than one formRest is productive – it improves performance, decision-making, empathyRest is intentional – it re

🧭 REBEL Rundown 🗝️ Key Points 💉 Hydrocortisone Saves Lives:The 2023 Cape Cod Trial (NEJM) showed a clear mortality benefit and reduced need for intubation in severe CAP patients treated with hydrocortisone.📊 Guidelines Are Catching Up:The SCCM (2024) and ERS now recommend steroids for severe CAP, while ATS/IDSA updates are still pending.🔥 Redefining “Severe”:Patients requiring high FiO₂ (>50%), noninvasive or mechanical ventilation, or PSI >130 meet criteria for steroid therapy — even outside the ICU.🍬 Main Risk = Hyperglycemia:Elevated glucose was the most consistent adverse effect, but rates of GI bleed and secondary infection were not increased.🧭 Early, Targeted Use Matters:Start hydrocortisone within 24 hours of identifying severity — especially in patients with high CRP (>150) or strong inflammatory response. Click here for Direct Download of the Podcast. 📝 Introduction Corticosteroids have long sparked debate in the treatment of bacterial pneumonia — once viewed with skepticism, now increasingly supported by high-quality evidence. In this episode, Dr. Alex Chapa joins the REBEL Core Cast team to explore how the 2023 Cape Cod Trial (NEJM) reshaped practice and guideline recommendations for severe community-acquired pneumonia (CAP). 📖 Historical Context & Long-Standing Skepticism For decades, the use of steroids in pneumonia was controversial.Early Use: Steroids entered practice in the 1940s and 50s for autoimmune inflammation, but there was immediate hesitation regarding secondary superinfections.Mixed Data: From the 1980s to the 2000s, small studies emerged on severe pneumonia and ARDS, but the data was inconsistent. Different trials used varying definitions of “severe” pneumonia and different C-reactive protein (CRP) cutoffs, making the data “spread” and easy to “cherry pick” to support or deny a benefit.Past Guidelines: This uncertainty was reflected in official guidelines:2007 (ATS/IDSA): The American Thoracic Society and the Infectious Diseases Society of America did not address the topic due to insufficient data.2019 (ATS/IDSA): Pre-COVID, the guidelines recommended against using corticosteroids in severe CAP. They acknowledged no benefit for non-severe pneumonia, but the data for severe pneumonia was considered too weak to endorse.Pre-Trial Consensus: Prior to 2023, the consensus was to avoid steroids in non-severe pneumonia, while severe pneumonia remained a “gray area” with no treatment showing a clear mortality difference. 📜 The Landmark Cape Cod Trial (NEJM 2023) The Cape Cod trial, published in the New England Journal of Medicine in 2023, reignited the discussion by providing robust, positive data.Trial Design: Phase 3, multi-center, double-blind, randomized, controlled trial.Intervention: 800 patients randomized to two groups, Hydrocortisone as a continuous infusion (200mg/day) versus a placebo infusion.Taper: On day 4, clinicians would decide whether to continue the infusion or begin a taper based on clinical response.Population: Patients with severe CAP, defined by meeting at least one of the following criteria:Pneumonia Severity Index (PSI) > 130.O2 by FiO2 ratio < 300.Need for mechanical or non-invasive ventilation (with PEEP ≥ 5).Need for high FiO2 (>50%) via non-rebreather or heated high flow.Primary Outcomes: Death for any cause 6.2% (hydrocortisone) vs 11.9% (placebo)Secondary outcomes:Death from any cause at 90 days 9.3% (hydrocortisone) vs 14.7% (placebo)Endotracheal intubation 18% (hydrocortisone) vs 29% (placebo)Hospital-acquired infections 9.8% (hydrocortisone) vs 11.1% (placebo)Gastrointestinal bleeding 2.3% (hydrocortisone) vs 3.3% (placebo)Vasopressor initiation by day 28 15.3% (hydrocortisone) vs 25.0% (placebo)Key Findings: The trial demonstrated superiority for hydrocortisone 📋 Updated Guidelines & Current Practice The Cape Cod trial, along with subsequent meta-analyses, has begun to change official recommendations.Society of Critical Care Medicine (SCCM): In 2024, an SCCM expert panel, reviewing the Cape Cod trial and 18 others, strongly recommended corticosteroids for severe CAP. They concluded that steroids reduce mortality and the need for mechanical ventilation.Meta-Analysis (Smit et al.): A 2024 meta-analysis in Lancet Respiratory confirmed the 30-day mortality benefit.European Respiratory Society (ERS): The ERS has issued a recommendation to use steroids for severe pneumonia but still urges caution regarding side effects.ATS/IDSA: As of the podcast recording, the ATS/IDSA had not yet updated their 2019 guidelines. 🛠️ Practical Application for Clinicians Defining “Severe” CAP: The key is to identify patients who qualify as “severe”. This can be done using:Scoring Tools: The PSI is the best validated tool for mortalit

🧭 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 two phenomenal educators: Drs. Sara Crager and Ryan Ernst 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. ️What's an Essential Question? Essential questions are open-ended, thought-provoking, and intellectually engaging inquiries that inspire deeper exploration into topics. In the context of medical education, they challenge practitioners to think critically and reflect on their practice deeply. By focusing on essential questions, medical educators aim to inculcate a culture of continuous learning and curiosity, ensuring that medical professionals stay adaptable and insightful in their approach to patient care. 🎮Rapid Sequence (no not the intubating style...)  The Rapid Sequence game is an innovative tool that Sara and Ryan designed to enhance the learning experience for emergency medicine clinicians. It mimics real-life scenarios requiring rapid decision-making in high-pressure situations, such as those faced in emergency medical settings. This clinical case-based game aims to improve cognitive and procedural skills, allowing participants to hone their ability to respond effectively under pressure, thereby enhancing their real-world clinical performance.You can try it out for free on their website here!Their work was featured in the September 2025 edition of Annals of Emergency Medicine as a 2025 ACEP Abstract 🌳The Arboretum Teaching Collective An arboretum is a space that cultivates a wide variety of diverse, unique, and symbiotic growth. Arboretum provides a creative space to decrease barriers, open opportunities, and support the development of extraordinary teachers. The Arboretum Teaching Collective is a non-profit organization dedicated to supporting emergency medicine education in countries where it is a new or evolving specialty.  Their aim to facilitate the development of expert teachers by reducing barriers, providing opportunities, and curating talent.  Their goal is to create a community of educators around the globe who share a vision of bringing excellent, innovative emergency medicine teaching to where it is most needed.  Their approach is driven by curiosity, humility, and sustainability.If you want to learn more and get involved, check out the Arboretum Teaching Collective Website Here ️ See you in Spain! The upcoming conference aims to gather world-class educators once more and promises an enriching experience for all attendees. Drs. Sara Crager and Ryan Ernst, 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! Sara Crager, MD Associate Professor, Critical Care and Emergency Medicine UCLA, Los Angeles, CA Ryan Ernst, MD Assistant Professor of Emergency Medicine, Section Chief of Global EM University of Utah, Salt Lake City, UT Mark Ramzy, DO Co-Editor-in-Chief Rutgers Health / RWJBH, Newark, NJ 🔎 Your Deep-Dive Starts Here REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Sara Crager and Ryan Ernst Host Dr. Mark Ramzy shines a spotlight on two phenomenal ... Resuscitation 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 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 Incrementum Conference 2026: Revolutionizing Emergency Medicine in Spain In this special episode of Rebel Cast, we spotlight the ... Read More The post REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Sara Crager and Ryan Ernst appeared first on REBEL EM - Emergency Medicine Blog.

🧭 REBEL Rundown 📌 Key Points 💪 Building Resilience: Rebel MIND, in partnership with Arena Labs, introduces a science-based performance coaching platform specifically tailored for healthcare professionals, focusing on stress management and burnout prevention.🤝 Personal Insights: Jackie Penn shares her journey from exercise science to digital coaching, highlighting the importance of tailored coaching in high-pressure environments like healthcare.🎯 Clinician-Centric Approach: Understanding unique challenges faced by ER doctors, the program provides practical tools for stress and transition management, improving both professional and personal life balance.💻 Revolutionary Wearables: Utilizing wearables, the program offers objective feedback on recovery and health metrics, allowing personalization of strategies to enhance clinician well-being. Click here for Direct Download of the Podcast. 📝 Introduction Welcome back to REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. In this episode, we’re excited to continue collaboration with Arena Labs, where host Dr. Marco Propersi interviews Jackie Pen, Heading of Performance Coaching at Arena Labs. Arena Labs is helping us measure healthcare performance through innovative programs designed to combat burnout and enhance personal wellness using data-driven strategies.  🔙Previously Covered on REBEL MIND: Performance Under Pressure – What Medicine Can Learn from Elite Teams 🤔Cognitive Question How do specific performance coaching strategies and tools assist healthcare professionals, particularly those in emergency medicine, in managing stress and preventing burnout effectively? 💭 Why This is Important Burnout among healthcare workers is a growing concern, especially in such high-pressure environments as emergency and intensive care units. The collaboration with Arena Labs brings forth a vital focus on using data and coaching to build resilience among medical professionals. 🏥How This Applies to the Emergency Department or ICU? In the chaotic and high-stakes environment of the ED/ICU, healthcare professionals are often required to make split-second decisions under pressure while managing emotional stress. This necessitates not just clinical acumen but also strong emotional resilience and stress management skills. Performance coaching provides the tools and frameworks to enhance these skills, offering strategies like the de-stress breath and transition protocols to help clinicians navigate between high-pressure situations efficiently. These tools are designed to not only improve their professional performance but also ensure they are emotionally present for their personal lives, ensuring a healthier work-life balance. ⏩ Things You Can Do on Your Next Shift Practice the De-stress Breath: Before moving from one critical case to another, take a moment to take two inhales through the nose followed by an extended exhale, helping to reset your nervous system by activating your parasympathetic nervous system.Implement a Transition Protocol: Choose a point in your journey home to mentally switch from clinician to family member, helping you to be more present outside of work.Optimize Your Nutrition and Rest: Even small changes during your shift, like meals that promote easy digestion or quick physical activities, can make a significant difference in your energy levels.Engage with Wearables: If possible, use wearables to monitor your physiological responses, helping tailor personalized strategies for your shifts 👀 Where to Learn More Intrigued by the possibilities this partnership offers? You can explore more by visiting Arena Labs’ website here. Also, check out the comprehensive coaching program available, designed specifically for healthcare providers looking to enhance their well-being and performance. 🚨 Clinical Bottom Line In an era where burnout is pervasive, our collaboration with Arena Labs offers a beacon of hope for healthcare workers. By leveraging cutting-edge data insights and practical coaching, this partnership aims to redefine healthcare wellness, fostering a sustainable, resilient workforce that’s equipped to navigate the pressures of modern medicine. Join us in this journey towards enhanced well-being and workforce empowerment, ensuring that those who care for us are also cared for. Meet the Authors Marco Propersi Co-Editor-in-Chief Vassar Brothers Medical Center, Poughkeepsie, NY Jackie Pen Head of Performance Coaching Arena Labs The post REBEL MIND: The Power of Performance Coaching in Medicine appeared first on REBEL EM - Emergency Medicine Blog.

🧭 REBEL Rundown 📌 Key Points 🎯Partnership Focus: New collaboration with Arena Labs aimed at enhancing healthcare worker wellness.🏃🏽‍️‍➡️Personalized Coaching: Tools and coaching programs designed for stress management and performance improvement.📊Data-Driven Insights: Utilizing wearable sensor data to tackle burnout effectively.🌄Broad Impact: Offers a unique opportunity to contribute to large-scale healthcare improvements. Click here for Direct Download of the Podcast. 📝 Introduction Welcome back to REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. In this episode, hosted by Drs. Mark Ramzy and Marco Propersi, we’re excited to introduce a collaboration with Arena Labs. Arena Labs is helping us measure healthcare performance through innovative programs designed to combat burnout and enhance personal wellness using data-driven strategies.  Cognitive Question What would it look like in emergency medicine and critical care to be set up with the same tools as elite teams and professional athletes when it comes to measuring performance and recovery? How would our patients benefit? 💭 Why This is Important Burnout among healthcare workers is a growing concern, especially in such high-pressure environments as emergency and intensive care units. The collaboration with Arena Labs brings forth a vital focus on using data and coaching to build resilience among medical professionals. 🌟Be Brilliant at the Basics Ask yourself — “What is it on your time off that gives you a deep sense of fulfillment?”On your time off are you doing things that fill your bucket and add to your recovery? What is Allostasis and Allostatic Load Allostasis: Our body’s ability to adapt over time to stress. It’s relevant to the phase you are in during this particular season in your life. Ex. You are a first year medical student freaking out about your very first exam. Over time as you do more exams, they are still stressful, but by now you have developed modified study habits to succeed and get used to the frequent examsIn the context of emergency medicine, you may be nervous or stressed about your first shift at a new hospital but overtime you learn the staff, the location of equipment, the acuity of that particular site, the patient population so over time you get used to the stress of a shift at that new hospitalAllostatic Load: The wear and tear on the body from chronic stress due to maladaptation or poor recovery methods.This refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity.Ex. You are an emergency medicine physician at a very busy, high acuity center and have never prioritized taking care of yourself on/during a shift. As a result, external factors add to not being able to fully recover when you get home or are off shift (ie. Admin work, teaching obligations, family/friends) and so you never fully recover before you have to go back on shift to the same stressors you just exposed yourself to. So the cycle continuesFigure 1: Long term effects of Chronic Stress (Source: Andrew Hogue from NeuroFit) 🏥How This Applies to the Emergency Department or ICU? Healthcare workers in emergency departments (ED) and intensive care units (ICU) are often under enormous stress due to the nature of their work. Arena Labs’ program offers tailored solutions, helping ED and ICU staff manage their unique challenges through effective recovery techniques and performance tools. This approach caters specifically to the demanding schedules and the unpredictability inherent in these environments. 👀 Where to Learn More Intrigued by the possibilities this partnership offers? You can explore more by visiting Arena Labs’ website here. Also, check out the comprehensive coaching program available, designed specifically for healthcare providers looking to enhance their well-being and performance. 🚨 Clinical Bottom Line In an era where burnout is pervasive, our collaboration with Arena Labs offers a beacon of hope for healthcare workers. By leveraging cutting-edge data insights and practical coaching, this partnership aims to redefine healthcare wellness, fostering a sustainable, resilient workforce that’s equipped to navigate the pressures of modern medicine. Join us in this journey towards enhanced well-being and workforce empowerment, ensuring that those who care for us are also cared for. 📚References Guidi J, et al.Allostatic Load and Its Impact on Health: A Systematic Review. Psychother Psychosom. 2021; Epub 2020 Aug 14.

🧭 REBEL Rundown 🗝️ Key Points 💨 NIV = Support without a tube: CPAP, BiPAP, and HFNC improve oxygenation and reduce the work of breathing.🫁 CPAP = Continuous pressure: Best for hypoxemic patients (e.g., pulmonary edema, OSA).️ BiPAP = Two pressures (IPAP/EPAP): Great for hypercapnic failure (e.g., COPD, obesity hypoventilation).🌬️ HFNC = Heated, humidified high flow: Reduces effort, improves comfort, and enhances oxygen delivery.🩺 Supportive, not definitive: NIV stabilizes patients while the underlying cause is treated. Click here for Direct Download of the Podcast. 📝 Introduction Non-invasive ventilation (NIV) refers to respiratory support provided without endotracheal intubation. The most common modalities include continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), and high-flow nasal cannula (HFNC). These therapies aim to improve oxygenation, reduce the work of breathing, and potentially prevent invasive mechanical ventilation. 💨 CPAP and BiPAP CPAP delivers a single, continuous pressure during inspiration and expiration. This pressure (commonly 5–10 cm H₂O) helps recruit atelectatic alveoli, reduce shunt, and improve oxygenation. It is commonly used for conditions like pulmonary edema, obstructive sleep apnea, or mild hypoxemia without significant ventilatory failure.BiPAP alternates between two pressures:Inspiratory positive airway pressure (IPAP), augments tidal volume and unloads inspiratory muscles.Expiratory positive airway pressure (EPAP), maintains alveolar recruitment and improves oxygenation.The differential between IPAP and EPAP is critical for reducing hypercapnia in patients with COPD exacerbations or acute hypercapnic respiratory failure.IndicationsCPAP: hypoxemia without major ventilatory failure (e.g., cardiogenic pulmonary edema, atelectasis, OSA).BiPAP: hypercapnia with increased work of breathing (e.g., COPD exacerbation, neuromuscular weakness, obesity hypoventilation).A helpful way to conceptualize CPAP and BiPAP is through the hairdryer analogy. Imagine placing a hairdryer in your mouth: 🩺 Clinical Considerations Masks can be uncomfortable, impair secretion clearance, and limit oral intake.Some patients require sedation to tolerate NIV, but this carries risks in patients with unprotected airways.NIV is thus a high-stakes intervention requiring close monitoring.Common starting dose to understand titration, but start at the level appropriate for your patient:  IPAP 10 cm H₂O / EPAP 5 cm H₂O (“10/5”) and are titrated:Increase IPAP to improve tidal volume and CO₂ clearance.Increase EPAP to recruit alveoli and improve oxygenation.Both may be raised simultaneously if the patient is both hypoxemic and hypercapnic. 🚀 High-Flow Nasal Cannula (HFNC) H: Heated & humidified – improves mucociliary clearance, prevents airway drying, and enhances tolerance. I: Inspiratory flow – high flow meets or exceeds patient demand, reducing respiratory rate and effort.F: Functional residual capacity – modest generation of positive end-expiratory pressure (PEEP), promoting alveolar recruitment.L: Lighter – generally more comfortable and less restrictive than mask-based NIV.O: Oxygen dilution – minimizes entrainment of room air, delivering higher and more predictable FiO₂.W: Washout – flushes anatomical dead space, reducing CO₂ rebreathing.HFNC delivers heated, humidified oxygen at high flow rates (30–60 L/min) through wide-bore nasal prongs. A mnemonic, H-I-F-L-O-W, helps summarize its mechanisms:Indications: Traditionally used for acute hypoxemic respiratory failure (e.g., pneumonia), HFNC is increasingly studied for hypercapnic failure as well, with trials suggesting non-inferiority to BiPAP in select populations. Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Show Notes Syed Moosi Raza, MD PGY 3 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 137.0: A Simple Approach to Sinus Tachycardia Sinus tachycardia is the most prevalent cardiac dysrhythmia in critically ... Cardiovascular Read More 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 1.0 – The Intro REBEL EM-ers: Salim, Jenny and I would like to announce ... Read More The post REBEL Core Cast 148.0–Demystifying Non-Invasive Ventilation & HiFlow appeared first on REBEL EM - Emergency Medicine Blog.

🧭 REBEL Rundown 📌 Key Points 💀 Mortality: No statistically significant difference in 28-day mortality between ketamine vs etomidate for intubation in critically ill patients, though there was a ~1% absolute difference favoring ketamine. 📉🫀⚠️ Hemodynamics: Ketamine induction was associated with more cardiovascular collapse, mainly driven by new/increased vasopressor use (dose escalation or addition of a vasoactive agent). 💉⬆️ Click here for Direct Download of the Podcast. 📝 Introduction Etomidate or ketamine? The debate over the ideal agent for emergency rapid sequence intubation (RSI) has raged for years with no clear winner. Etomidate has been touted in the past for its rapid onset and minimal intrinsic effects on hemodynamics. However, the drug is well known as a transient adrenal suppressant though the impact of this suppression isn’t clear. Ketamine has risen in recent years as an alternative, due to its perceived hemodynamic stability, analgesic properties and absence of adrenal suppression. Additionally, recent data points towards improved mortality when ketamine was selected over etomidate (Kotani 2023). High quality randomized controlled trials are needed to further elucidate which agent should be selected in critically ill patients. 🧾 Paper Casey JD et al. Ketamine or etomidate for tracheal intubation of critically ill adults. NEJM 2025. PMID: 41369227 🔙Previously Covered On REBEL REBEL EM: The EvK Trial: Ketamine vs Etomidate for Rapid Sequence IntubationREBEL EM: From Debate to Data: Emerging Insights into RSI Induction with Ketamine vs Etomidate ️ What They Did CLINICAL QUESTION In critically ill adults undergoing tracheal intubation, does the use of ketamine instead of etomidate result in improved 28 day mortality? STUDY DESIGN Multicenter, randomized, open-label trial in both emergency departments and ICUs. POPULATION Inclusion Criteria:Critically ill patients > 18 years of age undergoing tracheal intubation with the use of an induction agentExclusion Criteria:Known pregnancyPrisonersPrimary diagnosis of traumaNeed for immediate intubation precluding randomizationClinicians determined that the use of ketamine or etomidate was either necessary or contraindicated INTERVENTION & COMPARATOR Ketamine Arm:Ketamine administered based on a provided nomogram: full dose (2.0 mg/kg), intermediate dose (1.5 mg/kg) or reduced dose (1.0 mg/kg)Etomidate Arm:Etomidate administered based on a provided nomogram: full dose (0.3 mg/kg), intermediate dose (0.25 mg/kg) or reduced dose (0.2 mg/kg) OUTCOMES Primary: In-hospital death from any cause by day 28.Secondary:Cardiovascular collapse during intubation defined as SBP < 65 mm Hg, receipt of new or increased dose of vasopressors or cardiac arrest.Exploratory Procedural:Lowest systolic blood pressureLowest systolic blood pressure below 80 mmHgHighest systolic blood pressure above 180 mmHgLowest oxygen saturationLowest oxygen saturation below 80%Successful first attempt intubationTime from induction to intubationExploratory Clinical:Number of ventilator free daysVasopressor-free daysICU free days Safety: Systolic blood pressure at 24 hours after enrollmentOngoing receipt of vasopressors at 24 hours 📈 Results: 2365 patients were randomizedKetamine: 1176Etomidate: 1189> 99% of patients received the drug they were randomized to receiveNMBA: 69% of patients in both groups received rocuronium~ 95% of patients had video laryngoscopy for the primary intubation attempt 💥 Critical Results 💪 Strengths Multicenter ED + ICU cohort of critically ill patients → improves external validityStrong randomization → balanced baseline characteristicsRight population for the question → appropriately focused on a sick cohort where induction choice matters mostHigh protocol adherence → most patients received the agent they were randomized toExcellent follow-up → minimal loss to follow-up / outcome capture ⚠️ Limitations No blinding → potential performance/resuscitation biasTrauma excluded → limits applicability to peri-intubation trauma careCase-mix skewed toward septic shock → may reduce generalizability to other shock etiologiesPower assumptions → designed to detect a 5% mortality difference (possibly overly ambitious)Equipoise-only enrollment → excluded patients with clear indication/contraindication → selection bias + reduced real-world applicabilityComposite secondary outcome with non-equivalent endpoints (e.g., cardiac arrest vs vasopressor titration)Ketamine dosing by actual body weight (vs ideal) → may have increased dose/exposure in some patients 🗣️ Discussion The increase in cardiovascular collapse seen with ketamine was driven by the “new or increased vasopressor use” piece of the composite outc

🧭 REBEL Rundown 📌 Key Points 🧠 We don’t know what we don’t know: Low experience can inflate confidence; true expertise usually brings humble certainty.🏥 ED relevance is universal: From central lines to transvenous pacing, over- or under-confidence shows up at every level—intern to seasoned attending.🧩 Metacognition matters: Accurate self-assessment is a clinical skill; reflection + feedback loops keep us calibrated.🛠️ Practice beats bravado: Skill decay is real; deliberate practice and HALO (high-acuity, low-occurrence) refreshers protect patients.🤝 Psychological safety ≠ niceties: “Confident humility” enables questions, feedback, and better resuscitation decisions—especially under uncertainty. Click here for Direct Download of the Podcast. 📝 Introduction Welcome to REBEL MIND—Mastering Internal Negativity during Difficulty. In this series, we turn the same critical lens REBEL EM uses for literature inward—into mindset, leadership, and psychological safety—so we can deliver better care outward to patients and teams.In this episode and blog post, hosts Mark Ramzy and Kim Bambach (Assistant Professor of Emergency Medicine, The Ohio State University) explore a deceptively simple question: How accurately can we assess our own performance? The answer hinges on a classic cognitive bias that touches all of us in emergency medicine. 🧾 Paper Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999 Dec;7 PMID: 10626367 Cognitive Question How accurately can we assess our own performance? 💭 What is the Dunning-Kruger Effect? The Dunning–Kruger Effect is a cognitive bias where:Lower-skill individuals tend to overestimate their competence, andHigher-skill individuals often underestimate theirs.Translation for the busy clinician: early on the learning curve, confidence spikes (“Mount Stupid”) because we don’t yet see the complexity. As experience accrues, confidence dips (“Valley of Despair”) with growing awareness, then rises again—grounded in nuance and humility.Key insight: True expertise ≠ louder certainty; it’s often quieter, more curious, and more collaborative. How It Applies to the Emergency Department Procedures (e.g., central lines, TVP): Watching a 5-minute video creates “I got this” energy—until the wire won’t pass, the patient thrashes, or you hit carotid. Competence includes troubleshooting in context.Skill Decay is Inevitable: If you haven’t done a chest tube or a TVP in months, you’re not as sharp as last time. Without deliberate refreshers, you drift below the safe-performance line.Everyone’s a Novice Somewhere: New disease entities, evolving algorithms, new tools (POCUS, decision support) mean even attendings routinely re-enter novice zones.Feedback Blind Spots: Lower performers can both overestimate their skills and resist feedback—while many high performers (particularly women, per discussed literature) undervalue their abilities.Culture is Clinical: The ED demands decisive action amid uncertainty. Psychological safety + confident humility lets teams surface alternative diagnoses, challenge momentum, and correct course fast. ⏩Immediate Action Steps for Your Next Shift Run a 60-second debrief on two casesWhat went well? What would I do differently next time? Write one improvement you’ll test today.Play “What if the opposite were true?”Anchored on “lumbosacral strain”, Ask, What if fever/incontinence appears? How does that change my path?Solicit 360° micro-feedbackAsk a nurse, resident, and peer: “One thing I did well; one thing to improve.” Say “thank you,” not “but.”Schedule a HALO refresher this weekPick one high-acuity, low-occurrence procedure (TVP, cric, thoracotomy). Do a 10-minute mental model + equipment walk-through; book sim time if available.Adopt a pre-procedure pauseIf X goes wrong, I’ll do Y. Name two likely failure modes (e.g., “wire won’t advance,” “delirium/agitation”) and your first corrective step.Language shift on shiftSwap “I’m sure” → “I’m reasonably confident, here’s my plan B.” Invite input: “What am I missing?” Conclusion The Dunning–Kruger Effect isn’t a moral failing; it’s a predictable human pattern that every clinician rides—often multiple times per day in the ED. The antidote is metacognition: routine reflection, explicit debiasing, deliberate practice, and feedback within a psychologically safe culture. 🚨 Clinical Bottom Line Competence is qui

🧭 REBEL Rundown 🗝️ Key Points 💨 Peak vs. Plateau Pressures: PIP reflects total airway resistance and compliance, while Pplat isolates alveolar compliance—elevations in both suggest decreased lung compliance (e.g., ARDS, pulmonary edema, pneumothorax).🧱 PEEP Protects Alveoli: Maintains alveolar recruitment and prevents collapse; typical range 5–8 cmH₂O, but higher levels may benefit moderate–severe ARDS.️ Driving Pressure (ΔP = Pplat − PEEP): Lower ΔP reduces atelectrauma and improves outcomes; optimize by adjusting PEEP thoughtfully.💥 Prevent VILI: Keep Pplat < 30 cmH₂O, use low tidal volumes (6 mL/kg IBW), and monitor for barotrauma, volutrauma, atelectrauma, and biotrauma.📚 Evidence-Based Practice: ARDSNet and subsequent trials confirm that lung-protective ventilation—low Vt, limited pressures, and individualized PEEP—improves survival in ARDS. Click here for Direct Download of the Podcast. 📝 Introduction This episode reviews essential ventilator pressures and how to interpret them during ICU rounds. 🚀 Under Pressure Peak Inspiratory Pressure (PIP)Definition: Total pressure required to deliver a breath.Reflects: Airway resistance + lung/chest wall compliance.Common Causes of ↑ PIP:Mucus pluggingBiting the endotracheal tubeKinked tubing or bronchospasmPlateau Pressure (Pplat)Definition: Alveolar pressure measured after an inspiratory hold.Reflects: Lung compliance (stiffness of lung tissue).When Both PIP & Pplat Are Elevated:→ Indicates poor compliance (e.g., ARDS, pulmonary edema, pneumothorax).Positive End-Expiratory Pressure (PEEP)Definition: Pressure remaining in airways at end-expiration to prevent alveolar collapse.Typical Range: 5–8 cmH₂O but needs to titrated to meet patient requirements Notes:Provides physiologic “glottic” PEEP in intubated patients.Using high PEEP strategy shows mortality benefit only in moderate–severe ARDS in meta-analysis.Driving Pressure (ΔP)Definition: ΔP = Pplat − PEEP.Reflects: Pressure needed to keep alveoli open during the respiratory cycle.Goal: Lower ΔP → less atelectrauma & improved outcomes.Optimize: Increase PEEP to reduce ΔP and alveolar cycling. 📖 Interpreting High PIP/High Pplat ↑ PIP & ↑ PplatInterpretation: ↓ ComplianceCommon Causes: ARDS, pulmonary edema, pleural effusion, pneumothorax↑ PIP & Normal/Low PplatInterpretation: ↑ Airway ResistanceCommon Causes: Mucus plug, bronchospasm, tube obstruction or biting 🤕 Ventilator-Associated Lung Injury (VILI) Barotrauma:Mechanism: Excessive airway pressure damages alveoli.Prevention: Keep Pplat < 30 cmH₂O.Volutrauma:Mechanism: Overdistension from excessive tidal volumes.Prevention: Use low tidal volume ventilation (6 mL/kg ideal body weight).ARDSNet trial: 6 mL/kg → lower mortality compared to 12 mL/kg.Ideal Body Weight: Based on height and sex, not actual weight.Typical patient: Tidal Volume: 6–8 mL/kg IBWARDS: Tidal Volume: 4–6 mL/kg IBWAtelectrauma:Mechanism: Repeated opening/collapse of unstable alveoli.Prevention: Optimize PEEP to keep alveoli open and reduce driving pressure.Biotrauma:Mechanism: Inflammatory cascade (↑ IL-6, TNF-α) from mechanical injury.Effect: Can trigger systemic inflammation & multiorgan dysfunction.Prevention: Minimize all other forms of VILI. Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Show Notes Joel Rios Rodriguez, MD PGY 3 Internal Medicine Resident Cape Fear Valley Internal Medicine Residency Program Fayetteville NC Aspiring Pulmonary Critical Care Fellow 🔎 Your Deep-Dive Starts Here It seems we can't find what you're looking for. The post REBEL Core Cast 147.0–Ventilators Part 5: Key Mechanical Ventilator Pressures & Definitions Made Simple appeared first on REBEL EM - Emergency Medicine Blog.

🧭 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 Ventilator management can feel overwhelming—there are so many knobs to turn, numbers to watch, and changes to make. But before adjusting any settings, it’s crucial to understand why the patient is in distress in the first place, because the right strategy depends on the underlying cause. In this episode, we’ll walk through three different cases to see how the approach changes depending on the problem at hand. ️ The 4 Main Ventilator Settings  Tidal Volume (Vt) 🌬️ Amount of air delivered with each breath Typically set based on ideal body weight (6–8 mL/kg for lung protection) Respiratory Rate (RR) ⏱️ Number of breaths delivered per minute Adjusted to control minute ventilation and manage CO₂  FiO₂ (Fraction of Inspired Oxygen) ⛽ Percentage of oxygen delivered Adjusted to maintain adequate oxygenation (goal SpO₂ 92–96%, PaO₂ 55–80 mmHg). PEEP (Positive End-Expiratory Pressure) 🎈 Pressure maintained in the lungs at the end of exhalation to prevent alveolar collapse and improve oxygenation 🧮 Modes of Ventilation AC/VC (Assist Control – Volume Control)How it Works: Delivers a set tidal volume with each breath (whether patient- or machine-triggered).When It’s Used / Pros: Most common initial mode; guarantees minute ventilation; good for patients with variable effort.Limitations / Cons: May cause patient–ventilator dyssynchrony if set volumes don’t match patient’s demand.AC/PC (Assist Control – Pressure Control)How it Works: Delivers a set inspiratory pressure for each breath; tidal volume varies depending on lung compliance/resistance.When It’s Used / Pros: Useful in ARDS (lung-protective strategy), limits peak airway pressures.Limitations / Cons: Tidal volume not guaranteed; must closely monitor volumes and minute ventilation.PRVC (Pressure-Regulated Volume Control)How it Works: Hybrid: set target tidal volume, ventilator adjusts inspiratory pressure breath-to-breath to achieve it (within limits).When It’s Used / Pros: Common default mode on newer vents; combines benefits of VC (guaranteed volume) + PC (pressure limitation).Limitations / Cons: Can increase pressures if compliance worsens.SIMV (Synchronized Intermittent Mandatory Ventilation)How it Works: Delivers set breaths, but allows spontaneous patient breaths in between (without guaranteed volume).When It’s Used / Pros: Used for weaning; allows patient effort.Limitations / Cons: Risk of increased work of breathing if spontaneous breaths are inadequate.PSV (Pressure Support Ventilation)How it Works: Every breath is patient-initiated; ventilator provides preset pressure support to overcome airway resistance.When It’s Used / Pros: Weaning trials; patients with intact drive who just need assistance.Limitations / Cons: Not a full-support mode; not for unstable patients without spontaneous drive. ♟️ Ventilation Strategies Airway ProtectionLow GCS, seizure, strokeLoss of gag/cough reflexHigh aspiration risk (vomiting, GI bleed, poor mental status)Hypoxemic Respiratory FailureSevere pneumoniaARDSPulmonary edemaInhalation injuryVentilatory (Hypercapnic) Failure / Increased Ventilation DemandSevere metabolic acidosis (DKA, sepsis, renal failure) → need high minute ventilationCOPD, asthma (if decompensating)Neuromuscular weakness (myasthenia, Guillain–Barré, spinal cord injury)Airway Obstruction / Anticipated Loss of AirwayTumor, anaphylaxis, angioedemaFacial or airway traumaPre-op / anticipated deterioration Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Show Notes Priyanka Ramesh, MD PGY 1 Internal Medicine Resident Cape Fear Valley Internal Medicine Residency Program Fayetteville NC Aspiring Pulmonary Critical Care Fellow 🔎 Your Deep-Dive Starts Here It seems we can't find what you're looking for. The post REBEL Core Cast 146.0–Ventilators Part 4: Setting up the Ventilator appeared first on REBEL EM - Emergency Medicine Blog.

🧭 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 CAST – RENOVATE Trial: HFNC vs BPAP in Acute Respiratory Failure The RENOVATE trial set out to answer a high-impact question ... Resuscitation Read More REBEL MIND: Performance Under Pressure – What Medicine Can Learn from Elite Teams Welcome back to Rebel MIND, the podcast where we sharpen ... Human Behavior Read More REBEL Core Cast 148.0–Demystifying Non-Invasive Ventilation & HiFlow Non-invasive ventilation (NIV) refers to respiratory support provided without endotracheal ... Thoracic and Respiratory Read More REBEL MIND – The Dunning Kruger Effect: Why Looking Inward Improves Patient Care In this episode and blog post, hosts Mark Ramzy and ... Human Behavior Read More REBEL Core Cast 147.0–Ventilators Part 5: Key Mechanical Ventilator Pressures & Definitions Made Simple This episode reviews essential ventilator pressures and how to interpret ... Thoracic and Respiratory Read More REBEL Core Cast 146.0–Ventilators Part 4: Setting up the Ventilator Ventilator management can feel overwhelming—there are so many knobs to ... Thoracic and Respiratory Read More The post REBEL Core Cast – Pediatric Respi

🧭 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 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 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 catheterizat

🧭 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 Cast Ep 43: Pain Control and Opioid Sparing Options in the ED Background: In the United States we are not only seeing ... Trauma Read More REBEL Cast Episode 42: Research From the Past Year – In the Pipeline Welcome back to Episode 42 of REBEL Cast. In this ... Read More REBEL Cast Episode 41: Research From the Past Year – Resuscitation Welcome back to Episode 41 of REBEL Cast. In this ... Read More REBEL Cast Episode 40: Research From the Past Year – Pain Control Welcome back to Episode 40 of REBEL Cast. We have ... Trauma Read More February 2017 REBEL Cast: The All Hyperoxia Edition Background: Many providers and health care workers place oxygen on ... Resuscitation Read More REBEL Cast Episode 29: IDSA Pneumonia Update Every few years we get updates in the guidelines based ... Infectious Disease Read More The post REBEL Core Cast 144.0: Tourniquet Tips appeared first on REBEL EM - Emergency Medicine Blog.