When would you use a sub-dissociative dose of Ketamine? For acute pain! Here's a REBEL REVIEW discussing the studies by @PainfreeED from @Maimonides_EM Also @srrezaie goes into further detail here: https://loom.ly/vXK6v0Q #FOAMed @EMSwami @MRamzyDO @Marco_propersi

🚨 New REBEL Core Cast! Ep 138: A Simple Bedside Approach to Shock💥 Start with the 4 L’s: Lucid, Limbs, Leak, Lactate Pulse pressure = your shock type cheat code 🎧 Listen now: https://loom.ly/ntey1VU #FOAMed #EMIMCC #MedSky

🤔How smooth is the transition from junior to senior in your emergency department? 🔍Effective leadership requires zooming in on specific tasks & zooming out to manage the big picture 🗣️Talk the Talk with clear, structured communication 👀Check out the blog post here: https://loom.ly/lz9YUQU

🚺What Is the Role of TXA in Dysfunctional Uterine Bleeding? ♀️We explore this in our latest clinical conundrum post by @EMSwami 💉Tranexamic acid (TXA) is a safe and effective treatment for dysfunctional uterine bleeding. 👀Read more about it here: https://loom.ly/iKgOlDQ #FOAMed

🚨 REBEL EM Gear Available! 🚨 Show your love with our I Love EBM—REBEL EM Heart Logo collection! 🎉 T-shirts, hoodies, mugs, and stickers—perfect for the EBM community! 🫁💥 👉 Shop now and wear your passion! https://loom.ly/voSxpiI #REBELEM #EMIMCC #FOAMed

🧪 ICARUS-ED: Early albumin in sepsis? 📉 Minor gains in numbers, no real outcome benefit 💰 30x the cost vs crystalloids ⚠️ Outcomes > optics 🔍 Full breakdown: https://wp.me/pdrP8b-5oc ❤️ Like 🔁 Repost 🔔 Follow for more #FOAMed #MedX #MedTwitter #MedEd

⚡Do alternative defibrillation strategies like Double Defibrillation or vector change reduce the amount of time patient's are in RVF?! 🔥DSED shows greatest reduction in time spent in VF 🔁If another defibrillator isnt available, using vector change is just as good! #FOAMed

🥇What does performance under pressure in medicine look like? 🏃🏽‍♂️‍➡️What if we had the same tools as professional sports teams and elite athletes? 🧠 We've partnered with Arena Labs for data driven insights! 👀https://loom.ly/YvLC3F8 @Arena_Labs @MRamzyDO @Marco_propersi @EMSwami

🚨EVERDAC Trial Post is out! 🚨 💉Is non-invasive BP an acceptable alternative to arterial lines in critically ill patients? 🟰 NIBP monitoring is noninferior to a-line when comparing 28 day mortality rates. #FOAMed

🚨 New Core Cast Drop! 🫁 Sudden crash after central line or in a vented patient? Think tension pneumothorax! 🖐️🔪 Skip the needle. Finger thoracostomy is faster, more reliable, and definitive. 🧠 Use POCUS if stable. Don’t delay. 🎧 Listen now: https://wp.me/pdrP8b-5oj #MedSky #EMIMCC #FOAMed

⁉️Does continuous suctioning during RSI lead to rapid deoxygenation? 🙅🏽‍♂️NOPE - it did not cause more rapid deoxygenation when compared to a PRN approach 👀Check out the full blog post by @EMSwami here: https://loom.ly/aND5tTw #FOAMed #Meded @MRamzyDO @marco_propersi @srrezaie

📉 Does trending biomarkers help stop antibiotics sooner safely in sepsis? 👀 More here: https://wp.me/pdrP8b-5mL #FOAMed #EMIMCC #MedSky

🤔Ever wondered what the safety & efficacy are of different oxygenation strategies for critically ill patients needing intubation?! 👀Check out this Meta-Analysis Post here: https://loom.ly/hbrW8XY 🗝️NIPPV and/or HFNC should be routinely used as preoxygenation strategies for critically ill

🧠Whats holding you back? Do you have a fixed or growth mindset? 💭Reframe your view of the word "yet" and see how it can change your perspective 🎧Listen to our latest MIND Episode on reframing how you approach challenges: https://loom.ly/QlV61NU #FOAMed @MRamzyDO @Marco_Propersi @EMSwami

🎧 REBEL Cast: Acetaminophen Toxicity 🧪 When to start NAC 📈 Use the Rumack-Matthew Nomogram 🧠 King's College Criteria 💊 Fomepizole—future role? 🎙️ By @emswami 🎧 listen: https://wp.me/pdrP8b-5lZ #FOAMed #Toxicology #EmergencyMedicine #MedSky #MedEd

🫀Norepi or Epi after Cardiac Arrest? 🤔Was there a lower rate of recurrent cardiac arrest when using one over the other? 📚This meta-analysis & systematic review sought to answer that! 👀Check out the full post by Drs. Elizabeth Smith & Dorian Alexander from UTHealth Houston (@uthoustonemres)

🚨 REBEL EM Gear Available! 🚨 Show your love with our I Love EBM—REBEL EM Heart Logo collection! 🎉 T-shirts, hoodies, mugs, and stickers—perfect for the EBM community! 🫁💥 👉 Shop now and wear your passion! https://loom.ly/voSxpiI #REBELEM #EMIMCC #FOAMed

🚨 PEERLESS Trial: intermediate-risk PE (selected for catheter therapy) — FlowTriever LBMT vs CDT. LBMT “wins” the 5-part win ratio mainly via ICU use; remove ICU metrics and it’s NS. Mortality/ICH/bleeding similar. #FOAMed 🔗 https://wp.me/pdrP8b-5tG

✌🏽DKA: Covering the SCOPE DKA Trial 💧Do different fluids affect how quickly DKA resolves?! 🎙️Drs. Frank Lodeserto & Mark Ramzy (@MRamzyDO) discuss that & more here: https://loom.ly/ZcL5VTc 🌊Check out our fluid composition REBEL REVIEW Below #FOAMed @EMSwami @Srrezaie @Marco_propersi

🧠Check out our latest REBEL MIND Episode on Human Factors w/Drs. Chris Hicks & Andrew Petrosoniak 🧩Unseen behaviors and considerations critical in the ED & ICU 🎯 System Design impacts team performance that facilitate decision-making Listen to our episode here: https://loom.ly/Xtt69Ss #FOAMed

🚨 TXA for Hemoptysis: We Put That $#!t on Everything (That Bleeds) Pt 2 🫁💨 Neb TXA worked faster & needed fewer procedures than IV in a small RCT PMID: 36410494 🌬️ Cheap, no IV, and maybe better ⚠️ Mostly TB patients, but results? 🔥 📖 www.rebelem.com #FOAMed #MedEd #EMIMCC #MedSky

🫀VTach Treatment starts w/identifying underlying cause 4️⃣Here's a REBEL REVIEW describing 4 ways to manage this life-threatening arrythmia! 👀More at https://loom.ly/LNw6HwY #FOAMed @emswami.bsky.social @mramzydo.bsky.social

🚨NEW REBEL EM POST: HI-PEITHO Trial 🚨 🏆 First RCT showing catheter-directed fibrinolysis plus anticoagulation reduces short-term hemodynamic decompensation vs anticoagulation alone in intermediate-high risk PE 🚑 Identify Early, Anti-coagulate First 💉 Is the Catheter Even Necessary? #FOAMed

⁉️Does continuous suctioning during RSI lead to rapid deoxygenation? 🙅🏽‍♂️NOPE - it did not cause more rapid deoxygenation when compared to a PRN approach 👀Check out the full blog post by @EMSwami here: https://loom.ly/aND5tTw #FOAMed #Meded @MRamzyDO @marco_propersi @srrezaie

🎧 NEW CoreCast! 🫁 Confused about hypoxia vs hypoxemia? We’ve got a simple bedside approach‼️ 🚫 Shunt ≠ Dead space 💡 Know when FiO₂ fails & PPV saves 🔗 https://loom.ly/hJFaydE #FOAMed #MedSky #EMIMCC

🫁 Tachypnea: What’s Behind the Breath? Shallow breaths? Think neuromuscular, bronchospasm, or poor compliance. Big breaths? It’s probably compensation. 👁 Observe ✋ Palpate 👂 Listen 🧠 Synthesize 🔗 https://wp.me/pdrP8b-5ng 🎙️ Frank Lodeserto MD #REBELEM #FOAMed #MedEd #MedSky #EMIMCC

🚨 REBEL EM x ResusX 🚨 Proud affiliate sponsors of ResusX—EM + Critical Care conference in Philly 🏙️⚡️ High-yield resus + practical ED/ICU pearls. Register here: https://loom.ly/f4mCyAk (supports free FOAMed) 🎟️ Use code: REBEL20 Tag a partner who’d actually go with you 👇

🚨 New Post Alert! Syncope is common in the ED—but which decision rule do you trust? ⚡ San Francisco Syncope Rule = fast but fallible 🧩 Canadian Syncope Risk Score = comprehensive but complex 🩺 Neither replaces clinical judgment 👉 Read here: https://wp.me/pdrP8b-5pF #FOAMed #EMIMCC #MedSky

🫁 New Core Cast: The Tachypneic Patient Short + shallow = BIG problem ⚠️ 👁 Watch chest rise ✋ Palpate abdomen 👂 Listen 🧠 Synthesize 🎧 Full episode: [https://wp.me/pdrP8b-5ng] #FOAMed #EmergencyMedicine #PulmPearls #Tachypnea #MedEd

⚡Do alternative defibrillation strategies like Double Defibrillation or vector change reduce the amount of time patient's are in RVF?! 🔥DSED shows greatest reduction in time spent in VF 🔁If another defibrillator isnt available, using vector change is just as good! #FOAMed

🚨 REBEL EM Gear Available! 🚨 Show your love with our I Love EBM—REBEL EM Heart Logo collection! 🎉 T-shirts, hoodies, mugs, and stickers—perfect for the EBM community! 🫁💥 👉 Shop now and wear your passion! https://loom.ly/voSxpiI #REBELEM #EMIMCC #FOAMed

🚨 Check it out on REBEL EM: Size Matters! Are you using the right cuff? New RCT shows the wrong cuff size skews SBP/DBP. 📉 Too Small cuff = High BP 📈 Too Large cuff = Low BP 📌 Details: https://wp.me/pdrP8b-5k6 @marco_propersi @EMSwami @srrezaie @MRamzyDO

POCUS diastology in the ED = 1 question: Is LAP elevated now? Measure E/e’ (mitral inflow E ÷ annular e’). ≥14 suggests elevated LAP/cardiogenic edema; ≤8 argues against; 8–14 indeterminate. https://loom.ly/DbZddQc #FOAMed

🚨 REBEL EM x ResusX 🚨 Proud affiliate sponsors of ResusX—EM + Critical Care conference in Philly 🏙️⚡️ High-yield resus + practical ED/ICU pearls. Register here: https://loom.ly/f4mCyAk (supports free FOAMed) 🎟️ Use code: REBEL20 Tag a partner who’d actually go with you 👇

🤔How smooth is the transition from junior to senior in your emergency department? 🔍Effective leadership requires zooming in on specific tasks & zooming out to manage the big picture 🗣️Talk the Talk with clear, structured communication 👀Check out the blog post here: https://loom.ly/lz9YUQU

💡 New REBEL Core Cast Drop Demystifying Non-Invasive Ventilation & HiFlow 🫁 CPAP: Best for hypoxemia ⚖️ BiPAP: Go-to for hypercapnia 🌬️ HFNC: Comfy + effective NIV ≠ cure NIV = bridge 📲 Listen now: https://wp.me/pdrP8b-5ru 🧠 Written by: Drs. Frank Lodeserto & Eric Acker #FOAMed

🦵 Ottawa vs Pittsburgh Knee Rules: Both are sensitive. Both are validated. But they answer slightly different bedside questions. 📏 Ottawa = maximize sensitivity 🎯 Pittsburgh = reduce unnecessary imaging And yes — limping still counts as weight bearing. 🔗https://loom.ly/msRsCVo

🛌🏽Rest is NOT Sleep! 🧠 Uncovering the seven types of rest can highlight diverse needs: physical, mental, sensory, creative, emotional, social, and spiritual 👀Check out our latest MIND Episode on the 7 Dimensions of Rest: https://loom.ly/IZcGTlQ #FOAMed #MedED @MRamzyDO @Marco_Propersi @EMSwami

🚨 NEW POST: MDCalc Wars 🛑💥 Are you using PERC and Wells correctly? ✅ Start with Wells to guide next steps 🚫 Don’t use PERC in moderate/high-risk 🧪 Use high-sensitivity D-dimer! 👉 Read now: https://wp.me/pdrP8b-5oN #FOAMed #EMIMCC #MEDSky

🤔Ever wondered what the safety & efficacy are of different oxygenation strategies for critically ill patients needing intubation?! 👀Check out this Meta-Analysis Post here: https://loom.ly/hbrW8XY 🗝️NIPPV and/or HFNC should be routinely used as preoxygenation strategies for critically ill

🆕 Rib fracture in older patients? Don’t rely on fracture count alone. The combo of RibScore (CT/anatomy) + SCARF (bedside physiology) catches the sickest patients before they spiral. 💡 >95% sensitivity for pulmonary complications 📚 Post by Eric Steinberg 🔗 https://wp.me/pdrP8b-5to #FOAMed

🦠 Sepsis antibiotics: Is 7 days enough? The BALANCE Trial says yes ⚠️ But watch for spectrum & selection bias 💡 7d may work for most, but not all 📖Read full post here: https://loom.ly/rnrHxg8 #FOAMed #MedSky #EMIMCC

💧How much fluid should be giving in Pancreatits? 🌊Check out the WATERFALL Trial: https://loom.ly/dBJbgl8 by @emswami.bsky.social #FOAMed @marco-propersi.bsky.social @mramzydo.bsky.social

🚨Our 1st REBEL MIND Post is out on the Dunning-Kruger Effect! 🧠MIND = Mastering Internal Negativity During Difficulty 🏁How accurately can we assess our own performance? 🎙️Listen to the episode & check out the post here: https://loom.ly/93Gd3_Y #FOAMed #MedEd @MRamzyDO @marco_propersi @EMSwami

🚨NEW BLOG POST🚨 ⁉️Does a restrictive vs liberal O2 strategy in trauma patients reduce mortality and/or major respiratory complications? 👀Find out here: https://loom.ly/fDJK4vw by @nyulangoneEM Drs. Ali and Aiad (@Maureen_NYUdoc) #FOAMed @EMSwami @MRamzyDO @Marco_propersi @Srrezaie

🚨EVERDAC Trial Post is out! 🚨 💉Is non-invasive BP an acceptable alternative to arterial lines in critically ill patients? 🟰 NIBP monitoring is noninferior to a-line when comparing 28 day mortality rates. #FOAMed

🚨 REBEL EM Gear Available! 🚨 Show your love with our I Love EBM—REBEL EM Heart Logo collection! 🎉 T-shirts, hoodies, mugs, and stickers—perfect for the EBM community! 🫁💥 👉 Shop now and wear your passion! https://loom.ly/voSxpiI #REBELEM #EMIMCC #FOAMed

❄️ Winter is coming… and so are the pneumonia admits. CURB-65, PSI/PORT, SMART-COP — they’re not answering the same question. One guides admit vs discharge, another predicts mortality, and one spots who’s about to crash. New on @REBEL_EM 👉 https://loom.ly/pUrda8w

🚨 PEERLESS Trial: intermediate-risk PE (selected for catheter therapy) — FlowTriever LBMT vs CDT. LBMT “wins” the 5-part win ratio mainly via ICU use; remove ICU metrics and it’s NS. Mortality/ICH/bleeding similar. #FOAMed 🔗 https://wp.me/pdrP8b-5tG

🚨 REBEL EM x ResusX 🚨 Proud affiliate sponsors of ResusX—EM + Critical Care conference in Philly 🏙️⚡️ High-yield resus + practical ED/ICU pearls. Register here: https://loom.ly/f4mCyAk (supports free FOAMed) 🎟️ Use code: REBEL20 Tag a partner who’d actually go with you 👇