Asthma and Redlining

“Take a deep breath and hold it. Now without exhaling, try to breathe in again.” We were in the cardiac room, discussing a young man that had died a few hours before we came onto our shift. He had been brought in after he was found in the subway with albuterol inhalers all around him. […]

TB in the ED

Tuberculosis in the ED Patient presents to Elmhurst ED with cough, hemoptysis, night sweats and fatigue – quick, what’s the first diagnosis that comes to mind? This is the classic presentation for tuberculosis. But several times now I have been surprised by less typical symptoms of TB. So I thought it might be helpful to […]

Sickle Cell Disease Emergencies

Sickle cell disease affects ~ 100,000 people in the US. Though pain is the most common ED presentation for patients with SCD, we should always consider life-threatening emergencies in this devastating and complicated disease.  Acute Chest Syndrome ACS is the leading cause of morbidity and mortality in patients with SCD. It’s caused by sickling in […]

Trauma in Pregnancy

Trauma is the leading cause of non-obstetric death in pregnant women. MVAs and intimate partner violence account for most cases.  Let’s first discuss the physiological changes to consider when managing a pregnant patient in a trauma. Management: Love, Julie Resources: https://www.uptodate.com/contents/initial-evaluation-and-management-of-major-trauma-in-pregnancy https://www.east.org/education-career-development/practice-management-guidelines/details/pregnancy-and-trauma https://www.jogc.com/article/S1701-2163(15)30232-2/pdf https://www.ajog.org/article/s0002-9378(13)00068-9/fulltext http://www.emdocs.net/resuscitation-of-the-pregnant-trauma-patient-pearls-pitfalls/

Managing Expectations

Let’s talk about managing expectations. You can do this with almost everyone/everything in your life, your goal being to under sell, over deliver. Some, not all, patients think that when they walk through these hallowed doors, that they’re walking into a place of truth and all-knowing information. They don’t realize the ED is more like a […]

The Ankle Radiograph

Anatomy First, we’ll refresh our bony anatomy to contextualize the radiographic images. The ankle is composed of the distal tibia and fibula and the superior talus, which is stabilized by several ligaments and the fibrous syndesmosis. The standard ankle radiographic series consists of the AP, mortise and lateral views. The AP View The Mortise View […]

Helmet Removal

Why should I care about this? Ok, so it may not be that interesting, however, we should still review how to responsibly remove a helmet. In NYC, we very rarely encounter injured patients with a helmet on and that’s probably because they were never wearing one to begin with, the patient removed it, or EMS […]

Lisfranc Injury

Summary Summary Anatomy of the Lisfranc Joint The Lisfranc joint consists of the articulation of the first three metatarsal bases with their respective cuneiforms and the 4th/5th metatarsal bases with the cuboid, along with associated ligaments. The lisfranc ligament, which joins the medial cuneiform (1st cuneiform) and the base of the 2nd metatarsal, provides primary […]

Central Line Week

Central Line Week TR Pearl Series (all three pearls combined for this post) by Ryan LeBuhn, PGY-3 Informed Consent I once described the risks of a procedure so thoroughly that the patient no longer wanted the procedure, though avoiding the procedure put her in greater danger than doing it would have. The next time I […]

POCUS guided LP

Intro Raise your hand if you ever struggled obtaining a CSF sample from a Lumbar Puncture. I “virtually” see that most if not all of you at one point in your career struggled with this. This pearl is inspired by an overnight Elmhurst A-side shift I had several months ago with a patient requiring a […]

May 2024
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