2016 Critical Ultrasound Course

On December 4th the Department of Emergency Medicine hosted its 11th hands-on ultrasound course at Mount Sinai. Over forty participants practiced critical ultrasound skills on live models and simulators, guided by a dozen of our faculty and fellows.  Read more

‘Brief Resolved Unexplained Events’ to replace term ALTE

The American Academy of Pediatrics has recently released new guidelines attempting to replace the term apparent-life threatening event (ALTE) with brief resolved unexplained event (BRUE). The term ALTE was somewhat subjectively defined and represented an event scary to an observer usually involving apparent apnea of an infant. BRUE is defined as an event occurring inRead more

A Case for Shared Decision Making: CT Angiography vs LP for Subarachnoid Hemorrhage

Scenario: The images from your patient’s non-contrast head CT are finally uploaded and it looks negative. Unfortunately, your patient has been having severe symptoms for almost 24 hours and you know this single study is not sensitive enough to rule-out a SAH. Have you ever informed your patient about the need for LP and haveRead more

Double Sequential Defibrillation for Refractory Vfib

In honor of 5/20/16, a day in which the Sinai ED managed three cardiac arrest patients in less than one hour, I wanted to post a pearl relevant to one of the cases we saw. Our initial goal during a Vfib arrest resuscitation is to optimize uninterrupted compressions and deliver a shock as soon asRead more

Zika: What We Know & What We Don’t

The WHO declared a Public Health Emergency of International Concern on February 1st, 2016 due to the outbreak of microcephaly and Guillain-Barre Syndrome cases associated with the Zika virus. Here’s a quick review of what we do and don’t know: Where is it? Outbreaks have been seen in Southeast Asia, Africa, and the Pacific Islands.Read more

Narcan for the road?

     I could bullet point plenty of statistics, but I don’t think I have to convince you: there is an opioid epidemic and it is getting worse.       We all have treated patients for opioid overdose in the ED. We also frequently identify substance abusers who are at high risk for futureRead more

Digital Intubations

Among the least commonly utilized intubation techniques stands the humble digital intubation. The name says it all: the intubator uses their index and middle finger like a miller blade to locate (by palpation) and lift the epiglottis before gliding the ETT between the fingers into the trachea. More commonly utilized in pre-hospital and tactical situations,Read more

Suturing the Thin-Skinned

The thin, friable skin of elderly patients can present a special difficulty for laceration repair. If you find yourself pulling through the skin as you try tighten knots, applying steri-strips along the edge of the skin can serve as a fortifying layer to make the repair easier. Technique illustrated below: essentially suture through the steri-stripRead more

Is it Really Necessary to Place NGTs for all SBOs?

When consulting your surgical colleagues about a potential small bowel obstruction, you may often be requested to place a nasogastric tube for bowel decompression regardless of how the patient appears clinically. Your patient will almost certainly dislike the procedure (prior studies have suggested patients find NGT placement to be the MOST painful ED procedure, overRead more

Single Injection Digital Nerve Block

Although not a difficult procedure, the traditional approach to a digital nerve block involves two painful injections to the the digital nerves on either side of a finger, and may yield inconsistent results. An alternative, the flexor tendon sheath injection, requires slightly more skill and a slightly more painful injection. But lo, another (not new)Read more