We do not encounter abdominal compartment syndrome often in the emergency department. With that said, this diagnosis enters our differential from time to time. Consider the patient with an active arterial bleed from a liver mass with large…
Quick word: Demonstrating a normal sized RV does not rule out PE. With that said, if you have a hypotensive patient in whom you are concerned about massive PE, demonstrating the patient has a normal sized RV can lead you to consider alterna…
This pearl will be a brief rundown of the hemodynamic effects of BIPAP on the patient with sympathetic crashing pulmonary edema. This is an apical four chamber view with a dilated right ventricle – stretched vertically to the point of…
As the title implies, this is a strange pearl. Imagine the following: You are in a can’t intubate/can’t ventilate scenario. The patient’s neck is large, and the landmarks are poor. You cut through a depth of redundant tis…
The Jaffe reaction, named for 19th century German biochemist Max Jaffe, is a colorometric assay used by most every clinical lab to measure creatinine. In an alkaline medium, creatinine reacts with picric acid to form a red colored compound;…
CAUTION Messing with a pump is an easy way to draw the ire of your nursing colleagues. There are ways to mess this up, and every change in rate needs to be charted. If you’re going to start a drip or change a drip rate, make sure you…
There are better tutorials on how to set up a pressure transduction line. This tutorial specifically addresses the equipment available in the resuscitation bays at Mount Sinai. You need: (1) Bag of normal saline (any volume will do, prefera…
This is the last segment of the LVAD-oriented series of pearls. There are a number of LVAD-related complications to be aware of. Disclaimer: I am an emergency medicine resident, not a heart failure fellow. This is my synthesis of a potpourr…
There is a critical addendum to yesterday’s post, courtesy of Sam Schuberg. Patients with LVAD’s can go into dysrhythmias (VT, VF) despite the appearance of stability. Obtain an ECG on arrival in unstable patients with an LVAD. …
LVAD management is an appropriate topic for a fellowship; not necessarily a TR pearl. But, resuscitating the sick LVAD patient is firmly within our scope of practice, and requires some basic knowledge of LVAD physiology. Enter rough sketch…
The monitors at Mount Sinai (and at Elmhurst, and at most hospitals) allow you to add a tone to the pulse oximeter waveform (see: plethysmograph). The tone is a simple beep, but as the saturation drops so too does the frequency of that beep…
