At our wellness conference we talked about different strategies to manage burnout through gratitude, deep breathing exercises and story-telling. Today we will add another technique to our wellness arsenal: spending time in nature. In NYC, t…
Article Citation: Palamidessi N, Sinert R, Falzon L, Zehtabchi S. Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis. Acad Emerg Med. 2010 Feb;17(2):126-32. PMID: 20370741 What…
A 44M with no PMH slipped and fell on his hand while playing with his kids in the park. He has swelling and pain over thumb MCP joint that is exacerbated by movement. The xray of his thumb is above, what is your diagnosis? This injury is kn…
We do a lot of life-saving procedures and interventions on a daily basis in the emergency room. However, there are some much less frequent but equally as important life-saving procedures we need to know how to do. Today we will review how t…
A mother brings her 4 day old newborn baby boy into the Peds ED for bilateral eye discharge. Mom tells you he was full-term and healthy, but she did not have prenatal care. The baby is well appearing and is eating, urinating and defecating …
Article Citation: CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a random…
Acute non-traumatic temporomandibular joint (TMJ) dislocations occur after extreme opening of the mouth (yawning, eating, laughing, singing or dental treatment. TMJ dislocation is when the anterior condyle moves too anteriorly and becomes l…
The NYC Marathon is this Sunday! The city has been gifted with some unseasonably warm weather the past couple days, but this has the potential to cause problems for the thousands of runners. Today we will talk about heat exhaustion and stro…
Case: 40 year old male presenting with rash for one day. Patient recently started Bactrim, endorsing flu-like symptoms for the past 2 days. Chest and back are erythematous and warm. In the ED, patient is febrile and tachycardic. Based on th…
Article Citation Stiell IG, Greenberg GH, McKnight RD, Nair RC, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993 Mar 3;269(9):1127-32. PMID 8433468 What we already k…
A 36F presenting with wrist pain after a fall on an outstretched hand. She has pain and swelling over the dorsal-radial aspect of her hand. Her xray is below, what is the diagnosis? It’s the spilled tea cup sign, but can you remember which…
Yesterday, we learned about acute mountain sickness (AMS) and high altitude cerebral edema (HACE). Today we will tackle high altitude pulmonary edema (HAPE), the deadliest of the altitude illnesses. HAPE generally occurs above 3000m, but in…
While we may not see as many wilderness related injuries in the concrete jungle of NYC, they are important to know. Especially when you ski out west, tick off the bucket list item of trekking K2 or when it inevitable shows up on the boards….
Article citation: Backus BE, Six AJ, Kelder JC, Bosschaert MA, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. (Link to the article here)…
In the ED we think a lot about pulmonary embolism, and thus decision rules, d-dimers and CTAs. Because we have a low threshold to test for PE, we spend a fair amount of time trying to not get that CTA. There are a number of tools to risk st…