Blog

Interscalene Nerve Block – Knockout That Upper Extremity

The Interscalene Block So, you want to provide local anesthesia to the patient with a broken clavicle or a dislocated shoulder. Maybe there’s a proximal / mid-humeral fracture or an injury over the deltoid. Whatever your needs may be, the interscalene block is an option for targeted anesthesia in the upper extremity to knock out partsRead more

Lower Extremity Nerve Block: The Posterior Tibial Nerve

Today’s lower extremity block is going to be the posterior tibial nerve. The sensory distribution should be helpful for things like foreign bodies that need to be taken out of the foot.     Anatomy – The largest of the five nerves at the level of the ankle, the posterior tibial nerve is posterior toRead more

Lower Extremity Nerve Block: The Sural Nerve

  The next three series in the SinaiEM pearls will be on nerve blocks of the foot. Today is going to cover the sural nerve block which should anesthetize the area depicted by the cross-hatched area in the figure.   As a terminal branch of the sciatic nerve, the sural nerve innervates the lateral portionRead more

Awake Intubation Topicalization

Compiled from a variety of sources from #FOAMed (specifically, NYSORA and the ACCRAC podcast) and inspired by morning report today with Taryn and Tina, here is a quick and dirty rundown for awake intubation. Firstly, we should be considering this method when the two Venn diagrams of “anatomically challenging” and “enthusiastically cooperative” overlap in theRead more

How-To: Preoxygenation via SIMV Noninvasive Ventilation

Inspired by a morning report discussion from our very own Lara Vanyo on preoxygenation strategies, I thought it would helpful for a brief run-down on the button-pushing needed to perform preoxygenation by way of noninvasive ventilation. The video below is specific to the vents we have at Sinai–Weingart and Elmer have already shown us how toRead more

That Vitamin C in Sepsis Newsflash

A number of really bright people are still unsure of what to make about the vitamin C, steroids and thiamine newsflash that’s taken Twitter by storm yesterday. At Sinai here we’re the curious types, so we chatted with our pharmacist who similarly didn’t know what to make of the headlines given the lack of a randomizedRead more

Giving tPA to a patient on aspirin? What about aspirin and Plavix?

Does it matter if my patient getting tPA is on prestroke antiplatelets?   The neurology and ED teams have decided to give tissue plasminogen activator (tPA). As an outpatient, the patient is on aspirin and clopidogrel dual antiplatelet therapy. Does it matter that they’re on aspirin and Plavix? Does prestroke antiplatelet therapy in acute ischemicRead more

That Prolonged QT Warning?! Magnesium for Cardiac Arrhythmias

You get a pop-up warning in the electronic medical record about potentially adverse interaction with a prolonged QT interval. What’s the risk, right? Afraid of a little torsades de pointes? Can’t we just give some prophylactic magnesium and call it a day? Let’s see if there’s any literature out there… First off, let’s review magnesium.Read more

The 52 in 52 Review: Comparison of Dopamine and Norepinephrine in the Treatment of Shock

The 52 in 52 Review: Comparison of Dopamine and Norepinephrine in the Treatment of Shock   Article Citation: De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-89.   What We Already Know About the Topic: The recent 2016 Surviving SepsisRead more

Mechanical Ventilation Protocol in the ED

Citation Fuller BM, Ferguson IT, Mohr NM, et al. Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial. Ann Emerg Med. 2017; Clinical Question Does a multifaceted, 4-part, ED-based mechanical ventilator protocol improve respiratory and ventilator-associated outcomes? The Short Version: Using a mechanical ventilation protocol (i.e., protective tidal volumes, appropriate PEEP, lowRead more