Tca in Peds.

You are on your PEM shift overnight when a 9 year old boy with history of behavior disorder, BIBEMS only moments (<30min) after witnessed ingestion of 500mg of his grandmother’s amitriptyline. On arrival, ABC’s intact, and the patient is sleepy but easily arousable. Normal vitals for his age. An EKG is performed, which appears normal.Read more

Status Epilepticus

69 yo M with remote h/o CVA with residual aphasia and R–sided hemiparesis, BIBEMS from NH with concern for status epilepticus (SE). Per EMS, the patient began to have 3-4 episodes of generalized convulsive activity that began about 30 minutes PTA and refractory to both IV Ativan given by NH and IV Valium given byRead more

Wide-complex, Irregular Tachycardia

You are catching up on some charts in the resuscitation area of your ED when your triage nurse pushes in a 37 yo M with no PMHX, who presented to your ED complaining of sudden onset lightheadedness and L sided chest pain about 10 minutes PTA while at rest. No prior episodes. No CAD riskRead more

Lump in My Throat…

A 19-year-old-male with no known past medical history, presents in progressive respiratory distress shortly after undergoing a tooth extraction about 6 hours prior to presentation. Symptoms began initially as “a lump in his throat” and difficulty swallowing, but eventually progressed to mild dyspnea after 1-2 hours. Denies FB or allergies. On arrival he appears anxiousRead more

Did Hemodialysis Just Remove All My Patient’s Meds?

44 yo F with h/o ESRD on HD and neurosarcoidosis complicated by panhypopituitarism on chronic steroids and thyroid replacement, BIBEMS obtunded. Last seen normal a few hours ago. The patient is hypotensive SBP ~75 and FSBG is undetectably low. The patient’s mental status responds well to D50. She denies exogenous insulin, or other ingestions. AdmitsRead more

2015 Peds Ultrasound CME course

Over forty participants joined Sinai faculty Jim Tsung, Ee Tay, Bret Nelson, Joshua Guttman, Jacob Goertz, Turan Saul, Jenny Sanders, Kimberly Kahne, Michelle Vazquez, Joe Sorravit, and Rupi Mudan. Course Directors Ee Tay and Joshua Guttman organized great didactic content and lost of hands-on training (HOT) with pediatric models. Participants from many pediatric and acuteRead more

It’s Not a Coma..

54 yo F with no PMHx, but admittedly has not been seen by an MD in many years, presents after her daughter visited from our-of-town and found her slightly confused. The patient is disoriented, but able to provide some history. She describes progressive fatigue over several weeks. Vitals signs are remarkable for hypothermia 94F, HRRead more

Aortic Stenosis

56 yo F with no PMHX, presents complaining of increased DOE and orthopnea for several weeks. She also reports intermittent, mild mucosal bleeding. She denies syncope. Physical exam is notable for an obvious crescendo- decrescendo murmur over the right sternal border. CXR shows an enlarged heart and pulmonary congestion. The patient is suffering from severeRead more

The Bends

You are fed up with the big city, so you decide to take a job as an ‘island doc’ in the Caribbean. Life is good. It’s your second day on the job, and an 18 year old man is carried into your clinic with severe knee pain and shortness of breath. He’s just been diving.Read more

A 30 year old male presents to your ED, complaining of wrist pain following a fall while playing roller hockey. He denies wearing protective gear. On exam he has point tenderness over the dorsal aspect of his R wrist. You order an plain film: What is your diagnosis? Scapholunate dissociation (SLD) refers to a disruptionRead more