Resus SinaiEM Blog – Page 57

Motor Vehicle Accident and Chest Pain

Posted on January 27, 2015 by sinaiem

A 50-year old man with no known medical history (“I don’t see doctors. I don’t like doctors.”) presents to the ED because he crashed his car into a pole after driving after a “wintry mix” weather event (#blizzard2015). There was no loss of consciousness. Airbags deployed. The car sustained damage to the bumpers and one […]

Small Bowel Obstruction Likelihood Ratios.

Posted on January 26, 2015 by sinaiem

A 78-year old man presents with abdominal pain and decreased oral intake. His vitals are normal but he looks uncomfortable. After you introduce yourself, you palpate his abdomen which is diffusely tender. Your immediate gestalt is “Small Bowel Obstruction” but you’re not sure why. Frankly, you think, “I can do better than gestalt.” Can you? […]

Ignoring Hiccups Lasting >48 Hours is a Bad Idea. Here’s Why and What to Do…

Posted on January 23, 2015 by sinaiem

Chief complaint: Hiccups (i.e. “singultus”). Timing: 3 days. Diagnosis: Persistent hiccups. Etiology: Unknown. Who cares? You care. Why? Because persistent hiccups (>48 hours) and intractable hiccups (>1 month!) is likely indicative of an underlying illness that needs work-up/diagnosis. 1. What is the difference between a “bout,” “persistent,” and “intractable” hiccups? 2. What’s an ED-ready trick […]

6 Month Old Wheezer. Trial of Saline and Albuterol Nebs, Right?!

Posted on January 20, 2015 by sinaiem

PEM fellow Dr. Michelle Vazquez presents a case of: A 6 month old boy comes to the ED with an elevated respiratory rate and lots of wheezing on exam. He had a tactile fever at home and in the ED his temperature is measured at 100.4F. His oxygen saturation is 90% on room air. There […]

How Many Chest X-rays Would It Take….

Posted on January 19, 2015 by sinaiem

A young woman presents to the Emergency Department with chest pain of sudden onset while blowing up a balloon at her kid’s birthday party. Vitals are normal but due to slightly decreased breath sounds on the left, you are concerned for pneumothorax. ECG is normal. No other complaints. You order a chest x-ray but the […]

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Predicting and Dealing with Difficult Peripheral Iv Access.

Posted on January 16, 2015 by sinaiem

Nurse: Doctor, this patient is a tough stick. I tried 3 times and I got nothing. Can you help? Doctor: Sure! I’ll grab the linear ultrasound vessel finder and get that line in for you, thereby potentially saving this non-critically ill patient from an unnecessary central venous catheter (free pearl #1). Nurse: Ok! Do you […]

Wet Read on Lateral Knee Film

Posted on January 15, 2015 by sinaiem

Your 14 year old male patient fails the Ottawa Knee or Pittburgh Knee clinical decision tool after gettting whacked in the knee with some object of some kind or another. He’s tender near the tibial tuberosity and he refuses to extend his leg. You can’t tell whether this is pain limited or whether something else is going […]

Stroke Alert! Wait, What Does Acep Want Me to Do?

Posted on January 13, 2015 by sinaiem

A 75-year old man comes to your Emergency Department with an acute onset of left sided weakness and a facial droop. His NIH Stroke scale is 15. A stroke alert is called and the stroke fellow and her team race-walks to the Emergency Department. A vigorous discussion of whether to give tPA (alteplase) as a […]

He Keeps Repeating Himself, Himself, Himself….

Posted on January 12, 2015 by sinaiem

A 60 year-old male patient with a history of hypertension is BIBEMS with his spouse two hours of sudden onset memory loss. She noticed he began asking her if she wanted coffee every 3 or 4 minutes, apparently not remembering he had already asked. He knows his name, where he is, and the date. He correctly […]

Femoral Nerve Blocks for Hip Fractures

Posted on January 9, 2015 by sinaiem

by @benazan I have been surprised by the lack of pain in some patient with hip fracture. Most I have seen seem to be fine as long as the remain perfectly still. However, how often does that happen? After x-rays, multiple attending and resident exams patient will hate you if their pain is not well […]

Cus It Up with Teamstepps…

Posted on January 2, 2015 by sinaiem

by @BenAzan Over the last several months, the Mount Sinai Emergency Department has been implementing TeamSTEPPS to improve the workflow, communication and operations in the Emergency Department. What is TeamSTEPPS? It’s essentially a nomenclature for team training and teamwork. It was put together by Agency for Healthcare Research and Quality (AHRQ). It’s a set of terms and approaches […]

A Brief History of Today

Posted on December 31, 2014 by sinaiem

By @BenAzan What pearl could I possibly find worthy of continuing tweets and dissemination? The last two posts, one of which was retweeted by both @M_Lin and @precordialthump (thanks!), are a tough act to follow. So first I thought about maybe high flow nasal cannula, the forgotten oxygenation method. I could highlight those magical nasal prongs that can deliver up […]

Predicting a Difficult Airway

Posted on December 29, 2014 by sinaiem

By @BenAzan Today’s post on Resus.me by @cliffreid was yet another reminder of how challenging (if not impossible) it is to predict a difficult airway. The study he quotes (1) looked at ~188000 intubations by anesthetists in Denmark. For each case, the anesthetists recorded pre-intubation if they expected a difficult intubation and if they expected the patient […]

How to Succeed in 2015

Posted on December 26, 2014 by sinaiem

As the year is coming to an end, a great place to look for inspiration for 2015 is Academic Life in Emergency Medicine’s series “How I work Smarter“. I’ve been reading these and wanted to share some highlights. The first thing that really jumps out is, in order to excel in the world of FOAM/Academic […]

Wide Complex Tachy…a Case

Posted on December 23, 2014 by sinaiem

A nurse hands you this EKG with a concerned look… She say it’s a 35 y/o man who is coming in for shortness of breath and palpitations since last night. The next question you ask is vitals? Yes! BP 96/57, HR 201 ,RR25, pO2 99 on 4LNC and Afebrile. You put your thinking cap on […]