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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.

Intra-arrest Goal-directed Monitoring in 2014

Post by @Fteranmd

Screen Shot 2014-11-06 at 9.22.41 Pm

Thinking outside ACLS: Summary slide for conference lecture -Pathophysiology of Cardiac Arrest-

http://edecmo.org/intra-arrest-goal-directed-monitoring-beautiful-nutshell-felipe-teran-md/

55 F W/ Headache, Aphasia and Low-grade Fever

Post by @FTeranmd

55 yo F with PMHx of asthma who presented to the ED complaining of headache, low grade fever and word-finding difficulty. On further interrogation, patient endorsed having eaten Brie cheese recently. Her medications included albuterol and inhaled fluticasone.

In the ED patient was uncomfortable-appearing, with VS: T 101, HR 105, BP 130/70, RR 16 Sat O2 97% RA.

Physical exam was remarkable for low-grade fever, expressive aphasia and no meningeal signs.

ED team was concerned for possible CNS infection. CT non contrast was done given focal symptoms but no abnormalities were identified.

Blood work was remarkable for leukocytosis with bandemia. Patient was given empiric antibiotics and LP was performed.

Would you perform any additional imaging on this patient?

What specific infection would you suspect?

Continue reading “55 F W/ Headache, Aphasia and Low-grade Fever” »

What Do You Mean You Don’t Have Your Icd Card?!

Post by @FTeranmd

Screen Shot 2014-10-30 at 8.48.45 Pm

Image from Jacob et al. Heart Rhythm. 2011 Jun;8(6):915-22

We’ve all had a patient who shows up at the ED with a pacemaker or implantable cardioverter-defibrillator (ICD) that may be malfunctioning.  The patient didn’t bring the manufacturer ID card and isn’t sure about the make or model. So there you are, looking at the CXR, trying to identify the type — or at least the manufacturer. Is there anything we can actually look for to reliably identify these devices?

Continue reading “What Do You Mean You Don’t Have Your Icd Card?!” »

Approach to the Bleeding Tracheostomy in the Ed

Post by @FTeranmd

Photo (2)

 

Clinical scenario: 72 yo F with history of lung carcinoma with permanent trachestomy placed four  months prior presentation, brought by EMS with profuse, active bleeding from the stoma site. Patient is ventilator dependent and is being assisted with BVM at arrival. Per nursing home staff bleeding was noted an hour prior presentation and there was no history of unusual manipulation or trauma. Previous management had included aspiration and local pressure with dressings. Patient’s O2 Saturation is 97% at arrival on 40% FIO2.  BP is 102/60 and HR 100. Mental status is normal.

What the next step in management of this patient?

Continue reading “Approach to the Bleeding Tracheostomy in the Ed” »

Intermittent Visual Symptoms

57 yo M with PMHx of uncontrolled DM and HTN who presents with 3 weeks of intermittent  visual problems. Patient reports he sees flashes on both left sides of visual fields in both eyes. He is also unable to process 3D spacing and has trouble walking and reading due to vision problems. Episodes of symptoms tend to last 3-4 hours. Additionally patient complaints of mild R parietal headache that usually coincides with visual symptoms. Denies weakness or sensation deficits, dizziness, seizures or fever.

Physical examination in the ED is remarkable for absent vision on both left sides of his visual fields. Detailed eye and neurological exam reveal no additional abnormalities

Labs are only remarkable for hyperglycemia of 600 mg/dl, with no ketones or acidemia.

Hemianopsia

 

 

 

 

 

Management of hyperglycemia did not improve symptoms.

Brain CT and MRI were performed showing no abnormalities that could explain clinical picture.

What is the name of this patient’s deficit and where is anatomically located ?

Continue reading “Intermittent Visual Symptoms” »

Chris Hansen


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