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.

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 cuffed 8-0 through easily with qualitative capnography and bilateral breath sounds. Now, post-intubation, her SpO2 is 86% and steadily dropping.

Your attending doubts your skills and wants to have a peek at your tube.

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Tca in Peds.

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. QRS 92 and the terminal R wave in aVR is <3mm. You are just about to given charcoal when the patient has a tonic-clonic seizure.

The EKG was normal right?

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Status Epilepticus

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 EMS.

The patient begins to seize shortly after arrival. You address ABC’s and give another dose of Ativan IVP and convulsions eventually stop after about 2 minutes, but you then note rhythmic eye movements, concerning for non-convulsive status.

What do you do next?

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Wide-complex, Irregular Tachycardia

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 factors. No illicit drug use. No family risk factors. The patient appears uncomfortable, diaphoretic and is clutching his chest.

Vitals at Triage:

Pulse 215

BP 87/60

RR 18

SpO2 100% NRB

As your patient is being attached to the monitor, you quickly assess ABC’s and perform a rapid exam. The patient is protecting his aware, lungs are clear bilaterally, and his hands feel cool. He’s AAO3.

Your ER tech then hands you this…

Pearlekg1

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