Resus SinaiEM Blog – Page 13

Acute Flaccid Myelitis

Posted on December 11, 2018 by Tina Mathew

We’ve gotten an email or two telling us to look out for Acute Flaccid Myelitis (AFM). What is it? Why does it matter? AFM causes flaccid weakness to one or more limbs rapidly in a polio-like neurologic fashion. There can also be cranial nerve involvement, including ophthalmoplegia and dysarthria. There were 80 cases in the […]

To bicarb or not to bicarb

Posted on December 7, 2018 by Tina Mathew

When, if ever, should we be giving bicarbonate in patients with metabolic acidosis? A study published in The Lancet in July 2018 involved a multicentre RCT in 26 ICUs with 400 patients, called the BICAR-ICU trial. It found that in severe acidemia (<7.2), sodium bicarbonate infusion compared with no infusion did not decrease mortality over […]

PTSD in EM Residents

Posted on December 4, 2018 by Tina Mathew

Winter is here. It’s colder. Sometimes we don’t see the sun for days. Let’s take a moment to think about some mental health issues. Published in Annals of Emergency Medicine in December 2017 was a piece by some of our very own (Lara Vanyo, Randy Sorge, Angela Chen, and Daniel Lakoff) on posttraumatic stress disorder (PTSD) in […]

Foot vs Bus

Posted on December 3, 2018 by Tina Mathew

In a totally hypothetical situation, imagine a resident’s foot got run over by a bus and looked like this after arriving in your ED… What sort of things should you be concerned about in injuries like this of extremities? 1. Vascular: Has a vessel been compromised, especially an artery? It is important to control hemorrhage. […]

The Golden S Sign

Posted on November 30, 2018 by Tina Mathew

Shoutout to the awesome David Cisweski for following up this tidbit from conference and giving us this pearl. Remember in conference when Dr. Jacobi was going over chest X-rays, was talking about the Golden S sign, and we could neither see the S nor the gold? What? – The Golden S sign is also referred to by the more […]

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SVT and Paranasal Etripamil

Posted on November 29, 2018 by Tina Mathew

Have you had one of those resus shifts where everyone and their mother seems to be in an arrhythmia? Have some of them been older patients with SVT that just make you a little antsy about giving medications like adenosine multiple times after Valsalva maneuvers haven’t worked or then having to try an IV beta […]

Air Pollution and Stroke?

Posted on November 27, 2018 by Tina Mathew

One growing global health issue is ambient air pollution. One of the leading risk factors for disease is fine particulate matter in outdoor air. The WHO states 1 in 8 deaths is due to air pollution. So what is it’s effect on cerebrovascular disease? In Annals of Emergency Medicine from this month, a study was published […]

Nursemaid’s Elbow Reduction

Posted on November 26, 2018 by Tina Mathew

Radial head subluxation, more commonly known as nursemaid’s elbow, can be seen more frequently in the pediatric population. Imagine a parent quickly pulling a child’s arm (usually 1-4 years old) that was held in extension in order to prevent a fall — the kid then holds their forearm in the pronated position and close to […]

Tis the season – for rhinosinusitis

Posted on November 23, 2018 by Tina Mathew

It’s an intake shift and yet another person comes in saying, “I feel congested doc. I need antibiotics for sinusitis.” A recent Cochrane review published in September 2018 that included 15 trials involving 3057 patients reviewed the need for antibiotics in acute rhinosinusitis (infection of the nasal passages and paranasal sinuses of less than 4 […]

Corticosteroids in Septic Shock

Posted on November 20, 2018 by Tina Mathew

Should patients in septic shock get corticosteroids? A meta-analysis of 22 randomized clinical trials (RCTs) published in Intensive Care Medicine in July 2018 compared low-dose steroids vs placebo in adults in septic shock. It found that giving steroids (typically hydrocortisone) did not affect short or long term mortality, but found that the duration of shock, […]

The Sinai Troponin

Posted on November 19, 2018 by Tina Mathew

What is Sinai’s troponin assay? Answer: ARCHITECT STAT Troponin-I A Global Task Force with involvement from the American Heart Association (AHA), American College of Cardiology Foundation (ACCF), European Society of Cardiology (ESC), and World Heart Federation (WHF) agreed on a universal definition of myocardial infarction that supports use of cTnI as a preferred biomarker for myocardial injury. Elevated levels […]

Vanc + Zosyn and acute kidney injury

Posted on November 15, 2018 by Latoshia Henderson

Vancomycin and Piperacillin-tazobactam (Zosyn) are two widely used broad spectrum antibiotics most ED providers use severe infections and especially undifferentiated sepsis. These antibiotics together synergistically fight off MRSA, Pseudomonas, and other dangerous gram negative and gram positive infections for our sick patients. Often times we use Vanc and Zosyn without considering other antibiotic therapy options […]

Time to Bind…

Posted on November 12, 2018 by Latoshia Henderson

So you’re working a busy A side shift at Elmhurst and you get an alert from EMS about a polytrauma. The patient rolls through the door alert but moaning in pain with obvious road rash to the bilateral lower extremities. He states he was in a motorcycle accident. He’s tachycardic and hypotensive. After a negative […]

Sphenopalantine Ganglion Block for Headache

Posted on November 6, 2018 by Latoshia Henderson

“I have a headache”….the number of times we as ED providers have taken care of a patient with this complaint is uncountable. Once we have established that the source of the headache is not life threatening we then move on to how to treat and make the patient more comfortable. Standard care of practice has […]

Insulin Bolus for DKA?….Not so fast

Posted on November 5, 2018 by Latoshia Henderson

DKA is a very common endocrine emergency that we encounter very frequently in the ED in both pediatrics and adults. Standard therapy of care includes IVF, correction of electrolyte disturbances, +/- bicarb, and of course insulin. Prior to starting the insulin drip many providers administer an insulin bolus with the thought that it will overcome […]