A Brief History of Today

By @BenAzan What pearl could I possibly find worthy of continuing tweets and dissemination? The last two posts, one of which was retweeted by both @M_Lin and @precordialthump (thanks!), are a tough act to follow. So first I thought about maybe high flow nasal cannula, the forgotten oxygenation method. I could highlight those magical nasal prongs that can deliver upRead more

Predicting a Difficult Airway

By @BenAzan Today’s post on by @cliffreid was yet another reminder of how challenging (if not impossible) it is to predict a difficult airway.  The study he quotes (1) looked at ~188000 intubations by anesthetists in Denmark. For each case, the anesthetists recorded pre-intubation if they expected a difficult intubation and if they expected the patientRead more

How to Succeed in 2015

As the year is coming to an end, a great place to look for inspiration for 2015 is Academic Life in Emergency Medicine’s series “How I work Smarter“. I’ve been reading these and wanted to share some highlights. The first thing that really jumps out is, in order to excel in the world of FOAM/AcademicRead more

Wide Complex Tachy…a Case

A nurse hands you this EKG with a concerned look… She say it’s a 35 y/o man who is coming in for shortness of breath and palpitations since last night. The next question you ask is vitals? Yes! BP 96/57, HR 201 ,RR25, pO2 99 on 4LNC and Afebrile. You put your thinking cap onRead more

Want to Get into Social Media?

Despite the fact that some at Sinai believe that social media is not essential for your education, others think it’s critically important. The concept is called FOAM for Free Open Access Medical education. You can read a full history of the term here. If you are new to the game, here are a few pointers toRead 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

Mr. Clean Trial is Here….a Quick Swipe at It.

Question: -In acute stroke, does the addition of intra-arterial management improve outcomes compared to usual care? Methodes:  -Multicenter, randomized, open-label (but blinded end points) in the Netherlands. 502 patients in 16 centers. -Comparing: (comparing intra-arterial intervention within 6 hours + usual care) vs. usual care. -Required a radiologically proven intracranial occlusion for study eligibility -Intervention was arterialRead more

Influenza is Here…how Do You Test for It?

Your 60 year old patient says he feels horrible. Fever, chills, body aches. His grandson has similar symptoms last week. His exam is significant for fever of 102, P105, 140/76, SpO2 97%,  upper respiratory congestion, with clear lungs, normal heart sounds and benign abdomen. Your attending is concerned he has the flu, says: “Hey, letsRead more

Yet Another Scary Ekg Finding…

@JoePinero As if there weren’t enough morphologies and subtleties in the EKG, here is another ekg finding that you should be aware of… de Winter T-waves 1-3 mm ST-depression upsloping at the J-point in the mid precordial leads leading to tall symmetric T-waves No large studies on the topic Several small case series show correlationRead more

Complex Regional Pain Syndrome

@JoePinero 50 yo M hx of NIDDM, recent left shoulder surgery x 4 mo ago for rotator cuff tear, currently presenting with left arm pain from shoulder to hand with swelling and tightness of the left hand and fingers. Exam: Well-appearing male holding his left arm at his side with obvious swelling to the handRead more