Lara Silverman MD/MPH, Emergency Medicine PGY3 Dizziness is vague, subjective, and the differential is literally everything from “you’re drunk go home” to life-threatening. Classically, we’re taught that dizziness is separated into 4 catego…
Intro: Stroke is the third leading cause of death and number one cause of disability in the United States. Classically, strokes present with sudden onset focal neurological deficits in a vascular distribution and need prompt assessmen…
CSF shunts – these are the most common pediatric neurosurgery procedure done in the United States. While very common, these also have the highest rate of neurosurgical complications. About 50% fail within the first year, and the median survival of a shunt is usually 8-10 years, so a patient can expect 2-3 shunt revisions over the course of 20 years.
Myasthenia Gravis: Disease Overview Who: Bimodal distribution. Ages 20-40 (female predominance) and 50-70 (male predominance). Increased risk of onset in postpartum period; juvenile and congenital forms possible What: At the NMJ, Ach recept…
Super cool case, admittedly, maybe not a super high yield diagnosis BUT, I hope we can all agree, still very dope. Case: CC: 46yo M p/w worsening b/l vision over 1mo, now blind. Vitals: WNL PMHx: L eye global rupture ~6mos ago 2/2 nail pen…
For today’s TR pearl, I’d like to take you back to January 2020, when covid was just a foreign virus and I was a fresh-faced intern, shadowing one of our recent grads, Dr. Sengupta in the cardiac room, along with Dr. Meyers. EMS…
I wanted to touch on some cool research that was circulated in the SinaiEM Journal Club WhatsApp this morning inspired by the Journal Feed newsletter. If you have trouble staying up to date on EM research, Journal Feed can help! It sends on…
Cervical artery dissection (CAD) accounts for 1-2% of all ischemic strokes but 10-25% of strokes in younger individuals. CAD includes extracranial carotid and vertebral artery dissections. A review of the literature suggests that there ma…
So, you’re working in the ED when a new stroke code is activated. You walk over and see a young gentleman with the complaint of left facial tingling, right arm and leg weakness with some tingling. Overall though, a relatively w…
A 45 year old male comes into the ED with a sudden, severe headache. It started while he was at work yesterday and was the worst of his life. It started feeling a little better, but hasn’t totally gone away and his wife made him come to get…
Bottom line up front: (1) Intubating those with TBI or spontaneous ICH is dangerous. You want to prevent increased ICP that is caused by laryngoscopy. (2) Pre-treat with fentanyl if time and the pt’s BP allow. The dose of fentanyl is larger…
Thrombectomy performed within 6 hours of symptom onset has been demonstrated to significantly improve clinical outcomes after stroke. Though there is generally diminishing benefit with increased time interval from last known well to the tim…
Article Citation Hacke W, Kaste M, Bluhmki E, Brozman M, et al; ECASS Investigators. Thrombolysis with alteplase 3 t…
There may be. Traumatic lumbar punctures occur in up to 30% of lumbar punctures. An observational, multicenter cohort study by Jeffrey Perry et. al. attempted to answer this question and enrolled sequential patients with acute…
Concerned about a SAH? The thunderclap worst headache of your patient’s life? Recent data suggests that a negative head CT within 6 hours of symptom onset in a neurologically intact patient doesn’t warrant an LP. Perry et al:…
