Resus SinaiEM Blog – Page 20

Troubleshooting PEG tubes

Posted on March 15, 2018 by Kathy Li

A patient is sent from nursing home at 10pm for a non-functioning PEG tube. He has a prior history of stroke with L sided weakness and is now bedbound at baseline. He has stable vitals, no abdominal tenderness, and is otherwise well appearing. What do you do next? You could call GI to help, but […]

Median and Ulnar Nerve Blocks

Posted on March 13, 2018 by Kathy Li

Injuries to the hands are a frequent complaint in the emergency department. When the injury isn’t limited to a single digit, or involves larger areas of the hand such as a burn or deep laceration, a nerve block can be an effective option for general pain control as well as any procedures you may need […]

Abdominal compartment syndrome and the logistics of measuring a bladder pressure

Posted on March 9, 2018 by Mark Andreae

We do not encounter abdominal compartment syndrome often in the emergency department. With that said, this diagnosis enters our differential from time to time. Consider the patient with an active arterial bleed from a liver mass with large hemoperitoneum who is transferred from an outside institution for IR embolization. His abdomen is rock solid, and his lactate […]

A not-so-comprehensive guide to assessing the right ventricle

Posted on March 6, 2018 by Mark Andreae

Quick word: Demonstrating a normal sized RV does not rule out PE. With that said, if you have a hypotensive patient in whom you are concerned about massive PE, demonstrating the patient has a normal sized RV can lead you to consider alternate dangerous diagnoses. RV size The ratio of RV:LV chamber size should be […]

BIPAP in SCAPE: (a few of) the hemodynamic effects of positive pressure ventilation

Posted on March 2, 2018 by Mark Andreae

This pearl will be a brief rundown of the hemodynamic effects of BIPAP on the patient with sympathetic crashing pulmonary edema. This is an apical four chamber view with a dilated right ventricle – stretched vertically to the point of being almost unrecognizable – superimposed on the screen of a ventilator. Yes. BIPAP works for […]

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A Strange Pearl

Posted on March 1, 2018 by Mark Andreae

As the title implies, this is a strange pearl. Imagine the following: You are in a can’t intubate/can’t ventilate scenario. The patient’s neck is large, and the landmarks are poor. You cut through a depth of redundant tissue to get to the cricothyroid membrane, make your incision, insert your finger, and place a bougie. The […]

AKI vs lab error: pitfalls in creatinine measurement

Posted on February 27, 2018 by Mark Andreae

The Jaffe reaction, named for 19th century German biochemist Max Jaffe, is a colorometric assay used by most every clinical lab to measure creatinine. In an alkaline medium, creatinine reacts with picric acid to form a red colored compound; the amount of color change is proportional to the level of creatinine. Increases in creatinine make […]

Proceed with caution: Pumps

Posted on February 23, 2018 by Mark Andreae

CAUTION Messing with a pump is an easy way to draw the ire of your nursing colleagues. There are ways to mess this up, and every change in rate needs to be charted. If you’re going to start a drip or change a drip rate, make sure you are communicating clearly with the nurse caring […]

Pressure Transducer Setup

Posted on February 22, 2018 by Mark Andreae

There are better tutorials on how to set up a pressure transduction line. This tutorial specifically addresses the equipment available in the resuscitation bays at Mount Sinai. You need: (1) Bag of normal saline (any volume will do, preferably 500-1000 mL bag) (2) Pressure bag (3) Pressure transduction line (4) Cable to go from transducer […]

LVAD Poutpourri

Posted on February 20, 2018January 6, 2022 by Mark Andreae

This is the last segment of the LVAD-oriented series of pearls. There are a number of LVAD-related complications to be aware of. Disclaimer: I am an emergency medicine resident, not a heart failure fellow. This is my synthesis of a potpourri of LVAD-related complications and emergent management options. Power shortage: Make sure the pump has […]

Approach to the LVAD Patient: Part 2

Posted on February 16, 2018January 6, 2022 by Mark Andreae

There is a critical addendum to yesterday’s post, courtesy of Sam Schuberg. Patients with LVAD’s can go into dysrhythmias (VT, VF) despite the appearance of stability. Obtain an ECG on arrival in unstable patients with an LVAD. Thanks for reading the pearl, Sam. Now, on with today’s #TRPearl There are four parameters the LVAD monitor will […]

Approach to the LVAD Patient: Part 1

Posted on February 15, 2018 by Mark Andreae

LVAD management is an appropriate topic for a fellowship; not necessarily a TR pearl. But, resuscitating the sick LVAD patient is firmly within our scope of practice, and requires some basic knowledge of LVAD physiology. Enter rough sketch of a patient with an LVAD. Excuse my lack of artistic prowess: There are a number […]

Listen for Hypoxia

Posted on February 12, 2018 by Mark Andreae

The monitors at Mount Sinai (and at Elmhurst, and at most hospitals) allow you to add a tone to the pulse oximeter waveform (see: plethysmograph). The tone is a simple beep, but as the saturation drops so too does the frequency of that beep. By the time the saturation reaches 92%, the once reassuring beep […]

Peds US PIV

Posted on February 9, 2018 by Greg Fernandez

“Hey doc, we can’t get a line on the kid in room 7, he’s going to need an US IV” is one of the last things I want to hear while working a peds shift. I’ve put US lines in teens, but they aren’t much different than adults in this regard. But what about younger […]

Calculous Cholecystitis: Early vs Delayed Cholecystectomy

Posted on February 8, 2018 by Greg Fernandez

Prompted by our M&M yesterday, below are the data surrounding delayed vs early cholecystectomy in patients with acute calculous cholecystitis. TL;DR: Current evidence supports early cholecystectomy provided the patient is medically stable for surgery. All sources I found recommended admission. I could not find any sources that recommended discharge from the emergency department. Meta […]