The Golden S Sign

Shoutout to the awesome David Cisweski for following up this tidbit from conference and giving us this pearl. Remember in conference when Dr. Jacobi was going over chest X-rays, was talking about the Golden S sign, and we could neither see the S nor the gold? What? – The Golden S sign is also referred to by the moreRead more

SVT and Paranasal Etripamil

Have you had one of those resus shifts where everyone and their mother seems to be in an arrhythmia? Have some of them been older patients with SVT that just make you a little antsy about giving medications like adenosine multiple times after Valsalva maneuvers haven’t worked or then having to try an IV betaRead more

Air Pollution and Stroke?

One growing global health issue is ambient air pollution. One of the leading risk factors for disease is fine particulate matter in outdoor air. The WHO states 1 in 8 deaths is due to air pollution. So what is it’s effect on cerebrovascular disease? In Annals of Emergency Medicine from this month, a study was publishedRead more

Nursemaid’s Elbow Reduction

Radial head subluxation, more commonly known as nursemaid’s elbow, can be seen more frequently in the pediatric population. Imagine a parent quickly pulling a child’s arm (usually 1-4 years old) that was held in extension in order to prevent a fall — the kid then holds their forearm in the pronated position and close toRead more

Tis the season – for rhinosinusitis

It’s an intake shift and yet another person comes in saying, “I feel congested doc. I need antibiotics for sinusitis.” A recent Cochrane review published in September 2018 that included 15 trials involving 3057 patients reviewed the need for antibiotics in acute rhinosinusitis (infection of the nasal passages and paranasal sinuses of less than 4Read more

Corticosteroids in Septic Shock

Should patients in septic shock get corticosteroids? A meta-analysis of 22 randomized clinical trials (RCTs) published in Intensive Care Medicine in July 2018 compared low-dose steroids vs placebo in adults in septic shock. It found that giving steroids (typically hydrocortisone) did not affect short or long term mortality, but found that the duration of shock,Read more

The Sinai Troponin

What is Sinai’s troponin assay? Answer: ARCHITECT STAT Troponin-I A Global Task Force with involvement from the American Heart Association (AHA), American College of Cardiology Foundation (ACCF), European Society of Cardiology (ESC), and World Heart Federation (WHF) agreed on a universal definition of myocardial infarction that supports use of cTnI as a preferred biomarker for myocardial injury. Elevated levelsRead more

Vanc + Zosyn and acute kidney injury

Vancomycin and Piperacillin-tazobactam (Zosyn) are two widely used broad spectrum antibiotics most ED providers use severe infections and especially undifferentiated sepsis. These antibiotics together synergistically fight off  MRSA, Pseudomonas, and other dangerous gram negative and gram positive infections for our sick patients.  Often times we use Vanc and Zosyn without considering other antibiotic therapy optionsRead more

Time to Bind…

So you’re working a busy A side shift at Elmhurst and you get an alert from EMS about a polytrauma. The patient rolls through the door alert but moaning in pain with obvious road rash to the bilateral lower extremities. He states he was in a motorcycle accident. He’s tachycardic and hypotensive. After a negativeRead more

Sphenopalantine Ganglion Block for Headache

“I have a headache”….the number of times we as ED providers have taken care of a patient with this complaint is uncountable. Once we have established that the source of the headache is not life threatening we then move on to how to treat and make the patient more comfortable. Standard care of practice hasRead more