Happy New Year SinaiEM! In keeping with the holiday spirit, today’s pearl is a bit about spinal taps, aka Lumbar Puncture. First is a review of what findings you would see for our most common differential diagnosis, and it is followed by some literature published by our very own PD. Bacterial Meningitis Appearance Cloudy &Read more
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Tentorial/Peritentorial Subdural Hemorrhage – rare, but this is what they look like on CT. They may resemble intraparenchymal bleed on CT but MRI can confirm exact location with regard to the tentorium. As a reminder, the tentorium is an extension of the dura; it separates the cerebellum from the inferior portion of the occipital lobes. Subdural hematomas occur betweenRead more
Now that you’ve gained a few extra pounds after holiday meals, or let’s say you gained 50lbs, should that change your ventilator settings if you get intubated? Answer: No. In order to avoid lung injury, critical care literature suggests using low volume ventilation (~ 6 cc/kg of predicted body weight, aka IDEAL BODY WEIGHT). Ideal body weight depends on genderRead more
The chef preparing your holiday meal is found in the kitchen unresponsive. He is taken to the ED and this is his EKG: What happened? As it turns out, the chef was so hot on this balmy Christmas Eve, that he decided to take a quick nap break in the freezer room. The EKG aboveRead more
Your 16 yo cousin comes to you with a one-week history of sore throat, difficulty swallowing and painful lesions of his lips, oral mucosa and oropharynx. He also has what he calls “blisters” on his hands. What does he have? Answer: Erythema Multiforme (EM) is an immune-mediated, self-limiting condition. The trigger is, 90%Read more
Your dad wanted to make this holiday season extra special, so he decided to paint the house in candy-cane pattern. The intermittent red and white stripes were so disorienting, that he mistook his paint thinner for his nalgene, and took a big swig of water. Oops! He arrives in your ED covered in red andRead more
An homage to my urologist husband: A 30 yo male arrives to your trauma bay intubated after a high speed MVC. He has signs of head trauma, bruises and abrasions diffusely and…an erect penis. This should signal two initial thoughts in your mind: 1. First and foremost, spinal cord trauma. Priapism due to spinal cordRead more
A 52 year old male with a history of hypertension arrives to your ED presenting with similar symptoms as the patient you treated for a PE two days ago. CT scan is “rebooting.” So again, you empirically go for heparin. Soon after, you receive a phone call that CT is up and running and sprint-pushRead more
A 36 year old male with a history of protein C deficiency (not on AC) is wheeled into your resuscitation bay tachypneic, tachycardic and hypoxic one week after a major surgery. You throw on your ultrasound probe and see a ballooned-out right heart. CT is backed up even more than usual. Your suspicion for PE isRead more
A classic tale: 24yoG2P1 at approximately 6 weeks by LMP presents with vaginal spotting. You perform your pelvic exam, noting scant bleeding and a closed os, followed by a bedside sonogram. But alas, you cannot find an IUP on your transabdominal exam and must move to the invasive intracavitary probe…and guess what, it’s dirty andRead more