Imaging in Intussusception

Posted on by Courtney Cassella

Clinical Scenario: A 2-year-old female with no significant past medical history presents with vomiting and abdominal pain for 1 day. Among other entities in your differential diagnosis you are considering intussusception, however it is lower on your differential. How would you work-up this child?   Presenting Symptoms for Intussusception1 Sudden onset of intermittent, severe, crampy, […]

52 in 52: Emergency Department Thoracotomy

Posted on by Courtney Cassella

Article Citation: Moore EE, Knudson MM, Burlew CC, Inaba K, et al; WTA Study Group. Defining the limits of resuscitative emergency department thoracotomy: a contemporary Western Trauma Association perspective. J Trauma. 2011 Feb;70(2):334-9. PMID: 21307731 Resident Reviewer: Courtney Cassella What we already know about the topic: Resuscitative ED thoracotomy (EDT) is a resource intense procedure with […]

Imaging in Clostridium difficile infection

Posted on by Courtney Cassella

Clinical Scenario: A 68-year-old man with a past medical history of diabetes mellitus, hypertension, and recent admission for pneumonia presents with fever and diarrhea for 5 days. The patient has had multiple watery stools per day. Associated symptoms include mild vague abdominal pain but no nausea or vomiting. Exam is notable for mild diffuse abdominal […]

Good news you’re pregnant… Now what?

Posted on by Courtney Cassella

Clinical Scenario: A 28-year-old G0P0, last menstrual period November 2, presents with amenorrhea. Urine pregnancy test is positive. Examination is normal. Bedside ultrasound demonstrates an early intrauterine pregnancy. After being given follow-up information and return precautions she asks for advice in order to have a healthy pregnancy. What do you tell her?   Foods to […]

52 in 52: Ottawa Subarachnoid Hemorrhage Rule

Posted on by Carl Mickman

Citation Perry JJ, Stiell IG, Sivilotti ML, et al. High-risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ. 2010;341:c5204 Resident Reviewer Carl Mickman Why this study is important Subarachnoid hemorrhage (SAH) is one of the most dangerous diagnoses made in the emergency department, and a large amount of resources […]

Coach, I Jammed My Finger, Can I Still Play?
Posted on by Carl Mickman

    Jammed fingers are a very common complaint in the emergency department, and while often sent home as soon as we verify they don’t have a fracture, there is another more serious complication that needs to be on our radar. Mallet finger, or baseball finger, is often caused by a sudden force that causes […]

Trigger Point Injections
Posted on by Carl Mickman

Back pain-related complaints account for millions of visits in emergency departments every year, and all of us have had patients that despite our best efforts aren’t satisfied with their pain control. Trigger point injections of local anesthetics well as anti-inflammatory medications have been common treatments in chronic pain and headache clinics for years, and are […]

Tenebrous Tenets of Testicular Torsion
Posted on by Carl Mickman

Testicular torsion is one of the most concerning diagnoses we can see in the emergency department, but a lot of the things we have come to accept as dogma regarding this dangerous diagnosis aren’t always as straightforward as board exams would have you believe! Dogma #1: Thunderclap Onset: Onset can be insidious, and may present […]

52 in 52 Review: POCUS vs CT for Suspected Nephrolithiasis
Posted on by Carl Mickman

Citation Smith-Bindman, C. Aubin, J. Bailitz, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med, 371 (2014), pp. 1100–1110. Resident Reviewer Carl Mickman Why this study is important The use of non-contrast CT has been the gold standard for diagnosing renal colic despite suggestion that ultrasound could also be used as […]

2016 Critical Ultrasound Course
Posted on by sinaiem

On December 4th the Department of Emergency Medicine hosted its 11th hands-on ultrasound course at Mount Sinai. Over forty participants practiced critical ultrasound skills on live models and simulators, guided by a dozen of our faculty and fellows.  

Other Options for Opiate Withdrawal Treatment
Posted on by Carl Mickman

All of us have seen the acutely withdrawing opiate abuser during our times in the emergency department, however aside from a little bit of clonidine and enrollment in a methadone clinic, it can sometimes seem like our options are fairly limited in treating these patients. It is rare as ED docs that we are able […]

How low should you go?
Posted on by Carl Mickman

  Hyperglycemia is frequently seen in the ED.  Practice variation is common in terms of glucose reduction for safe discharge.  The question is does improving this number benefit our patients?? Study: Driver, B et al. Discharge Glucose is Not Associated With Short-Term Adverse Outcomes in Emergency Department Patients With Moderate to Severe Hyperglycemia. Annals of […]

Pre-charging the Defibrillator in ACLS
Posted on by Carl Mickman

During ACLS, valuable seconds are often wasted while trying to analyze the rhythm on the tiny monitor. Is it VT? VF? PEA? Then when we decide we do want to deliver the shock, even more time is wasted charging the defibrillator. All this lost time translates to decreased time delivering perfusion-delivering compressions in critically ill […]

52 in 52 Review: HINTS to diagnose stroke in the acute vestibular syndrome
Posted on by Carl Mickman

  Citation Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. 2009. HINTS to diagnose stroke in the acute vestibular syndrome. Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 40:3504–10 Resident Reviewer Carl Mickman Why this study is important Posterior circulation strokes are extremely difficult to diagnose in the emergency […]

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