Thyroid Storm Management

TR Pearl: Thyroid Storm Management Diagnosing Thyroid Storm:  Management Things to keep in mind For patients in thyroid storm or impending storm If thyroid storm for sure, add glucocorticoids. They reduce T4 to T3 conversion….

PEG Tube Dislogement

Why is this a pearl? We get G-tube dislodgments quite often at Sinai, and they can be an easy patient encounter with a quick note and quick dispo. But they made me so nervous as an intern and early 2! Now I love ‘em and you can love ‘em too…

Asthma and Redlining

“Take a deep breath and hold it. Now without exhaling, try to breathe in again.” We were in the cardiac room, discussing a young man that had died a few hours before we came onto our shift. He had been brought in after he was found in the s…

TB in the ED

Tuberculosis in the ED Patient presents to Elmhurst ED with cough, hemoptysis, night sweats and fatigue – quick, what’s the first diagnosis that comes to mind? This is the classic presentation for tuberculosis. But several times now I…

Sickle Cell Disease Emergencies

Sickle cell disease affects ~ 100,000 people in the US. Though pain is the most common ED presentation for patients with SCD, we should always consider life-threatening emergencies in this devastating and complicated disease.  Acute Chest S…

Trauma in Pregnancy

Trauma is the leading cause of non-obstetric death in pregnant women. MVAs and intimate partner violence account for most cases.  Let’s first discuss the physiological changes to consider when managing a pregnant patient in a trauma. M…

Managing Expectations

Let’s talk about managing expectations. You can do this with almost everyone/everything in your life, your goal being to under sell, over deliver. Some, not all, patients think that when they walk through these hallowed doors, th…

The Ankle Radiograph

Anatomy First, we’ll refresh our bony anatomy to contextualize the radiographic images. The ankle is composed of the distal tibia and fibula and the superior talus, which is stabilized by several ligaments and the fibrous syndesmosis. The s…

Helmet Removal

Why should I care about this? Ok, so it may not be that interesting, however, we should still review how to responsibly remove a helmet. In NYC, we very rarely encounter injured patients with a helmet on and that’s probably because they wer…

Lisfranc Injury

Summary Summary Anatomy of the Lisfranc Joint The Lisfranc joint consists of the articulation of the first three metatarsal bases with their respective cuneiforms and the 4th/5th metatarsal bases with the cuboid, along with associated ligam…

Central Line Week

Central Line Week TR Pearl Series (all three pearls combined for this post) by Ryan LeBuhn, PGY-3 Informed Consent I once described the risks of a procedure so thoroughly that the patient no longer wanted the procedure, though avoiding the…

POCUS guided LP

Intro Raise your hand if you ever struggled obtaining a CSF sample from a Lumbar Puncture. I “virtually” see that most if not all of you at one point in your career struggled with this. This pearl is inspired by an overnight Elmhurst A-side…

ECMO made EZ

Intro For this week’s teaching pearl, I wanted to go back and cover a medical pearl. We always hear the word “ECMO” thrown around but I want to today go into a very brief overview of what ECMO is and why it is being used more commonly. I am…

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