Today’s lower extremity block is going to be the posterior tibial nerve. The sensory distribution should be helpful for things like foreign bodies that need to be taken out of the foot. Anatomy – The largest of the five…
The next three series in the SinaiEM pearls will be on nerve blocks of the foot. Today is going to cover the sural nerve block which should anesthetize the area depicted by the cross-hatched area in the figure. As a terminal b…
Inspired by a morning report discussion from our very own Lara Vanyo on preoxygenation strategies, I thought it would helpful for a brief run-down on the button-pushing needed to perform preoxygenation by way of noninvasive ventilation. The…
A number of really bright people are still unsure of what to make about the vitamin C, steroids and thiamine newsflash that’s taken Twitter by storm yesterday. At Sinai here we’re the curious types, so we chatted with our pharmacist who sim…
Does it matter if my patient getting tPA is on prestroke antiplatelets? The neurology and ED teams have decided to give tissue plasminogen activator (tPA). As an outpatient, the patient is on aspirin and clopidogrel dual antiplatelet…
You get a pop-up warning in the electronic medical record about potentially adverse interaction with a prolonged QT interval. What’s the risk, right? Afraid of a little torsades de pointes? Can’t we just give some prophylactic magnesium and…
The 52 in 52 Review: Comparison of Dopamine and Norepinephrine in the Treatment of Shock Article Citation: De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med….
Article Citation: Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739-46. What We Already Know About the…
The Right Ventricle The right ventricle (RV) has been getting more coverage lately from the Wilcox et al review article in Annals to the continued coverage in many critical care circles where anesthesia and emergency medicine overlap.(1) F…
In recent years, a number of states have decriminalized marijuana for medical use, and some have even decriminalized recreational use. This trend is likely to continue. Much of this marijuana – particularly when used recreationally – is con…
Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369(23):2197-206. What we already know about the topic: Patients generally have poor survival an…
Welcome to Digoxin Day, Part 2! Like all sequels, this is sure to be even better than the original. Cardiac Physiology of Digoxin: Cardiac glycosides increase parasympathetic tone by acting on the vagus nerve. They also depress myoca…
Digoxin is a cardiac glycoside, and it has a narrow therapeutic window (0.5-2 ng/ml). Due to its sub-milligram dosing, its dependence on renal clearance, and its interactions with many other drugs, digoxin toxicity is a real concern for pat…
When a patient presents with orbital compartment syndrome, performing a lateral canthotomy and cantholysis can be vision-saving. You may only have 60-100 minutes until the patient experiences permanent visual sequelae. Are you ready? …
Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. N Engl J Med. 1996 Feb 22;334(8):481-7. What we already know about the…
