Interpreting head CT’s can be daunting.  But it doesn’t have to be.  Just remember, “Blood Can Be Very Bad”. Blood –       blood up to 1 week old looks hyperdense to brain –       blood 1-4 weeks old looks isodense to brain –       blood after 4 weeks old looks hypodense to brain –       Types of intracranial hemorrhage: […]

Consider giving 2mg of lorazepam to your patient who’s back at baseline after one alcohol withdrawal seizure to possibly prevent recurrent seizures.  This may even save you an admission as long as the patient has been at baseline without signs or symptoms of alcohol withdrawal for at least 6 hours. D’Onofrio et al. performed a […]

Distinguishing early necrotizing fasciitis from severe cellulitis is difficult.  In 2004, Wong et al proposed the LRINEC(Laboratory Risk Indicator for Necrotizing Fasciitis) score as a means to distinguish necrotizing fasciitis from other soft tissue infections. The LRINEC Score C-reactive protein (mg/L)    <150 (or <1.5 mg/dL) 0  ≥150 (or ≥1.5 mg/dL) 4 Total white blood […]

Yes in fact we do have a massive transfusion protocol in place at Sinai.  It’s quite amazing and surprisingly simple as long as the tubing system isn’t down.  Follow the following steps. Call 46101 Ask for “Massive Transfusion Pack” Provide patient name and MRN Within 10 minutes, Blood Bank should tube you down blood products. […]

The incidence of hemorrhagic complications from large volume paracentesis (LVP) is unknown but hemoperitoneum from rupture of mesenteric varices is associated with a high mortality up to 70%. Signs and symptoms of hemorrhage can manifest from hours up to 1 week after LVP. It has been proposed that a sudden reduction in intraperitoneal pressure from […]

As you know, pregnancy increases the risk of thrombosis.  This risk is even higher postpartum (within 6 weeks after giving birth).  Relative to the nonpregnant state, the 6 week postpartum period has been associated with 3-9 times risk of stroke, 3-6 times risk of MI, and 9-22 times risk of venous thromboembolism (VTE). Risk factors […]

The vast majority of ventricular fibrillation arrest can be traced back to cardiac etiology (ie CAD, HOCM, myocarditis, etc). However there have been rare cases of v fib arrest secondary to nontraumatic SAH; one recently in our own backyard (Elmhurst)! Aneurysmal SAH is a relatively common cause of PEA, but VF arrest is almost unheard […]

 cyproheptidine is a second-line therapy for serotonin syndrome. not SSRI overdose. the vast majority of SSRI overdoses do not result in serotonin syndrome. what kills people with serotonin syndromeis hyperthermia. the most important treatment for serotonin syndrome is supportive care, active cooling. Thanks Dr. Strayer for the correct info

When does one administer iodide as a treatment for thyroid storm? A.as soon as possible B.never C.it doesn’t matter D. 1 hour before administering a thionamide E. 1 hour after administering a thionamide F. 1 hour after administering a betablocker G. 1 hour before administering a beta blocker Answer : E.  if given earlier, the thyroid will use […]

  A patient presents with sudden onset eye pain.  He states he was watching his friend’s car get towed out of a snow drift that had suddenly appeared beneath it, when the towing cable snapped and the pain began.   He shows you this picture from his camera, taken right before symptom onset.     […]