Resus SinaiEM Blog – Page 44

A Novel Idea for Airway Management

Posted on February 19, 2016 by Peter England

A 65 yo M is rushed into the resus room. He is pale and is vomiting a mixture of coffee ground emesis and bright red blood. His vitals are stable currently but he is continuing to vomit in the emergency department. This patient requires a definitive airway. You have studied the emcrit guidelines for intubating […]

Catheters

Posted on February 18, 2016 by Peter England

You are working resus at 2 am when EMS rolls in with a 60 year old patient with fever and cough, hypotensive to 83/40 with a HR of 142. This septic patient needs emergent fluid resuscitation. You notice the RN about to place a peripheral IV with a little blue angiocatheter and a little piece […]

Not quite a STEMI

Posted on February 16, 2016 by Peter England

ST elevation gets all the attention when discussing EKGs. We have special STEMI and C-port alerts making it particularly sexy. Everyone knows to look for STEMI and how to manage it (aspirin, +/- Plavix load and straight to cath lab). However, we cannot forget about other important critical EKG findings that manifest themselves with ST depression […]

LLQ abdominal pain

Posted on February 15, 2016 by Peter England

A 43 yo M presents with LLQ abd pain, non-bloody diarrhea and subjective fever for 1 d. His vitals are normal, has a WBC of 14 but otherwise normal labs. He is given IV analgesia and clinically has improved, tolerating PO. CT abdomen and pelvis shows diverticulitis without evidence of abscess or perforation. Time to pull […]

HIV-Related Heart Disease

Posted on February 12, 2016 by Sumintra Wood

CAD and ACS: Both HIV and anti-retroviral medications increase patients’ risk of cardiovascular disease HIV-infected patients tend to have a first episode of ACS at age 48 yrs, 10 years earlier than HIV negative patients Reasons for increased risk include higher rates of smoking in HIV+ patients (2-3 times greater than in general population) and […]

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Differential Diagnosis of Ocular Palsies

Posted on February 11, 2016 by Sumintra Wood

Abducens (CN VI) Nerve Palsy CN VI causes contraction of the lateral rectus muscle, allowing the eye to abduct. An abducens palsy will present with impairment of lateral gaze of the affected eye. Causes of an Abducens palsy include: Vasculopathic (DM, HTN) Traumatic Meningeal or parameningeal infections Idiopathic Giant cell arteritis Brainstem lesions (most […]

Ovarian Torsion: Literature Review and Predictive Signs

Posted on February 9, 2016 by Sumintra Wood

A recent systematic review in Pediatric Emergency Care attempted to identify the most reliable clinical, biological, and radiological signs of ovarian torsion in the pediatric population. Ovarian torsion is a rare but serious cause of abdominal pain in pediatric patients with an incidence of 0.5-2 per 10,000 patients. Delay in diagnosis correlates with decreased rate […]

Therapies for Beta Blocker Overdose

Posted on February 8, 2016 by Sumintra Wood

A 42 yr old male is BIBEMS by his friend after reportedly ingesting an unknown amount of metoprolol 5 hours prior to arrival. In the ED he is hypotensive to 80s, bradycardic to 40s, with decreased mental status. The patient is intubated, a percutaneous sheath introducer is placed and he receives two liters of fluids, […]

Easily missed upper extremity fractures

Posted on February 5, 2016 by Sumintra Wood

An uncommon fracture can be easy to miss, and if you do not look for it, you might not see it. Scapula fractures – Typically seen in association with other injuries in setting of major trauma, but may be missed in the patient with shoulder pain 2/2 lower impact trauma. Most isolated scapular fractures can […]

Risk factors for mortality in blunt chest wall trauma

Posted on February 4, 2016 by Sumintra Wood

In patients with not immediately life-threatening blunt chest wall trauma, it can be difficult to decide which patients may require hospitalization and which patients can safely return home. A systematic review assessing risk factors for mortality in blunt chest wall trauma patients defined blunt chest wall trauma as “blunt chest injury resulting in chest wall […]

Owyang and Meyers Fluid Responsiveness

Posted on February 4, 2016 by phil

Owyang and Meyers sounds like a great east village restaurant (critics rave “you just have to get the foie and cheetos”). Instead, they’ve published a great systematic review of fluids responsiveness assessment with TTE and passive leg raise in the latest issue of the annals of em.

Why is there a terminal R in aVR with TCA poisoning?

Posted on February 2, 2016 by Sumintra Wood

The terminal R in AVR can be seen with any significant ingestion of a sodium channel blocking agent (including TCAs). Sodium channel blocking agents work by delaying phase 0 (upward stroke) of the myocardial action potential. This leads to changes in QRS morphology and duration. The right-sided intraventricular conduction system is more vulnerable to toxic […]

Cervical artery dissections in the ED

Posted on February 1, 2016 by Sumintra Wood

Cervical artery dissections include carotid or vertebral artery dissections and can be seen in patients of all ages, although they are a more common cause of stroke in young patients Symptoms may be somewhat non-specific (headache, neck pain, dizziness) or can be more localized (partial Horner syndrome with carotid artery dissection, etc.) Minor […]

PSA/Conscious Sedation Checklist

Posted on February 1, 2016April 27, 2022 by Jason Huo

Reuben Strayer has written and talked extensively about proper PSA technique in the emergency department. Here is his checklist so that you can minimize complications and maximize your success: For more information check out his Procedural Sedation Trilogy on emupdates.

An unusual rash

Posted on January 29, 2016 by Sumintra Wood

A 19 yr old male with a history of depression presents to the ED with diffuse, worsening rash, arthralgias and fever for the past 2 days. The patient recently started taking bupropion over the past 3 weeks and also started venlafaxine last week. He notes that the rash began as pruritic hives over his body […]