In honor of a rosh review question that I got wrong, lets review Lyme disease!


Lyme disease is caused by the spirochete Boriella burgdorferi, transmitted to humans through tick bites from ixodes ticks.

Location: US, endemic in NE coast, midatlantic region, and north central states.
Transmission: transmission of the spirochete occurs during feeding which happens approximately two days after attachment ot the person.
stage 1 – erythema migrans rash and viral syndrome (1-2 weeks)
stage 2 – early disseminated infection with multiple annular lesions sparing the palms and soles, AV blocks and dysrhythmais, radiculopathy, cranial nerve palsies, conjunctivitis, optic neuritis, (days to weeks)
stage 3 – late disseminated infection with arthritis, encephalopathy, fatigue, polyneuropathy, (months to years)
if positive, obtain Western Blot
cultures, serologies
LP for patients with neuro findings (lymphocytic pleocytosis, elevated protein, normal glucose)
Doxycyline 200mg x 1 for prophylaxis (if tick attached >24 hrs)
Doxycycline 100mg PO BID x 14-21 days
Amoxicillin 500mg PO TID x 14-21 days if pregnant
Treat lyme meningitis for longer duration with doxy (14-28 days)
  • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

  • Bag Mask Ventilation During Intubation

    A few days ago NEJM published the results of an investigation with profound implications for our specialty.  A group of intensivists and anesthesiologists conducted a multicenter, randomized trial conducted in seven ICUs to study theRead more

  • Gastric Emptying for Acute Poisonings

    At the request of department leadership, we will be revisiting methods of gastric decontamination for today’s pearl.  Two methods in particular. Ipecac-induced emesis and gastric lavage are two procedures that we read about in medicalRead more

  • Pacemakers Review pt. 3

    Today we will review complications associated w/ implanted pacemakers that you may encounter in the ED and thus ought to be familiar with. Generally, complications can be divided into two categories: early vs. late EarlyRead more

  • Pacemakers Review Pt. 2

    Cardiac pacing as an intervention can be conceptualized as addressing problems in electrophysiological conduction and/or.  So, for example, if there is a disruption in the electrical continuity between the atrium and the ventricle, a pacerRead more

  • Pacemakers Review Pt. 1

    The pursuit of mastery over cardiovascular emergencies demands a rough familiarity with implanted devices which includes why they get implanted in the first place (indications), how they work, how they malfunction, and how they affectRead more


    Your patient has an SBO and has repeated bilious emesis on the side. The surgery team is in the OR and they ask if you can place the nasogastric tube (NGT). Lets review proper NGTRead more

  • No, that’s not an olive. That’s Pyloric Stenosis!

    Inspired by what appears to have been a very interesting day in the Peds ED, lets review a rare but interesting pediatric entity: PYLORIC STENOSIS Background: MC in Males (5:1) & firstborn children (30%) UsuallyRead more

  • Ouch that monkey bit me!

    At the request of a colleague who recently treated a patient bitten by a monkey, I am going to write about treatment and prophylaxis for animal bites. First, a little BIT (get it?) about monkeyRead more