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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.

Meconium Staining

26 yoF 36 weeks by dates presents to the ED in labor, and has a precipitous birth in the resus area.  The infant is covered with a greenish liquid the consistency of split-pea soup.

How do you address this?

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Ddavp for Hemorrhage in Esrd Patients

CASE:

45F h/o ESRD on dialysis presents ped struck.

Pt is obtunded, intubated for airway protection.

CT head shows subdural hematoma with midline shift.

Neurosurgery is activated.

No antiplatelets or anticoagulants.

Is this person coagulopathic simply by having ESRD?

If so, should we address it with any particular medication?

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Bp Goal in Intracerebral Hemorrhage

55 yoF h/o HTN presents BIBEMS with acute onset decreased level of consciousness, onset 3 hours prior to arrival.

BP 220/140 HR 50 T 98.0 RR 10 SPO2 92%.

Pt is obtunded, no localizing neuro findings.

Pt intubated for airway protection.

CT shows 30ml intracerebral hemorrhage.

 

What are your management goals for blood pressure?

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Pharmacologic Intervention for Prevention of Post-traumatic Stress Disorder After Trauma

In the ED we often provide first line care for patients as the result of traumatic events.  Beyond attending to clinically apparent injuries, pain, and distress, we would be in a position to apply prophylactic treatment to attempt to prevent PTSD, a debilitating sequela of trauma, if such treatment were to exist and founded in good science.

Does such pharmacologic treatment exist?

Note: Cognitive behavioral therapy after trauma has been shown to attenuate development of PTSD and associated symptoms.

Below lie many oversimplifications and likely misinterpretations of clinical psychology, neuroscience, and PTSD.  Proceed with caution.

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Norepi Vs Dopamine

A 75M presents with several days of cough, fever, and progressive lethargy.
CXR demonstrates RLL pneumonia.
BP 70/50. HR 130. Lactate 5. T38.0
2L bolus NS given.
Antibiotics started.
Bedside sono shows noncollapsing IVC, hyperdynamic LV.
Recheck BP 72/50. Lactate 5.0
DX: Septic shock.
Plan: Central line, start a pressor, then intubate.

Question: What pressor do you want to start with, and why?

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