Look into my seeing EYE ball

Posted on by Wuya Lumeh

THE EYE EXAM Keep it basic… APD Intra-ocular Pressures: Tono-pen v Applanator (Goldmann) Visual Acuity or be a Slit Lamp KWEEN Move outside in: Lids → Eyeball Lids: ducts, eyelashes, orbital lesions or findings EYE: Full EOM assessment and conjunctival assessment Anterior: Cornea for opacity, irregularities, fluericin staining for abrasions/ulcerations. Anterior chamber assessment for “cell […]

Oh no baby WHAT IS U DOIN’?

Posted on by Wuya Lumeh

Neonatal Resuscitation. (Some descriptors for reference: Terrifying. Scary. Fear-inducing. Horrific. Chilling.) But fear not! Your TR pearl today is brought to you by the NICU rotation + Jillian Nickerson/T.Webb doing some excellent preparatory work for/with you. So there’s this thing called the NRP — Neonatal Resuscitation Program. It different from PALS mainly that it pertains […]

Amanita Muscaria

Posted on by Jonathan Mishoe

For those of you who remember Super Mario Bros… how awesome was it to gobble up that red and white mushroom gliding along the ground and get huge for a few seconds? The result of consuming this mushroom was a bigger and badder Super Mario who was ready to break bricks and take names. However, the color and […]

ED Postpartum Hemorrhage

Posted on 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 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 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 […]

Health Information Exchange: Quest for the Omni-Chart.
Posted on 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 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 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 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 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 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 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% […]