Amiodarone or Procainamide for the Acute Treatment of Stable Vtach?

Per ACLS guidelines, stable ventricular tachycardia can be treated with either IV Amiodarone or IV Procainamide. Clinically it appears that Amiodarone has been the preferred agent, although both drugs have received a class II recommendation. There is one study in particular, the PROCAMIO Trial, that compares the effectiveness of both drugs and their side effectsRead more

Nebulized TXA for hemopytsis

Tranexamic acid (TXA) is a synthetic anti-fibrinolytic agent used to treat many different bleeding complications. It’s implications in trauma as well as its various routes of administration including orally, IV, and topically have been well studied. However there are rather few studies that detail the benefit of nebulized TXA. One case in particular involving massiveRead more

Quadriceps tendon rupture. Xray or not?

The quadriceps tendon attaches the quadriceps muscle to the patella. Tears most often occur just above the insertion on the patella. They more commonly occur in men (8:1 ratio) and patients report hearing a popping sensation doing activities that involve a change of direction while jumping or landing from a jump. Diagnosis can often beRead more

Mandible Fracture? That’s what a tongue depressor is for…

So you’re working a Saturday overnight B side shift at Elmhurst. Its 3am and you have a patient in the hallway who looks questionably intoxicated and has been assaulted. Grossly he has no facial or head injuries (no lacs or abrasions) but you walk over to the patient and he is grabbing his jaw. YouRead more

Put down that FOBT

“The HgB has dropped, have you checked a guaic?” How many times have you checked a FOBT in your workup for anemia? Let’s take a look at what FOBT is supposed to be used for. FOBT is a visual stool assay in which heme in the stool reacts with reagent hydrogen peroxide to oxidize guaiac, leadingRead more

A ‘normal’ chest Xray

What do you see when you take a look at this Chest radiograph? It isn’t immediately noticeable (and was read as normal), and is a good reminder of why you should always check your own films, and why a systematic read is important.  If all you were looking for was “r/o PNA/PTX” you could easilyRead more

Overshot that INR

There have been a few cases of supra-therapeutic INR in the Sinai ED recently, and at the request of one of our superstar interns, below you will find a brief set of recommendations regarding Supratherapeutic INR. The following bolded recommendations are for your patients who have no clinically significant bleeding: (These are recommendations based on AmericanRead more