Resus SinaiEM Blog – Page 10

ED Postpartum Hemorrhage

Posted on April 23, 2019December 16, 2021 by Jonathan Mishoe

So you’re in the ED and a G9P8 patient at 40w2d rolls in with contractions every 3 minutes. Before sending the patient upstairs you do a brief examination and you see this… You deliver the baby flawlessly and even protect the perineum like a pro; however, the baby is quickly followed by the placenta […]

Lewis Leads & Invisible P’s

Posted on April 18, 2019December 16, 2021 by Wuya Lumeh

You ever have a tough time visualizing P waves on EKGs? Have no fear, a Lewis Lead EKG might just be the thing you need! The Lewis Lead (aka S5) is a modified EKG obtained in a manner that basically triangulates atrial activity to help make the p-waves of your EKG more prominent. Lead placement includes the RA […]

Head Scratcher of a Head CT?

Posted on April 15, 2019December 16, 2021 by Wuya Lumeh

Hey there guys and gals and welcome back to my channel! If you’re like me and TERRIBLE at reading your own imaging studies, settle in for a quick 20 minute run down for all those CT heads everybody be ordering without a second though. But before we get into it, don’t forget to like and […]

Central Line Troubleshooting. Beyond the Basics.

Posted on April 9, 2019December 16, 2021 by Jonathan Mishoe

Needle, wire, nick, dilate, catheter. Sounds simple right? However, simple doesn’t always mean easy. Placing a central line on a mannequin can be much easier than the 250lb ESRD patient with peripheral vascular disease and a MAP of 50. Below are ten tips to help assist with successful line placement: 1) Manipulate the syringe […]

Narcan Overdose. Too Much of a Good Thing?

Posted on April 8, 2019December 16, 2021 by Jonathan Mishoe

What do smack, dragon, horse, salt, brown sugar, china white, and black pearl have in common? That’s right… they are all nicknames for heroin. We all know that Naloxone (Narcan) is a useful antidote in overdose, however appropriate dosing and timing can be more of an art than a science. The most important concept […]

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Health Information Exchange: Quest for the Omni-Chart.

Posted on April 5, 2019 by apakama

Have you ever opened a chart of a very sick or obtunded patient, only to find it completely blank? Of course you have…probably at some point today. The minor panic that having to find vital collateral information in a timely fashion induces can be hard to shake. Is it unavoidable? Traditionally when health records were […]

Clinical Decision Support…your daily helper.

Posted on March 28, 2019 by apakama

Continuing with the theme of clinical informatics, today we will touch on the topic of Clinical Decision Support Systems (CDSS), or sometimes just called Clinical Decision Support (CDS). The basic premise of clinical decision support is that it delivers timely and useful patient/disease/ or treatment-related information in an organized manner, with the goal of improving […]

What Is Clinical Informatics?

Posted on March 26, 2019 by apakama

If you loved the super sexy topic of cerumen impaction yesterday…Well, hold on to your socks, because today we will continue our rousing educational foray by tackling the riveting question: What is Clinical Informatics? Shall we begin? According to the Oxford dictionary: Informatics is the science of processing data for storage and retrieval. In the […]

Cerumen Impaction: an Update.

Posted on March 25, 2019 by apakama

The last time www.sinaiem.org addressed the topic of cerumen (ear wax) impaction was in 2013. See this post: http://sinaiem.org/50yo-man-with-chest-pain-and-also-with-r-ear-pain/ If you’re like me, you likely believe that the world of cerumen impaction is a rather static one. Given that, another post on cerumen impaction would seem to be duplicative…Well you (and I) are wrong, and here’s […]

Cervical Artery Dissection

Posted on March 7, 2019 by Ravi Katari

Cervical artery dissection (CAD) accounts for 1-2% of all ischemic strokes but 10-25% of strokes in younger individuals. CAD includes extracranial carotid and vertebral artery dissections. A review of the literature suggests that there may be a significant risk of recurrence in subsequent years. At this time, it is unclear whether an anti-platelet or anticoagulation […]

Opioid Substitution Therapy

Posted on March 5, 2019 by Ravi Katari

ED physicians need to be comfortable with the various modalities of opioid substitution therapy (OST) and their associated complications. We are all familiar with the patient who has missed a daily dose of methadone on the way to booking and is subsequently brought to the ED by corrections officers to address this issue. A recent […]

Use the HEART Score

Posted on March 1, 2019 by Ravi Katari

There are approximately 8 million ED visits annually in the United States for chest pain. 10%-20% go on to receive an acute coronary syndrome diagnosis. The goal of the ED physician is to differentiate between ischemic chest pain and other, more benign causes of chest pain. Historical features and laboratory values are helpful, but 2%-5% […]

Permissive Hypotension

Posted on February 26, 2019 by Ravi Katari

Resist the urge to administer a large crystalloid bolus in hypotensive trauma patients. Doing so worsens coagulopathy and acidosis. This practice should be abandoned. Normotensive trauma patients need no fluid resuscitation. The practice of permissive hypotension in trauma improves has been demonstrated to improve morbidity and mortality (selected references below). Hypotensive trauma patients require surgical […]

PE Risk after Induced Abortion

Posted on February 25, 2019 by Ravi Katari

It’s well known that the risk of venous thromboembolism is increased during pregnancy. It is thought to be two-to-six times higher than the risk in non-pregnant women. However, these risk estimates are based on pregnant populations that go on to deliver a baby. Last year Ray et al. published a paper describing their findings on […]

Bag Mask Ventilation During Intubation

Posted on February 21, 2019 by Ravi Katari

A few days ago NEJM published the results of an investigation with profound implications for our specialty. A group of intensivists and anesthesiologists conducted a multicenter, randomized trial conducted in seven ICUs to study the use of bag-mask ventilation to prevent hypoxemia during intubation. 401 patients were randomized to either bag mask ventilation or no […]