Resus SinaiEM Blog – Page 54

Bloated and Upset

Posted on May 8, 2015 by sinaiem

47 y/o female PMH appendectomy presents with three days of worsening abdominal pain and constipation. Over the past day she has had persistent vomiting. She appears ill and has a diffusely tender abdomen. You quickly order labs and an obstructive series with upright chest XR with concern for a perforated viscus. To your surprise the […]

Confused and Hypertensive

Posted on May 7, 2015 by sinaiem

52 y/o female with a PMH of HTN and HLD presents with mental status change over the past 12 hours. She is non-compliant with medications and her initial BP is 252/130. Physical exam shows pt is A&Ox1, with an otherwise normal neuro exam. Labs show some AKI on CKD, CT-Head is normal. You plan to […]

Slow and Steady….

Posted on May 5, 2015 by sinaiem

75 y/o M with a past medical history of atrial fibrillation presents to the ED not feeling well for several days. He has some diarrhea but has continued to take his medications. He is mildly hypotensive. While IV access is established, you are shown his ECG…. Whats the problem with this ECG?

Remember to Check the Back…

Posted on May 4, 2015 by sinaiem

51 y/o M with a hx of smoking and HTN presents with acute onset of chest pain…. Is this anteroseptal ischemia or posterior MI?

Posted on May 1, 2015 by sinaiem

You have just intubated a 65 year old woman with sudden respiratory failure. On arrival, she had a pulse but cool extremities. She was obtunded and agonal with SpO2 was in the high 70’s. After pre-oxygenating with BVM to 100%, the intubation went smoothly. You had a clear view of the cords and passed a […]

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Tca in Peds.

Posted on April 28, 2015 by sinaiem

You are on your PEM shift overnight when a 9 year old boy with history of behavior disorder, BIBEMS only moments (<30min) after witnessed ingestion of 500mg of his grandmother’s amitriptyline. On arrival, ABC’s intact, and the patient is sleepy but easily arousable. Normal vitals for his age. An EKG is performed, which appears normal. […]

Status Epilepticus

Posted on April 27, 2015 by sinaiem

69 yo M with remote h/o CVA with residual aphasia and R–sided hemiparesis, BIBEMS from NH with concern for status epilepticus (SE). Per EMS, the patient began to have 3-4 episodes of generalized convulsive activity that began about 30 minutes PTA and refractory to both IV Ativan given by NH and IV Valium given by […]

Wide-complex, Irregular Tachycardia

Posted on April 23, 2015 by sinaiem

You are catching up on some charts in the resuscitation area of your ED when your triage nurse pushes in a 37 yo M with no PMHX, who presented to your ED complaining of sudden onset lightheadedness and L sided chest pain about 10 minutes PTA while at rest. No prior episodes. No CAD risk […]

Lump in My Throat…

Posted on April 21, 2015 by sinaiem

A 19-year-old-male with no known past medical history, presents in progressive respiratory distress shortly after undergoing a tooth extraction about 6 hours prior to presentation. Symptoms began initially as “a lump in his throat” and difficulty swallowing, but eventually progressed to mild dyspnea after 1-2 hours. Denies FB or allergies. On arrival he appears anxious […]

Did Hemodialysis Just Remove All My Patient’s Meds?

Posted on April 20, 2015 by sinaiem

44 yo F with h/o ESRD on HD and neurosarcoidosis complicated by panhypopituitarism on chronic steroids and thyroid replacement, BIBEMS obtunded. Last seen normal a few hours ago. The patient is hypotensive SBP ~75 and FSBG is undetectably low. The patient’s mental status responds well to D50. She denies exogenous insulin, or other ingestions. Admits […]

2015 Peds Ultrasound CME course

Posted on April 20, 2015 by sinaiem

Over forty participants joined Sinai faculty Jim Tsung, Ee Tay, Bret Nelson, Joshua Guttman, Jacob Goertz, Turan Saul, Jenny Sanders, Kimberly Kahne, Michelle Vazquez, Joe Sorravit, and Rupi Mudan. Course Directors Ee Tay and Joshua Guttman organized great didactic content and lost of hands-on training (HOT) with pediatric models. Participants from many pediatric and acute […]

It’s Not a Coma..

Posted on April 17, 2015 by sinaiem

54 yo F with no PMHx, but admittedly has not been seen by an MD in many years, presents after her daughter visited from our-of-town and found her slightly confused. The patient is disoriented, but able to provide some history. She describes progressive fatigue over several weeks. Vitals signs are remarkable for hypothermia 94F, HR […]

Aortic Stenosis

Posted on April 16, 2015 by sinaiem

56 yo F with no PMHX, presents complaining of increased DOE and orthopnea for several weeks. She also reports intermittent, mild mucosal bleeding. She denies syncope. Physical exam is notable for an obvious crescendo- decrescendo murmur over the right sternal border. CXR shows an enlarged heart and pulmonary congestion. The patient is suffering from severe […]

The Bends

Posted on April 13, 2015 by sinaiem

You are fed up with the big city, so you decide to take a job as an ‘island doc’ in the Caribbean. Life is good. It’s your second day on the job, and an 18 year old man is carried into your clinic with severe knee pain and shortness of breath. He’s just been diving. […]

Posted on April 10, 2015 by sinaiem

A 30 year old male presents to your ED, complaining of wrist pain following a fall while playing roller hockey. He denies wearing protective gear. On exam he has point tenderness over the dorsal aspect of his R wrist. You order an plain film: What is your diagnosis? Scapholunate dissociation (SLD) refers to a disruption […]