Blog

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

Absolute Lymphocyte Count as a Predictor of CD4

An HIV positive patient presents to the ED but doesn’t know his CD4 count. He hasn’t been taking his HAART and you’re rightfully concerned that he might be susceptible to opportunistic infections. Unfortunately, you can’t find any information about how immunosuppressed he is. Is there a way to estimate his CD4 count? Luckily, there is!Read more

Just a simple guaiac test….but what makes it tick?

Lets be honest: whether you like it or not, it’s a rare day working in the ED when you don’t guaiac someone. To “guaiac them” is of course slang for performing a point of care fecal occult blood test. Its a valuable tool and can yield useful clinical information when used appropriately. But do youRead more

Tumor Lysis Syndrome

A young lad with acute lymphocytic leukemia (ALL) shows up to your ED feeling very weak and c/o sever muscle cramps. On further questioning he reveals that he started chemotherapy 3 days ago. Labs show potassium of 6.5 mEq/L, calcium of 6.3 mg/dl and a creatinine of 11.1 mg/dL. How are you going to help this lad? ANSWER:Read more

Six of One, Half Dozen of the Other?

Your patient is a 50 year old male who presents with head trauma.  He takes aspirin daily.  Neuroimaging demonstrates subdural and subarachnoid hemorrhage.  You plan to treat with DDAVP and platelet transfusion.    When ordering the platelets you note that, whereas you are used to ordering a platelet “six pack,” the default order is forRead more

Pittfalls in Dvt Management

You’re on your last patient of the day, starting to thinking about which type of sushi you’re going to order later, when the ultrasound comes back. Positive study, you were sure of it, after all, the patient had a hx of cancer and 3 days of progressive leg swelling and pain. He looked like this:Read more

Ddavp for Hemorrhage in Esrd Patients

CASE: 45F h/o ESRD on dialysis presents ped struck. Pt is obtunded, intubated for airway protection. CT head shows subdural hematoma with midline shift. Neurosurgery is activated. No antiplatelets or anticoagulants. Is this person coagulopathic simply by having ESRD? If so, should we address it with any particular medication?Read more

Head Injury in Hemophilia

An 8 year old female is brought in by her mother after falling off her scooter one hour ago. She was not wearing a helmet, and hit her head on the ground. Patient and mother deny LOC. On exam, she is well-appearing, playing with her mother’s cell phone. She has a mild hematoma over herRead more

Heme Questions

Here are some Heme questions for your holiday weekend. Enjoy! 1. A 9-year-old female with mild type I von Willebrand’s disease presents with mild gingival bleeding after her first overly vigorous attempt to use dental floss. She stopped as soon as she noticed bleeding, which is limited to the space between her upper central incisors.Read more

Pearl for 12/21

A 25 yo male with no PMH walks into your ED complaining of right neck pain, right shoulder stiffness,  and cough x 1 month, no fevers chills. On exam his vitals are all within normal limits, exam is notable for right sided swelling and asymmetric neck. CXR as below:       What are youRead more