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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.

Doc, I’m Feeling Lightheaded…

A 43-year-old patient arrives to the ED complaining of palpitations. Vitals are HR 298, BP 107/74, SpO2 100% RA, RR 18. The patient is diaphoretic, uncomfortable appearing, and heart sounds are fast and irregular. You obtain an EKG which shows the following:

What’s your differential?

  • Atrial fibrillation with bundle branch block
  • Atrial fibrillation with accessory pathway (as in Wolff-Parkinson-White)
  • Polymorphic VT (as in Torsades de pointes)

Your diagnosis is atrial fibrillation with WPW!

In contrast to a fib with bundle branch block, atrial fibrillation with WPW:

  • Has a rate of 200-300 bpm
  • QRS complexes change in shape and morphology

In contrast to polymorphic VT:

  • Axis remains stable

Why is this important?

AV nodal blockers can cause for these patients to decompensate into ventricular fibrillation. AV nodal blockers include calcium channel blockers, adenosine, beta blockers, and amiodarone – most of which are common treatments for atrial fibrillation. This would allow for the selective conduction of atrial impulses through the accessory pathway which does not have a refractory period.

So now what?

If patients are stable, procainamide is a good choice for antiarrhythmic agent as it will selectively block the accessory pathway. In unstable patients, electrical cardioversion is ideal as procainamide has been shown to cause profound hypotension.

Pearl 1 - a Fib with Wpw

For more information on WPW, check out http://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/


Sterile Glove Used As a Drain for a Skin Abscess?

The loop technique involves making two incisions at either pole of a skin abscess to initially drain its purulent contents. A loop drain is then inserted into one incision site and out the other, tied off above the skin with some movement of the loop drain allowed. The drain can be cut at follow-up in 7-10 days.


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Accuracy of Bedside Dvt Study

The two-point compression ultrasound exam assesses the lower extremity venous system at two points: common femoral vein and popliteal vein. Signs of DVT include lack of compressibility and visualized thrombus.


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Procedural Risks for Abd Paracentesis

Diagnostic abdominal paracenteses are frequently performed in the ED for patients with known liver disease. What complications can occur? What if the INR is elevated, as in many patients with liver disease?

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Pocus Ruq

A 40 y/o G10P10 presents with RUQ pain worse with fatty foods.

  1. When evaluating for acute cholecystitis, what 5 sonographic findings do you look for?
  2. What is the Mickey Mouse sign?
  3. What is the mantle clock sign?

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Greg Fernandez, MD