Stroke Mimics: A Review

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

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

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

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

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

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

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)

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 […]