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.

Frostbite Review

Chilly day, time to review frostbite recommendations….

 

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Admit for Esbl Uti?

You have a patient sent by her PMD for a UTI. She had just received her culture results showing ESBL that is susceptible only to carbapenems. The PMD wants her admitted for IV antibiotics. She has no other symptoms. Is there a way to avoid this admission?

Rob Rogers on Aortic Dissection

Rob Rogers gave a great lecture on aortic dissection at the NYU Med Ed conference yesterday. Here are the highlights:

-not common, but it is a killer
-classic presentation in 1/3
-aortic dissection can be subtle (isolated abdominal/extremity/back pain, syncope, hypotension, painless dissection) and you must think about the diagnosis
-as per John Elefteriades (chief of CT surgery at Yale), it is ‘almost the standard of care to miss this diagnosis’
-missed/delayed diagnosis will lead to malpractice
-however, cannot scan and admit everyone
-5 tips to decrease your chance of missing the dx:
     1. symptoms above and below the diaphragm (ie: chest or neck pain + abdominal, pelvic, or lower extremity complaint)
     2. “chest pain and …” syndrome: consider dissection when CP comes with additional complaints such as leg pain, weakness, neuro complaints
     3. remember med mal clusters. scenarios that seem to recur in missed dissection cases include:
          - acute severe (thunderclap) unexplained chest or back pain
          – young patient with abdominal pain, hypertension and cocaine/vascular disease/smoking
     4. remember young patients can have a dissection (ie. Marfan’s in writer of Rent)
     5. patients who ‘look bad’ may be harboring a dissection
-consider suprasternal notch ultrasound to visualize proximal aorta
-chart should reflect your consideration of dissection, for example “equal pulses bilaterally, no murmur”
-negative d-dimer may not exclude dissection (intramural hematoma)

Five Huge Pearls About Blood Transfusions (#4 Will Astound You!)

Thank you for going for our click bait!

Approximately 41,000 blood transfusions are needed daily in the United States. While transfusions are largely safe and save countless lives, here are five pearls you should know.

1. The most common adverse reaction to transfusion is a fever and is treated with supportive care such as acetaminophen.

2. A minor allergic reaction limited to uticaria/hives can be treated with antihistamines and if symptoms resolve, the transfusion CAN be safely resumed (Tintinalli 6th ed).

3. Even though it is rare, Transfusion-Associated Acute Lung Injury (TRALI) is actually the most common cause of death from blood transfusions.

4. In massive transfusion or patients receiving chronic transfusions, hypocalcemia is often seem because of citrate in the blood products. While hypocalcemia often causes an abnormally long QT interval, using ECG findings to assess the significance of a patient’s hypocalcemia is not reliable.

5. Transfusion-Associated Circulatory Overload is most likely to effect geriatric patients (lower volume status).

 

References

Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. Emrey M: Blood and Blood Components, in Marx JA, Hockberger RS, Walls RM, et al (eds): . St. Louis, Mosby, Inc., 2010, (Ch) 5:p 45-

Tintinnalli, 7th edition, Chapter 233, “Transfusion Therapy.”

http://www.redcrossblood.org/learn-about-blood/blood-facts-and-statistics

http://foamcast.org/2014/06/09/episode-4-blood-transfusions-and-ingested-foreign-bodies/

Painless Vision Loss: a “true” Ophthalmologic Emergency.

A 50-year old man with atrial fibrillation and off of warfarin for the past 6 months comes to you with many complaints. But the one that catches your eye (pun intended. zing!), is that he complains of blurry vision.

1. What is the single most important test you must do on this patient?

2. Spoiler Alert: once you suspect central retinal artery occlusion, what can you do about it and how likely is the patient to improve?

3. What’s the pathophysiology and risks for this condition?

Continue reading “Painless Vision Loss: a “true” Ophthalmologic Emergency.” »


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