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E-point Septal Separation in the Patient with Congestive Heart Failure

By Phil | cardiology, critical care, Pearl of the Day, Sinaiem.us, Ultrasound | Comments are Closed | 23 May, 2019 | 0

Perhaps never explained so clearly, Cisewki and Alerhand’s article on EPSS is a wonderful read. Bottom line to remember: EPSS > 7 mm was 87% sensitive and 75% specific at identifying reduced EF (<50%).  This is the cutoff generally used to point to an abnormal EF (but isn’t it all about stroke volume, really?)Read more

Oh no baby WHAT IS U DOIN’?

By Wuya Lumeh | critical care, neonate, pediatrics | Comments are Closed | 30 April, 2019 | 0

Neonatal Resuscitation. (Some descriptors for reference: Terrifying. Scary. Fear-inducing. Horrific. Chilling.) But fear not! Your TR pearl today is brought to you by the NICU rotation + Jillian Nickerson/T.Webb doing some excellent preparatory work for/with you. So there’s this thing called the NRP — Neonatal Resuscitation Program. It different from PALS mainly that it pertainsRead more

ED Postpartum Hemorrhage

By Jonathan Mishoe | critical care, OB/GYN | Comments are Closed | 23 April, 2019 | 0

So you’re in the ED and a G9P8 patient at 40w2d rolls in with contractions every 3 minutes. Before sending the patient upstairs you do a brief examination and you see this…   You deliver the baby flawlessly and even protect the perineum like a pro; however, the baby is quickly followed by the placentaRead more

Central Line Troubleshooting. Beyond the Basics.

By Jonathan Mishoe | critical care, Sinai Resus, Tips and Tricks | Comments are Closed | 9 April, 2019 | 0

Needle, wire, nick, dilate, catheter. Sounds simple right? However, simple doesn’t always mean easy. Placing a central line on a mannequin can be much easier than the 250lb ESRD patient with peripheral vascular disease and a MAP of 50. Below are ten tips to help assist with successful line placement:   1) Manipulate the syringeRead more

Pacemakers Review Pt. 2

By Ravi Katari | cardiology, critical care, EKG, Pearl of the Day | Comments are Closed | 12 February, 2019 | 0

Cardiac pacing as an intervention can be conceptualized as addressing problems in electrophysiological conduction and/or.  So, for example, if there is a disruption in the electrical continuity between the atrium and the ventricle, a pacer maybe function by detecting a normal sinus impulse in the atrium (there is typically a right atrial lead connected toRead more

Overshot that INR

By Jayram Pai | critical care, hematology | Comments are Closed | 5 October, 2018 | 0

There have been a few cases of supra-therapeutic INR in the Sinai ED recently, and at the request of one of our superstar interns, below you will find a brief set of recommendations regarding Supratherapeutic INR. The following bolded recommendations are for your patients who have no clinically significant bleeding: (These are recommendations based on AmericanRead more

Ketamine PSA with Desaturation

By Jayram Pai | critical care, Pearl of the Day, pediatrics, PSA | Comments are Closed | 28 September, 2018 | 0

During a busy day in the ED, it becomes apparent that the pulling and yanking on your patient’s shoulder has done absolutely nothing to reduce their shoulder. You perform your pre-procedure PSA Checklist, know that this young and active 18 year old poses little difficulty, and push your desired dose of ketamine. Suddenly, you notice theRead more

Hurry Up & RUSH!

By Taryn Webb | critical care, Sinai Resus, Ultrasound | Comments are Closed | 7 September, 2018 | 0

You’re working in RESUS, and you get a notification for hypotension. He’s a 65 year old male noted to be hypotensive to 70/40 by EMS. On arrival, he’s altered and unable to provide any history, and EMS doesn’t have much more information. You don’t see any signs of trauma. Your attending suggests performing a RUSHRead more

The Neuroprotective Intubation

By Marty Casey | airway, critical care, neurology, Pearl of the Day | Comments are Closed | 6 August, 2018 | 0

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 than we are used to, dose 3 mcg/kg (or ~150-200mcg). (3) It isRead more

How Safe is Mechanical CPR?

By Sam Khan | cardiology, cases, critical care | Comments are Closed | 27 April, 2018 | 0

Question – How safe is mechanical CPR compared to manual CPR? There are two devices used for mechanical CPR – the AutoPulse and LUCAS – neither of which has been demonstrated to show a survival benefit over manual CPR in recent studies (CIRC, LINC, PARAMEDIC). Could these devices be causing more injuries compared to manualRead more

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