The terminal R in AVR can be seen with any significant ingestion of a sodium channel blocking agent (including TCAs). Sodium channel blocking agents work by delaying phase 0 (upward stroke) of the myocardial action potential. This leads to…
Cervical artery dissections include carotid or vertebral artery dissections and can be seen in patients of all ages, although they are a more common cause of stroke in young patients Symptoms may be somewhat non-specific (headache, n…
A 19 yr old male with a history of depression presents to the ED with diffuse, worsening rash, arthralgias and fever for the past 2 days. The patient recently started taking bupropion over the past 3 weeks and also started venlafaxine last…
Patients with connective tissue diseases and vasculitides can present to the ED with vague or seemingly innocuous complaints but may actually have a life threatening condition. Key conditions to assess for include: 1. Septic arthritis in th…
Liver cirrhosis is associated with hematologic derangements which can cause both coagulopathic and prothrombic states. However, it is less clear whether liver disease truly increases patients’ risk for intracranial hemorrhage (ICH). A…
Drowning is defined as “the process of experiencing respiratory impairment due to submersion/immersion in a liquid.” Pathophysiology: Drowning occurs as the patient’s airway is submerged below water. Initially, the…
Hypertrophic cardiomyopathy Genetic condition usually due to mutations in one of several sarcomere genes causing LVH and potentially LV outflow obstruction, diastolic dysfunction, mitral regurgitation. Patients may present with CP, dyspnea,…
A single-blind, randomized clinical trial of ED-initiated palliative care consultation for patients with advanced cancer showed a significant improvement in quality of life as measured by a change in the FACT-G score at 12 weeks. Median sur…
Both subxiphoid and parasternal approaches have been used for emergent pericardiocentesis in patients presenting with pericardial effusion and tamponade, but which approach minimizes procedural complications? In a 2012 review by Clinical An…
40 yo F, no PMHx, brought to ED for acute onset of shortness of breath, nausea, and vomiting. She was undergoing hair transplantation for traction alopecia at an outpatient surgi-center. BP 79/40, satting 75% on RA. Bedside sono shows you a…
A young man who works in a glass etching factory is rushed to ED for severe pain to his hand after a high concentration chemical solution spilled onto it. He complains of severe pain to the hand in the area of his injury, diffuse abdominal…
This young lady shows up to your ED with 1 week of rash over her abdomen. The rash was preceded by pain to the area, which improved but still bothers her, and much to her chagrin, the rash still has not resolved. She has no medical problems…
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…
