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.

Summer’s Around the Corner…need to Buff Up?

We’ve all heard that lidocaine buffered with sodium bicarbonate makes the local anesthetic closer to physiologic pH.  This in turn decreases time of onset and infiltration pain.  However, upon further investigation, this may not be so true.

Hobeich et al. concluded that 2% lidocaine with epinephrine buffered with 5% or 10% sodium bicarbonate did not significantly decrease time to anesthetic onset and infiltration pain when compared to nonbuffered solution.

Continue reading “Summer’s Around the Corner…need to Buff Up?” »

Starring Samuel L. Jackson in the Negotiator

When negotiations break down with an undifferentiated agitated patient, before you reach for your trusty 5:2, consider ziprasidone (Geodon).

Martel et al. concluded that droperidol or ziprasidone achieved better sedation of the undifferentiated agitated ED patient than midazolam.  But the onset of sedation was delayed with ziprasidone relative to the other agents.  Details of the study follow:

Continue reading “Starring Samuel L. Jackson in the Negotiator” »

Doppelgangers

Herpetic Whitlow

-       Viral infection of hand caused by inoculation of HSV into broken skin

  • Hand pain disproportionate to clinical presentation
  • Associated with influenza-like illness
  • Clear vesicles coalesce and become purulent but pulp space is soft (versus tense in bacterial infection) (Figure 1)
  • Beware of look-alikes (i.e. paronychia (Figure 2), felon (Figure 3)) as management differs

-       Treatment

Continue reading “Doppelgangers” »

I Scream, You Scream, We All Scream for Lactate.

We love our lactates and want to protect them from every slip and fall.  But are they a bit more resilient than we think?

Jones et al. concluded that point-of-care venous lactate in healthy patients does not significantly change over a course of 15 minutes either at -1˚ C or 23˚ C (room temperature) as well as with or without a tourniquet.

Continue reading “I Scream, You Scream, We All Scream for Lactate.” »

Blood Can Be Very Bad…indeed

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: epidural, subdural, intraparenchymal/intracerebral, intraventricular, or subarachnoid

Cistern

-       Is there blood?

-       Is it open?

-       Types of cisterns to identify: sylvian, quadrigeminal, suprasellar, and circummesencephalic

Brain

-       Check for symmetry

-       Check for grey-white differentiation

-       Check for shift

-       Check for hyper/hypodensity

Ventricles

-       Is there blood?

-       Is there compression/shift?

-       Is there dilation?

-       Type of ventricles to identify: lateral, 3rd and 4th ventricles

Bone

-       Fracture?

Zara Mathews


Archives

Categories