Resus SinaiEM Blog – Page 79

Clinical Pearl: July 3

Posted on July 3, 2012 by trevor

A 50 year old patient with HIV, HCV cirrhosis presents to the emergency room with subjective fevers and generalized abdominal pain with tenderness. As part of your workup, you plan for a diagnostic paracentesis. On ultrasound imaging, the patient has a large amount of easily tapped ascites. His INR, however, returns at 2.9. Should you […]

SAEM newsletter

Posted on July 1, 2012 by sinaiem

The current issue of SAEM’s resident newsletter features an interview with Bret Nelson regarding ultrasound training. He and Beatrice Hoffman, MD, PhD, RDMS (Director of Ultrasound Education for the Department of Emergency Medicine at Johns Hopkins School of Medicine) are featured. They describe their path towards emergency ultrasound, the value of fellowship training, advice for […]

Clinical Pearl: June 29th

Posted on June 29, 2012 by sinaiem

Interesting point from Amal Mattu. What historical factors of CP are predictive of ACS? 1) association with diaphoresis 2) association with vomiting 3) association with exertion 4) radiating to both arms or right arm All others are not predictive, including: sub-sternal pressure, lightheadedness, nausea, and dyspnea. Sources: 1. Swap CJ, Nagurney JT. Value […]

Clinical Pearl: Thursday, June 28th

Posted on June 28, 2012 by sinaiem

When assessing for a difficult airway what does the LEMON acronym remind us to check? In a study, only three factors from LEMON are associated with a difficult intubation, which are they?

Clinical Pearl: Tuesday, June 26

Posted on June 26, 2012 by sinaiem

Thanks to Brittany for this excellent Peds pearl. A 4 year old boy presents with a fever and a one-day history of rapidly worsening limp at the LLE, now with complete refusal to bear weight or range the L hip. You are concerned about a wide differential, but particularly about septic arthritis. Labs are sent […]

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Clinical Pearl: Monday, June 25th

Posted on June 25, 2012 by sinaiem

28F presents with two months of intermittent fevers and a new murmur. You suspect infective endocarditis. With this subacute presentation, how many blood cultures should you order? How far apart? What empiric antibiotics are indicated? What if the patient is unstable? how many blood cultures should you order? How far apart? What empiric antibiotics […]

Aneurysm screening

Posted on June 22, 2012 by sinaiem

Sweep through large AAA from Sinai EM Ultrasound on Vimeo. Abdominal aortic aneurysm (AAA) affects 5-10% of males age 65-79, and among males over 55 years of age represents the 14th leading cause of death. Ruptured aortic aneurysm is associated with a very high mortality rate. Up to 80% of patients die by the time […]

Clinical Pearl: Friday, June 15

Posted on June 15, 2012 by sinaiem

Thanks to A.Hill for today’s pearl: 19M presents with fever and rash on palms and soles x1 week. Vitals: Temp 101 HR 105 BP 130/80 RR 12 O2 100% What is the differential for rash on the palms and soles? Disseminated gonococcus Rocky mtn spotted fever Hand, foot, and mouth disease Secondary syphilis Kawasaki disease […]

Clinical Pearl: Thursday, June 14

Posted on June 14, 2012 by sinaiem

A patient presents after an episode of syncope vs seizure. Can a serum prolactin level be helpful in differentiating the cause?

Clinical Pearl: Tuesday, June 12

Posted on June 12, 2012 by sinaiem

Thanks to PEM fellow Brittany for today’s cases. A 1 week old presents with cyanosis and sweating with feeds. No history of fever, preceding illness. O2 sat is 85%. Child is placed on 100% O2 but O2 sat does not improve. What are some possible causes of these symptoms? What is your goal O2 sat for these patients? What is the treatment?

Clinical Pearl: Monday, June 11

Posted on June 11, 2012 by sinaiem

23yo M presents with 2 days of substernal CP associated with fevers and dizziness, he called EMS for a near syncopal episode today. His triage vitals: Temp: 102.1 HR: 105 HR: 126/64 RR: 18 O2: 99% RA Exam: unremarkable exam: no murmurs/rubs, clear lungs, no rash, no signs of trauma. His EKG is below (click […]

Clinical Pearl: Friday, June 8th

Posted on June 8, 2012 by sinaiem

A 20yo M is BIBEMS after falling from a scaffold at a construction site. He has signs of head trauma. Upon arrival his VS are: T=98.9 HR=75 BP=185/90 RR=12 o2 Sat=99% on NRB His neuro exam: PERRL, moving all extremities eyes open to pain making incomprehensible sounds painful stimulation to the nail bed on the right hand […]

Clinical Peal: Thursday, June 7

Posted on June 7, 2012 by sinaiem

The first three pearls from this week did not go out via email, although they are on sinaiem.org Today’s pearl: A 45F presents with 3 weeks of CP. Her vitals: Temp 36.8C HR 71 BP 95/65 RR 18 O2 98% RA Her exam is unremarkable, with no signs or symptoms of DVT. She […]

E M Pearl, June 1

Posted on June 1, 2012 by raashee

Tip of the hat to Raj Patel for inspiring this clinical question. 26F h/o lupus is brought into resus for positive sepsis screen at triage. Patient c/o pleuritic CP, SOB, headache, n/v starting today. Vitals are 101.3 140 74/55 24 96%. Patient is on prednisone for lupus. In addition initiating your work-up for infectious […]

Haiti 2012

Posted on June 1, 2012 by sinaiem

In early May, emergency ultrasound fellow Leila PoSaw and two Mount Sinai senior Emergency Medicine residents on the ultrasound track, Swathi Nadindla and Micah Nite, traveled to Haiti for an ultrasound education project. This project was at the Bernard Mevs/ Project Medishare hospital in Port-au-Prince, which is the only trauma, critical care, and rehabilitation […]