Welcome to the Mount Sinai Emergency Medicine Residency Website.

Here you will find information regarding rotation schedules, academic resources, wellness and facts about our program and residents. Check out our bios and photos. Please also visit the Emergency Department's official residency website. This site is intended for Mount Sinai EM residency purposes only, and no information on these pages is intended or should be construed as medical advice. Read more.

Did the Patient Finish Their Oral Contrast?


CT scans are cited as a frequent source of delay to disposition of our patients in the emergency department. A contributing factor to this delay is the time it takes one to drink their oral contrast and to allow this contrast to travel throughout the intestines. The truth is, very few people actually need oral contrast for their CT.

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Cardiac Tamponade

Cardiac tamponade is a condition in which there is life threatening compression of the heart as a result of external pressure from the presence of fluid, gas, pus, clots, or blood in the pericardial space.

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Abdominal Pressure Measurement

Abdominal compartment syndrome (ACS) is a condition in which the internal pressure of the abdomen becomes so great that it compromises venous return (and therefore hypotension), organ perfusion, and adequate ventilation. Continue reading “Abdominal Pressure Measurement” »

Doc, I’m Feeling Lightheaded…

A 43-year-old patient arrives to the ED complaining of palpitations. Vitals are HR 298, BP 107/74, SpO2 100% RA, RR 18. The patient is diaphoretic, uncomfortable appearing, and heart sounds are fast and irregular. You obtain an EKG which shows the following:

What’s your differential?

  • Atrial fibrillation with bundle branch block
  • Atrial fibrillation with accessory pathway (as in Wolff-Parkinson-White)
  • Polymorphic VT (as in Torsades de pointes)

Your diagnosis is atrial fibrillation with WPW!

In contrast to a fib with bundle branch block, atrial fibrillation with WPW:

  • Has a rate of 200-300 bpm
  • QRS complexes change in shape and morphology

In contrast to polymorphic VT:

  • Axis remains stable

Why is this important?

AV nodal blockers can cause for these patients to decompensate into ventricular fibrillation. AV nodal blockers include calcium channel blockers, adenosine, beta blockers, and amiodarone – most of which are common treatments for atrial fibrillation. This would allow for the selective conduction of atrial impulses through the accessory pathway which does not have a refractory period.

So now what?

If patients are stable, procainamide is a good choice for antiarrhythmic agent as it will selectively block the accessory pathway. In unstable patients, electrical cardioversion is ideal as procainamide has been shown to cause profound hypotension.

Pearl 1 - a Fib with Wpw

For more information on WPW, check out http://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/


Sterile Glove Used As a Drain for a Skin Abscess?

The loop technique involves making two incisions at either pole of a skin abscess to initially drain its purulent contents. A loop drain is then inserted into one incision site and out the other, tied off above the skin with some movement of the loop drain allowed. The drain can be cut at follow-up in 7-10 days.


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Greg Fernandez, MD