REBEL Cast Episode 69: Rebellion in EM Day 3 Speaker Summaries with Andy Little

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Mizuho Morrison & Tad Wilson – Codeine in Kids

1. Don’t use Codeine in kids
2. Lots of side effects and problems
3. Could potentially have issues with metabolism and metabolites

Hilary Fairbrother – Fluid Resuscitation in Pediatric DKA

1. Replete potassium, check early and replete early 
2. No perfect way to perfectly resuscitate pediatric DKA patient 
3. Cerebral edema is not associated with fluid resuscitation of pediatric patients

DeAnna Turner – Why Tramadol should be called Tramadont

1. Tramadol is pharmacokinetically messy, mechanism of action requires conversion to active metabolite.
2. Significant drug interactions increase risk of side effects
3. Seizures & Serotonin syndrome have been reported. SNRI symptoms, high addiction potential and patients will have opioid withdrawals from this medication.

Hilary Fairbrother – The Acute Scrotum

1. Acute scrotum is moderate to severe pain that starts over minutes & can last up to 2 days.
2. Testicular torsion and Fournier’s gangrene are surgical emergencies and need to be considered before moving onto other differentials. 
3. Most common cause of acute scrotum is epididymitis or epididymo-orchitis and can be infectious or noninfectious

Arlene Chung – Why we Should Pursue our Values Instead of our Goals

1. Developing a growth mindset is essential to building a long and fulfilling career
2. Imposter syndrome can present significant barriers to career choices that align with personal values
3. Self reflection and self assessment are important tools for clarifying our values

DeAnna Turner – Adventures in Alcohol Withdrawal

1. Think of adjunctive therapies with benzodiazepines like phenobarbital (gaba agonist) 
2. Dosing of phenobarbital 130mg – 260mg and can redose every 15 minutes
3. The literature for Ketamine is not quite there but the pharmacokinetics make sense
4. Dexmedetomidine is not a good agent, blunts sympathetic output can potentially mask symptoms. 

Salil Bhandari – ED Subaxone Administration

1. Recognize opioid addiction is not a moral failing but a chronic disease state that needs medication
2. Best Medication to treat is buprenorphine, best way to give is to give through ED programs.
3. We as ED physicians need to push for formation of buprenorphine programs in our EDs

Arlene Chung – Matching your Passion and Purpose at Work

1. Burnout has negative consequences for both physicians and patients
2. Wellness is more than the absence of burnout
3. Experience the full spectrum of human emotion is important to combat burnout and something we can experience everyday 

Salil Bhandari – ED Naloxone Distribution 

1. Requires prescription but is important that we give patients that overdosed a script or kit. 
2. Some pharmacies will have prescribers and standing orders to give our Naloxone
3. May take some time and resources but having kits in the ED can significant help these patients

Arlene Chung – Caring for Yourself: Health, Diet, and Sleep

1. Disruption in sleep and circadian rhythm are likely root cause of other poor health outcomes in shift work 
2. Individual practices can be immediately beneficial but require some planning
3. Departmental policy should be considered to improve the health of all providers 

Shownotes Written By: Miguel Reyes, MD (Twitter: @miguel_reyesMD)

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)