The Jaffe reaction, named for 19th century German biochemist Max Jaffe, is a colorometric assay used by most every clinical lab to measure creatinine. In an alkaline medium, creatinine reacts with picric acid to form a red colored compound;…
CAUTION Messing with a pump is an easy way to draw the ire of your nursing colleagues. There are ways to mess this up, and every change in rate needs to be charted. If you’re going to start a drip or change a drip rate, make sure you…
There are better tutorials on how to set up a pressure transduction line. This tutorial specifically addresses the equipment available in the resuscitation bays at Mount Sinai. You need: (1) Bag of normal saline (any volume will do, prefera…
This is the last segment of the LVAD-oriented series of pearls. There are a number of LVAD-related complications to be aware of. Disclaimer: I am an emergency medicine resident, not a heart failure fellow. This is my synthesis of a potpourr…
There is a critical addendum to yesterday’s post, courtesy of Sam Schuberg. Patients with LVAD’s can go into dysrhythmias (VT, VF) despite the appearance of stability. Obtain an ECG on arrival in unstable patients with an LVAD. …
LVAD management is an appropriate topic for a fellowship; not necessarily a TR pearl. But, resuscitating the sick LVAD patient is firmly within our scope of practice, and requires some basic knowledge of LVAD physiology. Enter rough sketch…
The monitors at Mount Sinai (and at Elmhurst, and at most hospitals) allow you to add a tone to the pulse oximeter waveform (see: plethysmograph). The tone is a simple beep, but as the saturation drops so too does the frequency of that beep…
“Hey doc, we can’t get a line on the kid in room 7, he’s going to need an US IV” is one of the last things I want to hear while working a peds shift. I’ve put US lines in teens, but they aren’t much diffe…
Prompted by our M&M yesterday, below are the data surrounding delayed vs early cholecystectomy in patients with acute calculous cholecystitis. TL;DR: Current evidence supports early cholecystectomy provided the patient is medical…
Case: Unk-FrequentFlyer is rushed back to you in the cardiac room by Unk-Intern. He was found in the back corner of the B side shortly after 7am sign out. The patient is in florid alcohol withdrawal, combative, hallucinating, and of course…
In asthmatics requiring endotracheal intubation airway stimulation can induce severe reflex-mediated bronchoconstriction. This reflex is neurally mediated in part by the vagal nerves. Is there any evidence for the use of lidocaine pretreatm…
Is bandemia with a normal WBC count concerning? TL;DR: Bandemia is concerning even in the absence of leukocytosis and/or abnormal temperature Drees et al evaluated whether patients admitted to the hospital with a normal WBC an…
Google recently published a study online (not peer reviewed) of its AI system that predicts medical outcomes such as in patient mortality, readmission, etc There is a lot of technical jargon in the paper, but here is a brief summary: -Previ…
