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40 yo F, no PMHx, brought to ED for acute onset of shortness of breath, nausea, and vomiting. She was undergoing hair transplantation for traction alopecia at an outpatient surgi-center. BP 79/40, satting 75% on RA. Bedside sono shows you a grossly reduced EF with poor myocardial contractility. What is happening to her? What isRead more

Hydrofluoric Acid Burn

A young man who works in a glass etching factory is rushed to ED for severe pain to his hand after a high concentration chemical solution spilled onto it. He complains of severe pain to the hand in the area of his injury, diffuse abdominal pain and intermittent twitching of several different muscles. On exam there is destructionRead more

Neck flexion injury

A diver shows up to your trauma bay in a c-collar and with complete motor paralysis of legs, torso, hands and weakness of shoulder muscles. He has no sensation to pain or temperature below his clavicles. His proprioception is intact. Which level spinal cord lesion is this? What is the diagnosis?   ANSWER: Anterior cord syndromeRead more

TCA overdose

The nurse comes running over from triage to the cardiac room because there’s a patient in triage who claims she took a whole bottle of her imipramine before she went to bed last night (12 hours ago). On exam, patient appears indifferent, says she lost the bottle, has no complaints except that she is fedRead 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

Iso Precautions for shingles?

This young lady shows up to your ED with 1 week of rash over her abdomen. The rash was preceded by pain to the area, which improved but still bothers her, and much to her chagrin, the rash still has not resolved. She has no medical problems, vitals are within normal limits, but she wantsRead more

Knee Immobilizer Pearl

53 yo F was walking in high-heeled boots on the cobblestones of the west village. She slipped and suffered a knee twisting injury. On exam, she has an effusion but her plain film is negative for fracture/dislocation. She is in too much pain to bear weight but there is no appreciable laxity in the kneeRead more

Gum pains

25 y/o F with multiple painful lesions of the right gingiva and low grade fever. The symptoms started off as a stinging sensation with sensitivity to the gums on her right side that she noticed 3 days ago, but now there are lesions that hurt to touch, especially when brushing teeth. She has never had this before.Read more

*Champagne Tap*

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

Tentorial Subdural Hemorrhage

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