The Dangers of Hiccups!

Posted on by Jason Barba

Intro For the first pearl during our reign, I wanted to teach about the most dangerous thing I could think of. Hiccups. There are some dangerous etiologies out there so stay tuned. TR Pearls – <5 minutes – Often benign and self-limiting, but if persistent may be due to a medication, GERD, stroke, ACS or […]

End Tidal Waveform Capnography

Posted on by Mariam Bhatti

tl;dr (<5 minutes) Quantitative end tidal: Partial pressure of CO2 in the gas sample at the end of expiration. You get a numeric value and a wave-form. EtCO2 is typically lower than PaCO2 due to anatomical and pathological dead space. Normal EtCO2 range is about 35-40 mmHg.  Role in Intubation: End tidal is used as […]

Stroke Mimics: A Review

Posted on by Teaching Resident

Intro: Stroke is the third leading cause of death and number one cause of disability in the United States.  Classically, strokes present with sudden onset focal neurological deficits in a vascular distribution and need prompt assessment and management to re-establish blood flow and avoid brain damage.  However, the diagnosis of stroke is not always straightforward.  […]

Unstable C-Spine Fractures

Posted on by Mariam Bhatti

Intro You are working a BNT shift at Elmhurst and you pick up a patient who is complaining of neck pain after a fall. Do they need to be in a c-collar? Should you order a CT c-spine? What are the unstable c-spine injuries you are looking for?  Shout out to Rozy for trying to […]

Tap that? VP Shunts & their complications
Posted on by Ahra Cho, MD/MBA

CSF shunts – these are the most common pediatric neurosurgery procedure done in the United States. While very common, these also have the highest rate of neurosurgical complications. About 50% fail within the first year, and the median survival of a shunt is usually 8-10 years, so a patient can expect 2-3 shunt revisions over the course of 20 years. 

A Killer Diagnosis- Aortic Dissection
Posted on by Mariam Bhatti

tl;dr – Story Time (<5 minutes) Patient is a 59 year old MTF with a PMH of HIV (undetectable viral load) and HTN (on amlodipine) BIBEMS for evaluation of “pinching” chest pain and right flank pain. EKG in triage revealed sinus bradycardia – HR 55 with a BP 130/70s. Patient was well appearing, endorsed chest […]

Chaotic Energy: A-fib RVR
Posted on by Mariam Bhatti

Intro: You are at Elmhurst and it’s your first cardiac shift ever. EMS rolls in, “Hey Doc, this patient is in a-fib.” The patient’s heart is beating fast. Your heart is beating fast.  He is a 70 year old patient with a PMH of HTN, CKD, and COPD presenting from the nursing home with SOB. […]

Mount Sinai and Elmhurst Haiku (Epic) Access
Posted on by Jason Huo

Here is a quick tip to swap between Mount Sinai and Elmhurst Haiku on your phone (iOS):Go to settings and search or scroll down to Haiku Under “Connection Settings” input the following “Server” and “Path” inputs for the respective site. Mount Sinai Server: epicsoapproxyprd.mountsinai.orgPath: interconnect-haiku-prd Elmhurst Server: epicproxypda.nychhc.orgPath: hhc-haiku Now you’re ready to re-login to […]

Paxlovid: The Need to Know
Posted on by Sarah Ring Gibbs

Why Paxlovid: According to Pfizer’s clinical trial data from 2021 (participants enrolled by 09/29/2021) which it used for FDA approval, subjects who took Paxlovid were 89% less likely to develop severe illness and death from COVID than those taking a placebo. Grain of salt here includes:  In the original study, participants took Paxlovid within 3 […]

The Unstable Pregnant Patient (2nd Trimester and Beyond)
Posted on by Sarah Ring Gibbs

Vital Signs: HR and BP Traditionally in medical school we were taught that physiologic changes in pregnancy caused a drop in BP and an increase in HR but generally it was not well-defined if a new range of criteria was required to be considered normal. Emerging data shows that modest changes can be expected with […]

Myasthenic Crisis
Posted on by Sarah Ring Gibbs

Myasthenia Gravis: Disease Overview Who: Bimodal distribution. Ages 20-40 (female predominance) and 50-70 (male predominance). Increased risk of onset in postpartum period; juvenile and congenital forms possible What: At the NMJ, Ach receptors are blocked by antibodies = decreased muscular contraction. Associated with fluctuating weakness. Home Treatments: Pyridostigmine (AchE inhibitor); +/- glucocorticoids, azathioprine, mycophenolate (immunosuppression) […]

Let’s Talk About Bicarb
Posted on by Fred Milgrim

If you’re like me, when you treat hyperkalemia, you make things easy on yourself and open up that HyperK orderset, or think about the mnemonic C BIG K DROP (Calcium, beta-agonist/bicarb, insulin, glucose, Kayexalate (Lokelma actually), Diuretics, ROP (“renal unit for dialysis of patient”). Then you move on with your life, recheck the BMP and […]

Burn Management
Posted on by Benjamin Hong

Trauma Survey: Burns are trauma, treat these pts as such. Don’t let yourself get distracted by the obvious superficial injuries/wounds and be sure to go down your algorithm so you don’t miss anything. PRIMARY: Airway: Look for signs of active or potential airway compromise/inhalation injury (e.g. soot, edema, or burns on the face, in oropharynx/nares, stridor, AMS). […]

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