We have a new resource in the Sinai ED. Say hello to your friendly ED pharmacist. In the past several years, the ED pharmacy has been centralized in a non-ED location. We all know well these faceless interactions with a human reminding you to renally dose your Zosyn, stop ordering the bicarb drip that way…andRead more
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THE EYE EXAM Keep it basic… APD Intra-ocular Pressures: Tono-pen v Applanator (Goldmann) Visual Acuity or be a Slit Lamp KWEEN Move outside in: Lids → Eyeball Lids: ducts, eyelashes, orbital lesions or findings EYE: Full EOM assessment and conjunctival assessment Anterior: Cornea for opacity, irregularities, fluericin staining for abrasions/ulcerations. Anterior chamber assessment for “cellRead more
Have you ever opened a chart of a very sick or obtunded patient, only to find it completely blank? Of course you have…probably at some point today. The minor panic that having to find vital collateral information in a timely fashion induces can be hard to shake. Is it unavoidable? Traditionally when health records wereRead more
The last time www.sinaiem.org addressed the topic of cerumen (ear wax) impaction was in 2013. See this post: http://sinaiem.org/50yo-man-with-chest-pain-and-also-with-r-ear-pain/ If you’re like me, you likely believe that the world of cerumen impaction is a rather static one. Given that, another post on cerumen impaction would seem to be duplicative…Well you (and I) are wrong, and here’sRead more
You are at elmhurst in the cardiac room. It is FREEZING outside. The triage nurse tells you there is a frequent flier in triage, EMS found him sleeping on the street with +AOB. He is confused and moaning to sternal rub. They cannot get an oral temp and they cannot find the rectal probe, butRead more
Tl;dr: (1) Never rock the pelvis. Firmly squeeze and hold. (2) Consider quickly assessing for rectal or vaginal bleeding prior to binder application as this would suggest an open fx into the vag / rectal vault. It will be difficult to complete the exam once the binder is on. (3) The binder is applied overRead more
A 74 year old female with a GI bleed is refusing treatment, stating that she just wants to go home rather than being transfused for her hemoglobin is 5. You attempt to convince her to stay but she steadfastly says that she just wants to leave. She mentions she has to feed her dog andRead more
In 2016, ACEP published “Clinical Policy: Critical Issues in the Evaluation of Adult Patients with Suspected Transient Ischemic Attack (TIA) in the Emergency Department” in the Annals of EM. Here is a brief refresher. Transient ischemic attack (TIA) is a part of a spectrum of ischemia affecting the central nervous system. “Transient episode of neurologicRead more
Must Know Spanish Phrases: We are going to discharge you – le vamos a dar de alta You can go home today – Hoy se puede ir a casa You need to be hospitalized – Necesita ser hospitalizado You have to stay in the hospital – Tiene que quedarse en el hospital You will beRead more
Inspired by the mysterious and salacious Jon Mishoe. Trying to explain ultrasound via text just won’t work. Instead I will attempt to describe various ultrasound concepts and possibilities and I encourage you to grab ultrasound faculty for hands-on demonstrations if the clinical scenario is appropriate. Given the small amount of subcutaneous tissue and small surfaceRead more