Core Content: Critical actions for the preeclamptic patient

Tl;dr: (1) Don’t forget to order a uric acid with the labs as it increases the specificity in diagnosing preeclampsia. (2) If the pt is preeclamptic with severe features (see below), then give 4g IV Mg followed by 1-2gr/hr infusion for 24hrs. (3) Unlike other hypertensive emergencies, start with push dose meds rather than ourRead more

Keeping Myxedema Coma in the Mix: Is Hypothyroidism in Your Differential?

Myxedema coma, or severe hypothyroidism, is an emergent condition with a high mortality rate (30-60%). Our patients rely on us to catch it early and treat aggressively. About 90% of cases occur during the winter months, and it is rarely seen in patients younger than 60.   Causes: Myxedema coma is usually precipitated by anotherRead more

Fitz-Hugh-Curtis Syndrome

Don’t forget to consider Fitz-Hugh-Curtis Syndrome in your right upper quadrant pain differential!   Fits-Hugh-Curtis Syndrome is a rare disease process characterized by perihepatitis as a complication of pelvic inflammatory disease (PID). Patients usually present with severe and sudden onset pain in the right upper quadrant. Movement will typically worsen the pain. The patient mayRead more

Bites Bites Bites

Animal Bites (Cat, Dog, Monkey, Lizard, Snake) Quick bullets to prep for in-training, let’s review Management for ALL animal bites X-ray if suspect foreign body Remove teeth Routine wound care/irrigation Update tetanus   Cats Pathogens: Pasteurella, Bartonella (cat scratch) Treatment Leave the wound open (don’t suture) Strongly consider antibiotics for ALL bites  Amoxicillin/clavulanate PCN allergic:Read more

High Altitude Illnesses, part 1

While we may not see as many wilderness related injuries in the concrete jungle of NYC, they are important to know. Especially when you ski out west, tick off the bucket list item of trekking K2 or when it inevitable shows up on the boards. Today we will talk about acute mountain sickness (AMS) andRead more

Unstable Cervical Fractures

Last pearl before our inservice tomorrow. Good luck to everyone. Hopefully this will buy you an additional point.   Jefferson Bit Off A Hangman’s Tit = Unstable cervical spine fractures   Jefferson Fracture A burst fracture of the ring of C1 Typically caused by an axial loading force to the occiput (think diving injury) TypicallyRead more


This pearl was created in light of our impending in-service exam this Wednesday.  Hopefully reading this will give you at least 1 point on the exam. A 19 yo F ingested 150 pills of Tylenol four hours ago and is presenting now because she does not want to die.  As your nurse is drawing labs yourRead more

Name That Poisonous Beast!: the Final Episode

In my last day as TR, I will end with a final “Name that Poisonous Beast!”.  Farewell, to poisonous beasts everywhere!  In this case, back in the garden. Name this poisonous beast! A) And it’s amphibian colleague: B)Read more

It’s Back! Name That Poisonous Beast! (reprise)

And back by popular demand, it’s another installment of “Name that Poisonous Beast!” Name this poisonous beast! A) And it’s stony neighbor: B)Read more

Shouldn’t I Just Give the Little Guy Some Albuterol?

You see a 20 month old with no PMH who has been wheezing and coughing for a few days.  His cousin has RAD.  Should you just give him a little albuterol and see how he does? Here’s his x-ray: What are you concerned for?Read more