Resus SinaiEM Blog – Page 27

Spin to Win

Posted on August 9, 2017 by Colin Pesyna

Dr. Michael McGonigal’s Trauma Professional’s Blog is a fantastic web resource with a nice, free monthly newsletter. I’ve been reading it regularly since medical school, and I’m pretty sure it’s the first place I remember learning the trick of rotating a chest x-ray 90 degrees when looking for rib fractures: Your mileage may vary, but there’s […]

A Whole New World

Posted on August 7, 2017 by Colin Pesyna

We all love FOAM, and we all love airway. Today’s pearl will introduce you to a corner of FOAM you may not have come across, as well as a corner of airway management you might not know about. I’m a big fan of Jed Wolpaw’s Anesthesia and Critical Care Reviews and Commentary podcast. Many of […]

The 52 in 52 Review: POCUS for Identification of Low CVP

Posted on August 3, 2017 by Colin Pesyna

Title: “The 52 in 52 Review: POCUS for Identification of Low CVP” Article Citation: Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med. 2010 Mar;55(3):290-5. PMID: 19556029 What we already know about the topic: […]

Hard Numbers and Blood Transfusions

Posted on August 1, 2017 by Colin Pesyna

Not infrequently we identify patients who need to have some sort of blood product transfused in the ER. Most of these patients are not crashing, and have time to have a formal conversation about risks, benefits, and alternatives to transfusion. Of course you know all of the risks associated with transfusion (you do know them, […]

Oops…is that part important?

Posted on July 31, 2017 by Colin Pesyna

There you were, minding your own business when EMS brings you a sick-as-can-be patient, intubated in the field for who knows what. Someone gets overzealous with their trauma shears and cuts off the pilot balloon on the endotracheal tube. This happened to me twice in my PGY2 year. Obviously, this ETT will need to be […]

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52 in 52: The Rivers Trial

Posted on July 28, 2017 by Angela Chen

Title: “The 52 in 52 Review: Early goal-directed therapy in the treatment of severe sepsis and septic shock” Article Citation: Rivers E, Nguyen B, Havstad S, Ressler J, et al; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77. PMID: […]

Ketamine for acute pain in the ED

Posted on July 25, 2017 by Angela Chen

Deaths from heroin rose to 8,260 in 2013, quadrupling since 2000 and aggravating what some were already calling the worst drug overdose epidemic in United States history. Overall, drug overdoses now cause more deaths than car crashes, with opioids like OxyContin and other pain medications killing 44 people a day. We’re aware that the opioid […]

Sphenopalantine Ganglion Block for Migraines

Posted on July 24, 2017 by Angela Chen

Patients presenting to the ED with migraine pain can often present a challenge in terms of pain control. For patients who have pain refractory to NSAIDs, IV fluids, and migraine abortive therapies, or those who would prefer not to receive an IV, what other options can we turn to? The sphenopalatine ganglion (SPG) plays a […]

Absolute Lymphocyte Count as a Predictor of CD4

Posted on July 21, 2017 by Angela Chen

An HIV positive patient presents to the ED but doesn’t know his CD4 count. He hasn’t been taking his HAART and you’re rightfully concerned that he might be susceptible to opportunistic infections. Unfortunately, you can’t find any information about how immunosuppressed he is. Is there a way to estimate his CD4 count? Luckily, there is! […]

Determining Capacity

Posted on July 20, 2017 by Angela Chen

A 74 year old female with a GI bleed is refusing treatment, stating that she just wants to go home rather than being transfused for her hemoglobin is 5. You attempt to convince her to stay but she steadfastly says that she just wants to leave. She mentions she has to feed her dog and […]

Globe Subluxation

Posted on July 17, 2017 by Angela Chen

Apologies for the lack of recent pearls. Now that the website is back up and running, we’ll be going back to our regularly scheduled programming. “Hey doc, my eyeball popped out”. It’s a chief complaint that we don’t hear too often in the ED but when it happens, it’s enough to make me sweat a […]

Ticked off

Posted on July 10, 2017 by Angela Chen

Today’s TR pearl is brought to you by Drs. Shearer, Hernandez, Sun and O’Halloran and summer in the Northeast. The weather is warm and people are flocking to the great outdoors. This means…ticks, as well as the tick borne diseases they may carry. For how to remove a tick, see Dr. Paulis’s excellent clinical pearl […]

52 in 52: A Clinical Predictive Tool for Intra-Abdominal Trauma in Pediatric Patients

Posted on July 6, 2017 by Angela Chen

Title: Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma Article Citation: Holmes JF, Mao A, Awasthi S, McGahan JP, et al. Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma. Ann Emerg Med. 2009 Oct;54(4):528-33. PMID: 19250706 What […]

Burn Baby Burn

Posted on July 4, 2017 by Angela Chen

Happy 4th of July! I’m taking the day to review a commonly incurred injury on the holiday: burns. Whether it’s from operating a grill after a few too many libations or an unfortunate encounter with fireworks, the incidence of burns seems to go up dramatically on the 4th. While we mostly see minor burns in […]

Direct/Video Laryngoscopy for Foreign Body Removal

Posted on July 3, 2017 by Angela Chen

[vc_row][vc_column][vc_column_text] [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]Imagine this. You’re sitting in intake when all of a sudden a new patient pops onto your board with the chief complaint “fish bone stuck in throat”. You go to meet the patient, a 30 year old otherwise healthy gentleman who says that he has had the sensation of something stuck in his throat […]