REBEL Cast

REBEL EM stands for Rational Evidence Based Evaluation of Literature in Emergency Medicine. REBEL Cast brings REBEL EM posts to life in audio form. We open with a clinical scenario and a focused clinical question, then critically appraise the study—key results, strengths, limitations, and what it means at the bedside. Every episode ends with actionable take-home points. Explore more at rebelem.com Have a paper we should review? Email rebelemteam@gmail.com.

REBEL MIND Ep7 - Growth vs Fixed Mindset in Medicine 04/01/2026

REBEL MIND Ep7 - Growth vs Fixed Mindset in Medicine 🔑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. 👀Previously Covered and Related Content: REBEL EM: REBEL EM: REBEL EM: EM Crit: 📝 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 static In 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 validation Feedback is a whole another topic that we plan to have dedicated episodes and blog posts. This is an area where sometimes faculty struggle and often learners are asking for more/improved feedback. 💬Conclusion Cultivating a growth mindset in medicine isn’t merely about staying positive; it’s about embracing continuous learning in the face of challenges. It involves creating supportive environments that encourage vulnerability, experimentation, and resilience. By adopting these practices, clinicians can improve not just personal competencies but also enhance patient care quality and safety. 🚨 Clinical Bottom Line Clinicians who embrace a growth mindset not only enhance their skills but also contribute to a more dynamic, adaptive, and error-resilient healthcare environment. Remember, the best clinicians are those who never stop learning, not the ones who never make mistakes. 📚Further Reading and References Claro S, Paunesku D, Dweck CS. Growth mindset tempers the effects of poverty on academic achievement. Proc Natl Acad Sci U S A. 2016 Aug 2. Epub 2016 Jul 18. PMID: Hopkins SR, et al.Trainee growth vs. fixed mindset in clinical learning environments: enhancing, hindering and goldilocks factors. BMC Med Educ. 2024 Oct 23 PMID: Memari M, Gavinski K, Norman MK. Beware False Growth Mindset: Building Growth Mindset in Medical Education Is Essential but Complicated. Acad Med. 2024 Mar 1. Epub 2023 Aug 30. PMID: Cite this article as: Mark Ramzy, "REBEL MIND – Growth vs Fixed Mindset in Medicine", REBEL EM blog, November 28, 2025. Available at: /episode/index/show/rebelcast/id/39201605

REBEL MIND Ep6 – How to Sleep When the World Says You Can’t 03/04/2026

REBEL MIND Ep6 – How to Sleep When the World Says You Can’t 🔑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. 👀Previously Covered and Related Content: REBEL Core Cast: REBEL MIND: Rebellion in EM: First10EM: REBEL MIND: 📝 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 systems We previously talked about the 7 types of rest and you can check that out Examples 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 schedule Circadian 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 & safety Sleep 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 risk. Possibly increased all-cause mortality. You’re already in a high-stress, high-exposure specialty. Chronically poor sleep amplifies that risk profile and can end a career early—or make you miserable while you’re still in it. Culture of “heroics” vs. health Skipping sleep to pick up extra shifts, late meetings, or “just one more note” is often praised. We rarely celebrate: The attending who says “no” to a 2 pm meeting post-nights. The resident who defends their blackout-curtains-and-earplugs routine. 🛏️Different Ways to Improve Your Sleep Clarify your “sleep non-negotiables” Decide how many hours you realistically need to function (e.g., 7–9 on off days, realistic blocks on nights). Treat those hours as you would a procedure time—blocked, protected, and respected. Use caffeine like a drug, not a reflex Aim for ≤ 2 cups equivalent on most days. Avoid caffeine within 4–6 hours of your planned sleep time (remember: it can hang around up to 12 hours). Consider scheduling caffeine for: Early in the shift for alertness. Strategic “coffee naps” (see below), not late-night chugging. Respect alcohol’s impact on sleep Recognize that even small to moderate doses degrade sleep architecture. Avoid using alcohol as a “sleep aid”—you’ll fall asleep faster but sleep worse. If you do drink, separate it from bedtime and keep it modest. Optimize food and fluid timing Hydrate consistently on shift, but taper fluids ~4 hours before bed to reduce nocturnal bathroom trips. Avoid heavy, spicy, or large meals within 2–3 hours of sleep to decrease reflux and discomfort. Plan a light, balanced “pre-sleep” snack if going to bed hungry keeps you awake. Move your body (but not right before bed) Regular exercise improves sleep depth and latency. Try to avoid intense workouts within 2 hours of bedtime. On shift: micro-movement (stairs, brisk walks between pods, quick stretch sessions) can help alertness without wrecking sleep later. Control light exposure Maximize sunlight or bright light after waking (even if that’s 3–4 pm after a night). Minimize bright light and screens before sleep: Dim lights. Use night mode/blue-light filters if you must scroll. For daytime sleep: Use blackout curtains, tinfoil, cardboard, or sleep masks. Yes seriously use tinfoil if you have to, we talk about it on the podcast episode! Aim for “I might be blind” darkness—so dark you can’t see your hand in front of your face. Dial in your sleep environment Cool room temperature (fan or AC if possible). White noise or sound machine to mask household/traffic noise. Earplugs and eye masks as needed. Bed used primarily for sleep (and sex)—not for charting, doom scrolling, or email. Strategic power naps Keep naps ≤ 20–30 minutes to avoid sleep inertia. Prefer early-afternoon or pre-night-shift naps. Coffee nap strategy: Drink a small coffee. Immediately lie down for a 20–30 min nap. Wake up as the caffeine kicks in, combining nap benefit + stimulant. Thoughtful melatonin use Remember melatonin is a hormone, not a vitamin gummy. Lower doses often work as well as (or better than) large OTC doses. Use it intentionally and intermittently, not as a crutch every night. Over-reliance may reduce your own natural production and its effectiveness over time. Build pre-sleep rituals Repeated, calming habits signal your body it’s time to downshift: Warm shower, gentle stretching, or yoga. Guided breathing or body scan. Brief journaling or “brain dump” of tasks to get them out of your head and onto paper. Protect from pathologic patterns If despite consistent effort you: Snore heavily, stop breathing, or gasp in sleep. Feel excessively sleepy driving home or at work. Cannot fall asleep or stay asleep for weeks to months. Consider evaluation for sleep apnea, insomnia, or shift-work sleep disorder with your physician or sleep specialist. ⏩Immediate Action Steps for Before/During/After Your Next Shift 1. **Before the Shift**: Plan a 20–90 minute nap before your first night shift (many clinicians find 3–5 hours earlier in the day is ideal). I treat ED and ICU shifts very differently. I always sleep 3-5 hours before my night shifts aiming for the full 5 (sometimes 6 or more) hours for my ED shifts because you always have to be “on”. Depending on the ICU I’m working in, I may have a bit more downtime so 3 to 5 hours is plenty. Set a caffeine plan: decide in advance when your last dose will be (e.g., none after 2–3 am if sleeping at 8–9 am). Tell your household, “This is my sleep block” and agree on a plan for kids, pets, deliveries, etc. On my calendar, I completely block off time called “Pre-call sleep” so no meetings can be scheduled and then put my phone in airplane mode 2. **During the Shift** Hydrate early; taper fluids in the last 3–4 hours of your shift Eat something light but adequate; avoid “last-minute” heavy meals right before sign-out. Build in micro-breaks and movement: one or two short walks, a few stretches, even a quick stair run if safe. Get outside or near a window for a few minutes of light exposure if possible. 3. **After the Shift** On the way home: Use sunglasses to reduce bright morning light if you’re aiming for sleep soon. Avoid “just checking” email or messages; shift into wind-down mode. At home: Do a brief, calming decompression (shower, light snack, 10–15 minutes of low-stimulation TV or reading). Make your room cold, quiet, and dark (blackout curtains, tinfoil/cardboard, white noise, fan). Put your phone on Do Not Disturb and physically place it away from the bed. On my calendar, I completely block off time called “Post-call sleep” so again no meetings can be scheduled and then I personally don’t just put my phone on Do Not Disturb but rather in airplane mode and WIFI OFF If you can’t sleep after ~20–30 minutes: Get out of bed, do something calming in dim light (breathing, gentle stretching, journaling). Return to bed when sleepy—this trains your brain to associate bed with sleep, not frustration. 💬 Conclusion Rest and sleep are both critical—but they’re not interchangeable. Rest helps you step out of the constant “on” of our jobs, while sleep is the biological intervention that restores your ability to show up safely and sustainably. Rest ≠ sleep. Rest reduces load; sleep repairs your brain and body. You need both, on purpose. As EM and ICU clinicians, we’re trying to perform formula-one-level medicine with engines that often only see half their maintenance. You won’t fix shift work. You can build a sleep system that respects your biology, your schedule, and your life at home. That system starts with valuing sleep, then prioritizing it, personalizing it, trusting the process when it’s imperfect, and actively protecting both your routine and your mindset. 🚨 Clinical Bottom Line Sleep is medicine. Shift work is biologically unnatural. Struggling does not mean you’re weak; it means you’re human fighting physiology. Use your tools deliberately. Caffeine, naps, light, food, movement, melatonin, and environment can be leveraged—or can quietly sabotage you. Build and defend a personalized sleep routine. Communicate it, normalize it, and protect it from casual encroachment. You can’t control every trauma, code, or admission—but you can control how seriously you take your own recovery. Your patients, your team, and your future self all benefit when you do. 📚 Further Reading Espie CA. The ‘5 principles’ of good sleep health. J Sleep Res. 2022 Jun; PMID: Solodar, J “Sleep hygiene: Simple practices for better rest.” Harvard Health, 31 January 2025 Link is Suni, E. “Mastering Sleep Hygiene: Your Path to Quality Sleep.” Sleep Foundation, 7 July 2025, Link is /episode/index/show/rebelcast/id/39443090

REBEL MIND Ep5 - Applying Performance Science In and Out of the Emergency Department 02/18/2026

REBEL MIND Ep5 - Applying Performance Science In and Out of the Emergency Department 📌 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. 📝 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. 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: 🤔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 . 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. /episode/index/show/rebelcast/id/40049310

REBEL Core Cast 150.0: Emergency Medicine Consults: How to Call a Consult + Handle Pushback 02/12/2026

REBEL CAST: The RSI Trial – Ketamine vs Etomidate in Rapid Sequence Intubation 02/08/2026

REBEL CAST - RENOVATE Trial: HFNC vs BPAP in Acute Respiratory Failure 02/05/2026

REBEL CAST - RENOVATE Trial: HFNC vs BPAP in Acute Respiratory Failure 📌 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. 📝 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? ⚙️ 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 trial 33 Brazilian hospitals Nov 2019 – Nov 2023 Adaptive Bayesian hierarchical modeling with dynamic borrowing Open label, outcome adjudicators blinded Patients were classified into 5 subgroups 💪 Strengths Broad, multicenter design: Large multicenter randomized trial comparing HFNC vs BPAP across several etiologies of acute respiratory failure in ED and ICU settings. Etiology-based and COVID-specific subgroups: Patients were stratified into prespecified clinical subgroups (COPD with acidosis, ACPE, immunocompromised hypoxemia, non-immunocompromised hypoxemia), and COVID-19 was later added and analyzed as a separate subgroup rather than being combined with the original ARF categories. Bayesian hierarchical model with dynamic borrowing: The primary analysis used a Bayesian hierarchical framework that allowed information to be borrowed across subgroups when treatment effects were similar and reduced borrowing when subgroups differed. Prespecified non-inferiority and futility rules: Each subgroup had predefined non-inferiority and futility boundaries, and enrollment in the immunocompromised subgroup was stopped early after crossing a futility threshold. Standardized BPAP delivery system: BPAP was delivered using a single BPAP system/interface across participating centers. Single healthcare system and population: All sites were within one national healthcare system, with broadly similar clinician training, practice patterns, and patient populations for that country. Current practice relevance: The trial addresses a post-COVID era question in which HFNC is widely used, providing comparative HFNC vs BPAP data across multiple ARF etiologies in a pragmatic ED/ICU population. ⚠️ Limitations Small subgroup sizes: The COPD (35 vs 42) and immunocompromised (28 vs 22) subgroups included relatively few patients compared with the other etiologic groups. Dependence on borrowing for COPD estimates: COPD treatment-effect estimates in the primary model were heavily influenced by borrowing from other subgroups, and no-borrowing sensitivity analyses showed wider intervals. Pre-randomization BPAP and exclusion criteria: COPD patients could receive up to 6 hours of BPAP before randomization, and ACPE patients judged to require immediate BPAP were excluded from enrollment. Rescue BPAP in the HFNC arm: Patients assigned to HFNC could receive rescue BPAP; BPAP settings were not standardized, and detailed reporting of rescue BPAP management and outcomes (including number of episodes) was limited. Non-standardized weaning strategies: Weaning protocols for HFNC and BPAP were not tightly protocolized or aligned, and HFNC weaning permitted flows down to 25–30 L/min. Single-country setting: All participating centers were located in one country. 🛣️Side Tangent on Bayesian Adaptive Model Prior to our deep dive into the discussion, lets first explain the importance of the statistical method used in the RENOVATE trial, the Bayesian Adaptive Model. A Bayesian Adaptive Model is a trial design that keeps updating its understanding of which treatment works better as new data are collected, and it allows the trial to change course in real time based on those results. Now imagine you’re comparing two pairs of running shoes. Your goal is to see which one helps runners finish faster, so you measure their race times. Runners try Shoe A or Shoe B, and as the results come in, you analyze the times. If runners wearing Shoe A and Shoe B are finishing within a few seconds of each other, you would conclude the shoes perform similarly, meaning they are non-inferior. If runners wearing one shoe are consistently finishing much faster, you can say that shoe is superior, and the trial may stop early because you’ve clearly found the better option. If one shoe repeatedly produces slower times compared to the standard, you may stop the trial for inferiority, because continuing would not benefit runners. This approach allows the study to learn as it goes and make decisions based on accumulating evidence rather than waiting until the very end. The Bayesian adaptive model also utilizes a statistical tool known as dynamic borrowing. Dynamic borrowing is a statistical method that allows data from related groups to be shared or pooled when their outcomes appear similar, but automatically reduces or stops that sharing when the groups differ, ensuring accuracy and preventing misleading conclusions. For example, if Shoes A and B are producing similar race times (non-inferior), the coach can combine or “borrow” data from both groups and average their times, which increases statistical precision. However, if one shoe becomes clearly superior or clearly inferior, dynamic borrowing stops, because the race times are no longer comparable and averaging them would distort the results. In this running-shoe analogy, the RENOVATE trial was essentially comparing Shoe A (BPAP) and Shoe B (HFNC) to see which helped patients “run faster,” or achieve better clinical outcomes in 5 different pathologies. In this running-shoe analogy, the RENOVATE trial was essentially comparing Shoe A (BPAP) and Shoe B (HFNC) to see which helped patients “run faster,” or achieve better clinical outcomes across five different respiratory pathologies. As results accumulated, the Bayesian adaptive model used dynamic borrowing and could combine results when both devices performed similarly, but stopped pooling data if one clearly helped patients more or less. 🗣️ Discussion What RENOVATE asked and what it found: The RENOVATE trial is the first multicenter randomized study to directly evaluate whether HFNC is non-inferior to BPAP for preventing intubation or death across multiple etiologies of acute respiratory failure. Overall, HFNC met non-inferiority criteria in four of the five predefined subgroups, with much of the statistical strength coming from the Bayesian borrowing structure. However, several design and analytic choices limit how confident we can be in these findings across all groups. Bayesian model, borrowing, and small numbers: The Bayesian hierarchical model improves precision by “sharing” information between subgroups when outcomes look similar, but this does not fully fix the problem of small sample sizes. In subgroups with low numbers, the model still has less power and more uncertainty, and the apparent stability of the estimates is heavily influenced by the borrowing framework rather than large, subgroup-specific datasets. COPD and ACPE – who actually got randomized: In both COPD and ACPE, enrollment decisions likely removed many of the sickest patients from randomization. COPD patients could be stabilized for up to six hours on BPAP before being randomized, and ACPE patients who clearly required immediate BPAP were excluded altogether. Because the trial never reported how many patients were treated or excluded in the ACPE group, we do not have a clear picture of how sick the randomized patients really were. Rescue BPAP in the HFNC arm: Rescue therapy adds another layer of ambiguity. Nearly a quarter of COPD patients in the HFNC arm required rescue BPAP, yet the study did not describe the BPAP pressure settings used, how many times rescue could be repeated, or whether these patients ultimately improved, failed, or required intubation. This is particularly important because the primary endpoint is intubation within seven days, and we do not know how much non-standardized BPAP rescue influenced that outcome in patients initially assigned to HFNC. Different weaning strategies between HFNC and BPAP: Weaning practices also differed meaningfully between HFNC and BPAP. HFNC patients could be considered “weaned” while still receiving flows that are well above physiologic baseline (25–30 L/min), whereas BPAP weaning was left largely to clinician judgment without tightly aligned criteria. This lack of standardized weaning makes it difficult to directly compare the two modalities in terms of duration of support and when a treatment should be considered to have “failed.” Value of multiple etiologic subgroups: Rather than asking a single global question of whether HFNC works for all causes of acute respiratory failure, the trial was designed with multiple etiologic subgroups. This allows us to compare HFNC and BPAP within distinct pathologies commonly seen in the ED and ICU. In practice, this design helps us look across each subgroup and think about which modality—HFNC or BPAP—may be most appropriate for a given underlying diagnosis. Immunocompromised subgroup had early futility and inadequate support: In immunocompromised patients, HFNC clearly underperformed BPAP on early outcomes. Intubation rates were higher with HFNC (50.0% vs 31.8%), and early deaths were also higher (17.9% vs 13.6%), leading this subgroup to cross a prespecified futility boundary and stopping further enrollment. By 28 and 90 days, mortality was similar between HFNC and BPAP in this cohort, suggesting that HFNC alone did not provide enough up-front respiratory support for this high-risk group rather than causing a lasting difference in long-term outcomes. Why COVID was separated from the original ARF subgroups: Early in the COVID-19 pandemic, clinicians were making treatment decisions in real time without established guidelines or a solid understanding of disease trajectory. Many COVID patients behaved clinically like an immunocompromised or atypical ARF cohort. If COVID patients had been left inside the original ARF subgroups, they could have distorted those results and biased the trial toward an apparent signal of HFNC futility. By separating COVID into its own subgroup, the investigators preserved the integrity of the non-COVID etiologic groups while still including COVID patients in the overall study population. This approach allowed for cleaner estimates within each subgroup and more appropriate borrowing across groups without letting a large, atypical population dominate the model. Standardized BPAP delivery as a control: Using one BPAP delivery method for all patients created a built-in control on the BPAP side of the trial. The interface and mode were standardized, so the main difference between patients was their underlying disease and assignment to HFNC vs BPAP. This consistency across BPAP subgroups reduces “noise” in how BPAP was delivered and makes it easier to attribute differences in outcomes to the disease process and modality choice rather than variation in the BPAP setup itself. Single-country setting and external validity: Running the entire study in one country means clinicians share similar training, practice patterns, and system-level resources, which helps keep management more consistent across subgroups and centers. The trade-off is external validity: what is considered “standard” care in this health system may look very different in other countries, particularly in resource-limited settings, so these findings may not translate perfectly to other practice environments. 📘 Author's Conclusion “HFNC met criteria for noninferiority to NIV for the primary outcome in 4 of the 5 patient groups. Small sample sizes and sensitivity to the analysis model suggest further study is needed in COPD, immunocompromised patients, and ACPE.” 💬 Our Conclusion HFNC appears to perform comparably to BPAP in non-immunocompromised hypoxemic and COVID-positive patients. However, the data in COPD, ACPE, and immunocompromised patients are limited and statistically fragile—heavily influenced by small numbers and modeling assumptions—so BPAP should remain the preferred modality when ventilatory support is clearly required and may offer more reliable benefit in these groups. 🚨 Clinical Bottom Line HFNC is a great option for many patients with acute respiratory failure, but some patients clearly need BPAP up front. In patients with obvious BPAP-responsive physiology—such as COPD with acidosis, ACPE with increased work of breathing, or frank hypercapnia—or in those who are crashing at the door, BPAP remains the first-line choice. In more stable patients, especially those without a strong indication for BPAP, with limited hypercapnia, or where comfort and longer-term tolerance matter, HFNC is a reasonable first-line option for extra respiratory support while you closely watch their trajectory and stay ready to escalate. /episode/index/show/rebelcast/id/39866095

REBEL MIND Ep4 – Rest Is Not Sleep: The Seven Dimensions of True Recovery 02/04/2026

REBEL MIND Ep4 – Rest Is Not Sleep: The Seven Dimensions of True Recovery 🗝️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. 📝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 tank 5️⃣Emotional 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 peace 6️⃣Social 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 form Rest is productive – it improves performance, decision-making, empathy Rest is intentional – it requires thoughtful engagement, not autopilot. Make a real plan Rest is layered – especially sensory, which uses all 5 senses Rest is about input and detox – what you consume, and what you remove. Social rest is a good example Rest is personal – one person’s recharge is another’s stressor Rest is deserved, not earned – full stop. 💬Conclusion Rest is a pivotal, multi-dimensional tool that extends beyond mere sleep. For healthcare professionals navigating the strenuous environment of an emergency setting, recognizing and implementing varied forms of rest can enhance overall well-being, decision-making, and patient care. Make rest a deliberate part of your routine, understand its different forms, and remember that it’s a necessity you deserve. 🚨Clinical Bottom Line Incorporating rest into your lifestyle aligns with the demands of your professional roles and personal health needs. By understanding and employing various types of rest, you not only support your individual wellness but also enhance your ability to care for patients effectively. Rest is vital; it is not a privilege earned but an essential right you deserve every day. /episode/index/show/rebelcast/id/38830320

REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia 02/02/2026

REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Sara Crager and Ryan Ernst 01/29/2026

REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Sara Crager and Ryan Ernst 📝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. 🤔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 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 ✈️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. See you there! /episode/index/show/rebelcast/id/39865585

REBEL MIND Ep3 - Performance Coaching in Medicine 01/28/2026

REBEL MIND Ep3 - Performance Coaching in Medicine 📌 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. 📝 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. 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: 🤔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 . 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. /episode/index/show/rebelcast/id/39865805

REBEL MIND Ep2: Performance Under Pressure - What Medicine Can Learn from Elite Teams 01/21/2026

REBEL MIND Ep2: Performance Under Pressure - What Medicine Can Learn from Elite Teams 🗝️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. 📝 Introduction Welcome back to Rebel MIND, the podcast series where we dive into crucial aspects of healthcare worker well-being. In this episode, hosted by Mark and Marco, 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. 🤔 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. By prioritizing their personal wellness, healthcare workers can provide more effective patient care, making this initiative crucial for the entire healthcare ecosystem. 🌟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 exams In 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 hospital Allostatic 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 continues 🏥 Relevance to the Emergency Department and 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 . Also, check out the comprehensive coaching program available, designed specifically for healthcare providers looking to enhance their well-being and performance. 💬 Conclusion 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. PMID: Frueh BC, et al. "Operator syndrome": A unique constellation of medical and behavioral health-care needs of military special operation forces. Int J Psychiatry Med. Epub 2020 Feb 13. PMID: /episode/index/show/rebelcast/id/39800005

REBEL Core Cast 148.0–Demystifying Non-Invasive Ventilation & HiFlow 01/12/2026

REBEL MIND: The Dunning Kruger Effect - Why Looking Inward Improves Patient Care 01/07/2026

REBEL Core Cast 147.0–Ventilators Part 5: Key Mechanical Ventilator Pressures & Definitions Made Simple 12/22/2025

REBEL Core Cast 146.0–Ventilators Part 4: Setting up the Ventilator 12/08/2025

REBEL Core Cast: Pediatric Respiratory Emergencies: Beyond Viral Season 12/04/2025

REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Tarlan Hedayati, Jess Mason and Simon Carley 11/20/2025

REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Tarlan Hedayati, Jess Mason and Simon Carley 📝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. 🤔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 fibrillation Maybe the atrial fibrillation is an adaptive response and slowing them down (whether chemically or electrically) may cause more harm than good Get in the mental space before having to perform a High Acuity Low Occurrence (HALO) procedure and walk through each of the parts step by step (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. See you there! /episode/index/show/rebelcast/id/39034905

REBEL Core Cast 145: Understanding QTc Prolongation: Causes, Risks, and Management 11/18/2025

REBEL Core Cast 144: Tourniquet Tips 11/03/2025

REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy 10/23/2025

REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy 📝Introduction: In this exciting episode of REBEL Cast, host Dr. Mark Ramzy joins forces with renowned educator and speaker, Dr. George Willis. Broadcasting straight from the ACEP 25 in Salt Lake City, the duo talk about bringing together the international emergency medicine community, as they reflect on their experiences at the Increment Conference in Murcia, Spain, and preview the upcoming event this spring. 🤔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 George's IncrEMentuM 2025 Lectures:Pearls from George's IncrEMentuM 2025 Lectures: Sodium Bicarbonate Use: Appropriate Use: Focus on specific instances like metabolic acidosis with renal failure or severe metabolic cases with tox patients (e.g., salicylate or TCA overdose). Emphasis on Patient-Centric Care: Treat the patient, not the number; avoid harmful overreliance on bicarb based solely on lab results Diabetic Ketoacidosis (DKA): Balanced Solutions: Preferenced over normal saline to prevent hyperchloremic acidosis. Potassium Management: Oral potassium is effective and should be utilized, challenging the myth of impaired gastric absorption in DKA. Squid Protocol: Usage of ultra-rapid insulin subcutaneously as an alternative to insulin drips in mild to moderate DKA cases. We covered this topic before on REBEL EM. Check out the and the Crashing Aortic Dissection: Hypotension Insights: Do not attribute sudden hypotension solely to medication; prioritize ruling out tamponade or cardiogenic shock. Ultrasound Utilization: Essential tool for detecting complications like tamponade or low EF due to myocardial infarction or aortic valve regurgitation. Controlled Pericardial Drainage: Crucial technique to stabilize hemodynamics without increasing mortality, avoiding extensive fluid removal Here's a helpful algorithmic infographic to reference for aortic dissection patients Image Courtesy of Dr. Mark Ramzy, DO (@) Hyperkalemia Not every patient needs calcium. Dont just give it prophylatically, only those with EKG changes should get it and get enough of it. Give an appropriate dose of your other medications. That includes giving 10 units of insulin and 2 amps of dextrose 50. One when they get the 10 units of insulin and the other 30 minutes later Patients may be dehydrated, dont give them furosemide or diuretics. Those patients need fluid to help perfuse their kidneys and eliminate potassium Here's George Willis' Hyperkalemia Removal Algorith: Here's a REBEL REVIEW breaking down the different electrolytes in each of the types of fluids: 🫣Teasers from George's IncrEMentuM 2026 Lectures: Severe Thyroid Storm: Diagnosis Reminder: Consider thyroid storm in febrile patients with altered mental status; order TSH tests. Beta Blocker Administration: Use ultrasound to assess heart function before administering propranolol to prevent low output heart failure. Medication Timing: Administer iodine after antithyroid drugs. Refractory Hypoglycemia: Early Use of Octreotide: Beneficial in sulfonylurea-induced cases; initiate treatment promptly for better efficacy. Broadened Perspective: Consider other endocrine disorders as potential causes beyond typical measures. Modern Management of SCAPE: Bolus Dose Nitroglycerin: A recommended practice for quick patient stabilization and improved outcomes in SCAPE scenarios. We covered this topic before on REBEL EM, see Dr. Marco Propersi's ✈️See you in Spain! The upcoming conference aims to gather world-class educators once more and promises an enriching experience for all attendees. George Willis, along with many others, will bring significant discourse to the event. See you there! /episode/index/show/rebelcast/id/38620385

REBEL Cast - DKA Part 2: Beyond the Basics - The SCOPE-DKA Trial 10/21/2025

REBEL Cast - DKA Part 2: Beyond the Basics - The SCOPE-DKA Trial 🗝️Key Points 💧 Fluid Choice Matters: Plasma-Lyte, a balanced crystalloid, corrected acidosis faster than normal saline in severe DKA patients, with no increase in adverse events. 🧪 Chloride Load Concerns: Normal saline’s high chloride content can worsen acidosis, potentially slowing bicarb recovery even after the anion gap closes. 🔬 Study Design Strengths: The SCOPE-DKA trial was a cluster crossover, open-label RCT, protocolizing all variables except fluid type, enhancing the reliability of its findings. 🧮 Base Excess & Strong Ion Difference: Base excess/deficit and strong ion difference are valuable but underutilized tools for assessing acid-base status—don’t rely solely on pH or bicarb. ⚠️ Limitations & Next Steps: The study did not include lactated Ringer’s, and fluid rates were left to clinical discretion. More research, including three-arm trials, is needed for definitive guidance. 📝 Introduction Managing diabetic ketoacidosis (DKA) requires careful consideration of fluid therapy, especially in severe cases. In part two of our REBEL Cast DKA series, we shifted from insulin strategies to fluid choice in severe DKA, diving into the SCOPE-DKA trial—a cluster, crossover, open-label RCT from Australia. While normal saline (NS) is commonly used, concerns about its high chloride content and impact on acidosis have sparked growing interest in balanced solutions like Plasma-Lyte. 🚨 Clinical Bottom Line Plasma-Lyte showed a modest but meaningful benefit over normal saline in resolving metabolic acidosis in patients with severe DKA. Though safety profiles were similar, the more balanced electrolyte composition of Plasma-Lyte helped normalize acid-base status slightly faster—without worsening ketosis. While this won’t revolutionize care overnight, it’s one more step toward physiologic resuscitation in DKA. Understanding fluid composition and its impact on acid-base balance is crucial for optimal patient care. /episode/index/show/rebelcast/id/36657535