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…
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…
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 lit…
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…
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? An…
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 bi…
An homage to my urologist husband: [spacer height=”20px”]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 shoul…
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…
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 righ…
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 transabdo…
You call your COPD patient’s pulmonologist to chit chat about his current exacerbation and like a reflex, she recommends azithromycin. You’re like but what about antibiotic resistance? Does he really need antibiotics? What…
We tend to think of pre-eclampsia as this dangerous yet somewhat nebulous hypertensive disorder in pregnancy that = OB consult, delivery. But what is the pathophysiology behind pre-eclampsia? And why the heck does it place one at risk for e…
You are working in the resuscitation bay when EMS rolls in with a hypotensive, hypoxic, meekly responsive febrile patient. You are preparing to intubate and the nurse asks what medications you would like (note: everybody is looking at you)….
Holidays can be a tough time. They can even drive one to the bottle. But which bottle? If you suspect your intoxicated patient may have ingested an alcohol other than ethanol but want some quick answers in the form of serum labs tests (aka…
With the advent of sepsis protocol masterminding, lactate has elbowed out the white blood cell count along with other parameters to become our primary measure of badness. But as we all know, while lactate elevation may indicate the severity…
