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REBEL Cast Ep116: The CLOVERS Trial – Restrictive vs Liberal Fluids in Sepsis-Induced Hypotension

RebelEM

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%

Sepsis 105
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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?

RebelEM

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. Click here for Direct Download of the Podcast Paper: Bouzat P et al. Severe acute traumatic coagulopathy = PT >1.5

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REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

RebelEM

Click here for Direct Download of the Podcast Paper: Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

Stroke 136
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REBEL Core Cast 132.0 – Recent-Onset AFib

RebelEM

REBEL Core Cast 132.0 – Recent-Onset AFib Click here for Direct Download of the Podcast. PMID: 25701296 The SGEM: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol) ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers. Read More Atzema CL, Barrett TW.

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Cardiac Rhythms/ECG Module

Don't Forget the Bubbles

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98
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Episode 7: Sepsis

PHEM Cast

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Arriving by Emergency Medical Services Improves Time to Treatment Endpoints for Patients With Severe Sepsis or Septic Shock. Link to the Sepsis-3 guideline.

Sepsis 52
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REBEL Cast Ep114: High Flow O2, Suspected ACS, and Mortality?

RebelEM

Click here for Direct Download of the Podcast Paper: Stewart, RAH et al. However, this was not the primary outcome of this trial and no definitive conclusions can be drawn. Based on recent studies, current guidelines recommend that O2 should not be given to non-hypoxemic patients with STEMI or NSTEMI [2,3]. Low O2 protocol: 3.1%