🗝️ Key Points

• 💨 NIV = Support without a tube: CPAP, BiPAP, and HFNC improve oxygenation and reduce the work of breathing.
• 🫁 CPAP = Continuous pressure: Best for hypoxemic patients (e.g., pulmonary edema, OSA).
• ⚖️ BiPAP = Two pressures (IPAP/EPAP): Great for hypercapnic failure (e.g., COPD, obesity hypoventilation).
• 🌬️ HFNC = Heated, humidified high flow: Reduces effort, improves comfort, and enhances oxygen delivery.
• 🩺 Supportive, not definitive: NIV stabilizes patients while the underlying cause is treated.

📝 Introduction

Non-invasive ventilation (NIV) refers to respiratory support provided without endotracheal intubation. The most common modalities include continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), and high-flow nasal cannula (HFNC). These therapies aim to improve oxygenation, reduce the work of breathing, and potentially prevent invasive mechanical ventilation.

Welcome to REBEL MIND—Mastering Internal Negativity during Difficulty. In this series, we turn the same critical lens REBEL EM uses for literature inward—into mindset, leadership, and psychological safety—so we can deliver better care outward to patients and teams.

In this episode and blog post, host Mark Ramzy and co-host Kim Bambach (Assistant Professor of Emergency Medicine, The Ohio State University) explore a deceptively simple question: How accurately can we assess our own performance? The answer hinges on a classic cognitive bias that touches all of us in emergency medicine.

🗝️Key Points

🧠 We don't know what we don't know: Low experience can inflate confidence; true expertise usually brings humble certainty.

🏥 ED relevance is universal: From central lines to transvenous pacing, over- or under-confidence shows up at every level—intern to seasoned attending.

🧩 Metacognition matters: Accurate self-assessment is a clinical skill; reflection + feedback loops keep us calibrated.

🛠️ Practice beats bravado: Skill decay is real; deliberate practice and HALO (high-acuity, low-occurrence) refreshers protect patients.

🤝 Psychological safety ≠ niceties: "Confident humility" enables questions, feedback, and better resuscitation decisions—especially under uncertainty.

💬Conclusion

The Dunning–Kruger Effect isn't a moral failing; it's a predictable human pattern that every clinician rides—often multiple times per day in the ED. The antidote is metacognition: routine reflection, explicit debiasing, deliberate practice, and feedback within a psychologically safe culture.

🚨Clinical Bottom Line

Competence is quiet and curious. The more we know, the more we recognize what we don't—and the better we become at caring for patients and each other.

📝 Introduction

Learn how to interpret PIP, Pplat, PEEP, and driving pressure on the ventilator. Understand lung compliance, VILI prevention, and ARDS ventilation strategies.

🗝️ Key Points

• 💨 Peak vs. Plateau Pressures: PIP reflects total airway resistance and compliance, while Pplat isolates alveolar compliance—elevations in both suggest decreased lung compliance (e.g., ARDS, pulmonary edema, pneumothorax).
• 🧱 PEEP Protects Alveoli: Maintains alveolar recruitment and prevents collapse; typical range 5–8 cmH₂O, but higher levels may benefit moderate–severe ARDS.
• ⚙️ Driving Pressure (ΔP = Pplat − PEEP): Lower ΔP reduces atelectrauma and improves outcomes; optimize by adjusting PEEP thoughtfully.
• 💥 Prevent VILI: Keep Pplat < 30 cmH₂O, use low tidal volumes (6 mL/kg IBW), and monitor for barotrauma, volutrauma, atelectrauma, and biotrauma.
• 📚 Evidence-Based Practice: ARDSNet and subsequent trials confirm that lung-protective ventilation—low Vt, limited pressures, and individualized PEEP—improves survival in ARDS.

Ventilator management can feel overwhelming—there are so many knobs to turn, numbers to watch, and changes to make. But before adjusting any settings, it's crucial to understand why the patient is in distress in the first place, because the right strategy depends on the underlying cause. In this episode, we'll walk through three different cases to see how the approach changes depending on the problem at hand.

Key Tips for Managing Pediatric Respiratory Cases In this episode of the Rebel Core Content Podcast, host Swami and PEM specialist Dr. Elise Perlman dive into critical insights for managing respiratory cases in infants, babies, and toddlers during the viral season. They discuss important pearls such as assessing patients from the doorway, localizing respiratory sounds, and differentiating between upper and lower airway obstructions. They also elaborate on managing common conditions like bronchiolitis, asthma exacerbations, and identifying zebras among routine viral cases. The episode provides valuable tips for emergency medical professionals to enhance patient care and avoid missing serious conditions.

00:00 Introduction and Guest Welcome
00:13 Diving into Viral Season in Pediatrics
01:15 Pearl 1: Observing Respiratory Patterns
03:17 Pearl 2: Localizing Respiratory Sounds
06:32 Treating Different Respiratory Conditions
10:57 Managing Severe Asthma Exacerbations
15:32 Identifying the Zebras: Uncommon but Critical Diagnoses
20:01 Conclusion and Final Thoughts

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.

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.

• 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
  • • EMRAP has uploaded the video of the Resuscitative Hysterotomy here (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)

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. For more information on the IncrEMentuM Conference and to register, visit their website! See you there!

The QT interval is a vital part of ECG interpretation, reflecting the heart's electrical recovery after each beat. When prolonged, it can set the stage for torsades de pointes. Understanding how to measure and correct the QT interval, identify high-risk medications, and act quickly when TdP occurs is essential for every clinician. This guide walks you through the physiology, interpretation, common causes, and emergency management of QTc prolongation to keep your patients safe.