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.

Do Less

A 4 y female arrives to ED accompanied by mother after witnessed mechanical fall off out of stroller (approximately 3.5 feet high) with head hitting linoleum floor.  Mom states that the child cried immediately afterwards and never experienced LOC.  Denies n/v.  Now acting normally.  Physical exam is remarkable only for a small, left parietal scalp hematoma, but no laceration.  Neurologic exam is WNL.  With the provided information what should be your next step?  Discharge home? Observe the patient? CT head?

Continue reading “Do Less” »

Respiratory Failure

As we all know, NiPPV is a well established practice and therapy of choice in patients with COPD and CHF exacerbations.  It is typically used in patients with hypercarbic respiratory failure.  But for those patients who come to the ED with pure hypoxemic respiratory failure (in say, someone with pneumonia) is there a better way to oxygenate them when standard nasal cannula isn’t doing the trick and you want to avoid intubation?  According to 2 recent studies high flow nasal cannula may provide the answer.  In comparing NiPPV to standard oxygen delivery therapy to high flow nasal cannula the intubation rates did not differ significantly, but appear to be lower in the high flow NC group.  Additionally, the 90 day mortality rate was significantly lower and ventilator free days were increased in the the high flow NC group compared to the other two.  The other benefit is that there was less patient discomfort in the high flow NC group.

It is important to note that high flow nasal cannula should probably only be thought of as a potential first line therapy for purely hypoxemic respiratory failure.   NPPV remains first line in hypercarbic respiratory failure.

To read these studies go to the following:

http://dx.doi.org/10.1056/NEJMoa1503326

http://dx.doi.org/10.1001/jama.2015.5213

 

I Think I Ate Something Fishy

31 y M presents with n/v/d and altered sensation to hands and feet several hours after going out for a seafood dinner.  Pt states that he ate red snapper at the request of a work colleague and prior to tonight was in his USOH.  Later, during the hospital stay the patient notes that the rail of the stretcher feels hot, but when you go to check said rail it feels cool to you.  What’s the diagnosis?

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Sob in Heart Failure

A 64 yo male with a history of CHF and COPD arrives with a complaint of acute onset SOB since this morning.  Lung exam is notable for diffuse Rhonchi.  You believe the patient is having a CHF exacerbation, but you’re also concerned for COPD (as well as the multitude of other pathologies that can give you SOB) given the history.  In addition to your standard labs and chest X ray what else might you think to do to evaluate for CHF?

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Ekg Fun

54 y M presents to the ED with complaints of chest pain starting acutely 4 hours ago.  The EKG is as follows:

Posterior Mi

What’s the diagnosis?  Continue reading “Ekg Fun” »

Leslie Pendery, MD


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