REBEL Cast

REBEL Rundown Key Points Fewer ICU Admissions Only 5 patients in the SQuID group required ICU care vs 99 in the traditional insulin drip group. Shorter ED Stays ED length of stay dropped by ~3 hours in the SQuID group—an operational win in crowded departments. No Drop in Nursing Workload Despite using subQ insulin, nurses still performed hourly glucose checks and frequent injections. Focus on the...

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 When y...

REBEL Rundown Key Points Start with Breath Types: Controlled, assisted, and supported breaths are the foundation of all modes. Comfort Over “Best Mode”: No mode improves mortality — focus on patient synchrony and comfort. Know the Big 5 Modes: AC : All controlled or assisted (volume or pressure). PS : Fully spontaneous, great for SBTs. PRVC : Pressure-delivered, volume-targeted hybrid. SIMV : Mixe...

REBEL Rundown Click here for Direct Download of the Podcast . Highlights 00:00 Introduction to Rebel Cast 00:10 Highlighting the Incrementum Conference 2026 00:34 Meet the Founders of Incrementum 01:21 The Journey to Incrementum 04:27 The Recognition of Emergency Medicine in Spain 06:04 What is Incrementum? 08:14 Bringing Together Top Emergency Medicine Experts 11:38 Exciting Sessions to Look Forw...

REBEL Rundown Key Points Master the 3 Types of Breaths Control , Assist , and Spontaneous — know the difference before tackling ventilator modes. Breath Delivery: Volume vs. Pressure Volume-Targeted = fixed volume → monitor pressure Pressure-Targeted = fixed pressure → monitor volume Lung Compliance = Pressure-Volume Relationship Volume mode: ↑ pressure = ↓ compliance (stiff lungs) Pressure mode:...

REBEL Rundown Key Points IO Lines Are Life-Saving in Extremis: IO access is fast, reliable, and can deliver nearly any resuscitative medication or fluid during cardiac arrest or hemorrhagic shock. Location Matters for Flow. Sternal IO : Fastest (up to 500cc/5 min). Humerus IO : Faster than tibia (300cc/5 min). Tibial IO : Slower (200cc/5 min) but easier to place during CPR Watch for Contraindicati...

REBEL Rundown Key Points Think Beyond Trauma: Don’t forget to suspect tension pneumothorax in ventilated patients who suddenly crash or after a central line placement! Confirm with Ultrasound: If the patient is stable enough, grab the probe! Ultrasound can rapidly confirm tension PTX and avoid unnecessary delays. Needles Are Out: Needle decompression? Meh. Finger thoracostomy is faster, more relia...

REBEL Rundown Key Points Shock is a Clinical Diagnosis — Not Just a Number Patients can be in compensated shock with normal BP. Look for signs like AMS, cool extremities, ↓ UOP, and ↑ HR/RR. Start with the 4 L’s Lucid (mental status), Limbs (warm/cold), Leak (urine output), and Lactate give you rapid bedside insight into perfusion status. Pulse Pressure Helps Pinpoint the Type Narrow PP = Cardioge...

REBEL Rundown Key Points Sinus Tachycardia = Clinical Clue: Don’t just treat the number—it’s a sign of underlying physiologic stress. Oxygen Delivery Equation: HR ↑ may compensate for ↓ hemoglobin, O₂ sat, or cardiac output. Know: DO₂ = CO x Hb x Sat + 0.003(pO₂) Systematic 8-Point Evaluation: Airway/Hypoxia, Breathing , Circulation, Drugs, Erythrocytes (Anemia), Fever, Glucose, “Holy Cow Th...

REBEL Rundown Key Points Short + shallow: Neuromuscular, bronchospasm, or compliance problem → act fast Normal/large tidal volume:  Compensation for metabolic/systemic cause Use all tools : Eyes: Chest rise, Hands: Palpate, Ears: Listen, Brain: Synthesize Click here for Direct Download of the Podcast . Introduction In this episode, we focus on the bedside evaluation of the tachypneic patient. Tach...

REBEL Rundown Key Points Hypoxemia = low blood oxygen Hypoxia = low tissue oxygen 5 causes of hypoxemia , but most hospital cases are either: Shunt = doesn’t improve with oxygen therapy Dead space = causes tachypnea but is easier to oxygenate Always start with maximizing oxygen delivery ( ), but recognize quickly when positive pressure ( ) is needed V/Q mismatch Shunt (refractory to oxygen therapy...

Acetaminophen (APAP) overdose remains one of the most common causes of acute liver failure in the United States. While its therapeutic use is widespread and generally safe, unintentional overdoses and delayed presentations can lead to devastating outcomes. In this episode of REBEL Cast, we break down the pathophysiology, clinical course, diagnostic approach, and evidence-based management of APAP t...

Introduction: In this episode of Rebel Cast, host Marco Propersi, along with co-hosts Steve Hochman and Kim Baldino, delve into the practice and importance of street medicine—the direct delivery of healthcare to homeless and unsheltered individuals. Special guests Dr. Jim O’Connell, a pioneer of street medicine, and Dr. Ed Egan, a recent street medicine fellowship graduate, share their exper...

Take Home points : Always suspect an open joint if there is a laceration, regardless of size, the lies over joint CT scan of the affected joint is widely considered to be the standard approach to evaluation but the saline load test may be useful in certain circumstances. Obtain emergency orthopedics consultation for all open joints and administer antibiotics and update tetanus in all patients   RE...

Take Home Points Early diagnosis: erythema and warmth of the skin surrounding the umbilicus isn’t normal. Get labs, start abx and get the patient admitted Consult peds surgery on all of these patients as progression to nec fast, while uncommon, is devastating If the patient appears toxic or has systemic symptoms, the simply omphalitis has progressed and aggressive treatment including surgery is li...

Take Home Points Orogastric lavage may still play an important role in treatment of the overdose patient.   Do not perform lavage if the ingestion has limited toxicity at any dose or the ingested dose is unlikely to cause significant toxicity. Strongly consider orogastric lavage in a patient who has taken an overdose of drugs that are particularly toxic, suspected extreme doses associated with hig...

Take Home Points Toxic alcohols generally refer to methanol and ethylene glycol as these substances pose significant metabolic derangement and end-organ damage. Patient who present shortly after ingestion will simply look inebriated – no different than ethanol intoxication. At this point, patients will have an elevated osmolar gap and little to no anion gap. Patient who presents in a delayed...

Take Home Points Anticipate anatomically challenging airways and consider early intubation prior to loss of airway anatomy. Skip the zones of the neck and focus on hard signs of vascular ( Shock w/o another source, Pulsatile bleeding, Expanding hematoma, Audible bruit, Signs of stroke) or aerodigestive (Airway compromise, Bubbling wound, Extensive SubQ air, Stridor, Significant hemoptysis/hemateme...

Background: Cath lab activation based on ST-elevation myocardial infarction (STEMI) criteria is founded on aging data and requires evolution. In the “ Occlusive Myocardial Infarction (OMI) Manifesto ,” emergency physicians Dr. Steve Smith, Dr. Pendell Meyers, and Dr. Scott Weingart introduced a new paradigm —OMI vs. non-occlusive myocardial infarction (NOMI). The OMI/NOMI paradigm focuses on the p...

Take Home Points Early administration of antibiotics (within 60 min) in patients with fever and neutropenia is life saving. Fever in sickle cell is an emergency and always requires cultures and antibiotics even if the child appears well. Avoid sedation and lying supine and steroids in patients with mediastinal masses. Red flags in patients with headaches that may suggest a brain tumor  include sig...

Take Home Points Always obtain an EKG in patients with ESRD upon presentation Always obtain an EKG in patients with hyperkalemia as pseudohyperkalemia is the number one cause If the patient with hyperkalemia is unstable or has significant EKG changes (wide QRS, sine wave) rapidly administer calcium salts In patients who are anuric, early mobilization of dialysis resources is critical REBEL Core Ca...

Take Home Points Management of severe beta-blocker and calcium-channel blocker toxicity should occur in a stepwise fashion: potential gastric decontamination, multiple lines of access, judicious fluids, calcium, glucagon, and vasopressors as needed. Initiation of high dose insulin therapy requires a tremendous amount of logistical and cognitive resources as it requires cross-disciplinary collabora...

Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. The key is in identifying and rapidly gaining control with a posterior pack or foley catheter. These patients often require surgical intervention so get ENT to the bedside and admit to a place with a higher level of monitoring. REBEL Core Cast 123.0 – Posterior Epistaxis Click here for Direct Download of the Podca...

Background: In May of 2018, Andexanet alfa gained accelerated approval by the FDA for the reversal direct oral anticoagulants (DOACs) despite a lack of robust evidence for use. The 2022 AHA/ASA guidelines give the drug a level 2A recommendation and recommend it over the use of 4F-PCC ( Greenberg 2022 ). FDA approval alongside guideline endorsement has led to the drug seeing a remarkable growth in...