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.

Happy Match Day!

Congrats to all that have matched today!

 

Interestingly enough, did you know that Lloyd Shapley and Alvin Roth won the Nobel Prize in Economic Sciences in 2012 for their research over many decades about stable matching, which is used in the NRMP’s Match algorithm?

 

Check it out: http://www.nobelprize.org/nobel_prizes/economic-sciences/laureates/2012/popular-economicsciences2012.pdf

Eye Trauma & Bradycardia

A 3yo M comes into your ED around midnight after a fall off a stool onto his face. He has been vomiting, is bradycardic in triage to the 50s so is brought into your pediatric RESUS bay. Mom states that his eyes “look weird”. On exam, pt is scared but awake and alert, with full EOMI of the L eye, unable to look superiorly or medially with the R eye. PERRL. Mild erythema and tenderness over R inferior orbit. Vision grossly intact to fingers and colors in both eyes. No photophobia. Rest of PE is normal. HR on monitor varies from 80s to the 40s.

CT scan of the head shows no bleed. Orbital cuts show a R inferior orbital fracture suspicious for muscle entrapment. Admitted to PICU for hemodynamic monitoring and continuous neuro checks, and OR in the am. EKG shows sinus bradycardia.

Why is he intermittently bradycardic?

Continue reading “Eye Trauma & Bradycardia” »

Drowning Pearls

Thanks to our PEM fellow Dr. Michelle Vasquez for a great morning report today!

Some questions that came up afterwards:

Is there a difference in drowning with salt vs freshwater?

-turns out that while there are blood and electrolyte shifts, the amount of water needed to induce a clinically significant difference between the two types of water is so much that the pt has essentially suffered a fatal drowning, and therefore the difference does not change management.  

UpToDate states “Aspiration of more than 11 mL/kg of body weight must occur before blood volume changes occur, and more than 22 mL/kg before electrolyte changes take place” but non fatal drowning usually is more on the lines of 3-4mL/kg.

When are antibiotics indicated in drowning?

No great evidence for antibiotics in drowning unless water is grossly contaminated. However if pt develops a pneumonia afterwards, make sure to cover for water-borne pathogens like Pseudomonas.

In the awake but symptomatic patient, what are indications for intubation?

•Signs of neurologic deterioration or inability to protect the airway

•Inability to maintain a PaO2 above 60 mmHg or SpO2 above 90 percent despite high-flow O2

•PaCO2 above 50 mmHg

Consider using bipap on patients who don’t meet the above criteria for immediate intubation, but are symptomatic

 

 

Afib with Pre-excitation

A young patient comes into your RESUS area complaining of palpitations, and you get handed this EKG. What do you do?

Continue reading “Afib with Pre-excitation” »

Nailbed Lacs

A young man comes into your ED after slamming his right middle finger in the door. You see a large gash over the nail, and your hand specialist is not available to take care of the injury. What do you do?

picture is from lacerationrepair.com

Continue reading “Nailbed Lacs” »


Archives

Categories