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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.

Don’t Forget About the Kids….

@JoePinero

Quick Case: 17 mo M child presenting with painless bright red rectal bleeding x 1 day. Benign physical exam. Afebrile, with stable vitals and normal labs.

Dx: Meckels Diverticulum
T99 scan for diagnosis (Sensitivity 85-97%, Specificity 97%)
Surgical treatment: Indicated in severe cases, significant blood loss, persistent abdominal pain, refractory to medical treatment. Most common procedure is the trans-umbilical laparoscopic-assisted (TULA) Meckel’s diverticulectomy, which allows the exteriorization of the diverticulum through the navel and the performance of the diverticulectomy outside of the abdomen with its repair in relationship to the enteric defect and morphology
Medical treatment: Indicated in the stable, non-severe cases, supportive care, high dose PPI, IV hydration

Continue reading “Don’t Forget About the Kids….” »

Prisoners Can Refuse Care Too

@JoePinero Prisoners can often cause a lot of ethical dilemma’s when attempting to treat them in the hospital setting. Often times, physicians are reluctant to allow prisoners to sign-out AMA. However, there have been several supreme court cases in the past that have set a solid precedent for allowing this. In brief, here is an interesting, and relatively recent case that might help you the next time a sick prisoner is requesting to sign out AMA.

State vs Reid 2007  ( http://law.ubalt.edu/downloads/law_downloads/Stouffer%20v.%20Reid.pdf )
Reid, sentenced for 40 years, refusing dialysis during his first few years of sentencing with full knowledge that he will not survive without it. The medical doctors went to supreme court in effort to force care and were overruled. Reid was deemed of sound mind and was allowed to forgo dialysis. He would die later that year.

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Cardiology Board Questions

1. Which of the following is the earliest EKG finding in acute MI?
A. hyperacute T waves
B. ST elevation
C. ST depression
D. T wave inversion
E. Q wave

2. Which of the followingis true regarding pediatric EKG analysis?

(A) Left axis deviation is normal in healthy neonates.

(B) Atrial fibrillation is the most common pediatric dysrhythmia.

(C) T-wave inversion in the anterior precordial leads (V1–V3) is a normal finding in school-aged children.

(D) Cardiac dysrhythmias are the most common electrocardiographic manifestation of underlying congenital heart disease.

(E) ST elevation is most commonly associated with myocardial injury.

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No Sir, You Cannot Eat or Drink While in the Ed

@JoePinero – Much literature has been devoted to the attempt of proving the benefit of fasting as it relates to dangerous aspiration events during intubation or procedural sedation. Despite an overwhelming amount of literature pointing out a lack of benefit to fasting, most radiologist and anesthesiologists are very upset if they find out that their patient had a glass of water 2 hours prior to being intubated. This myth dates back to 1946 when Mendelson studied 44000 OB cases undergoing general anesthesia, which resulted in 46 cases of aspiration and 2 deaths.

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Cannabinoid Hyperemesis Syndrome

@JoePinero – Cannabinoid hyperemesis syndrome (CHS) is a rare diagnosis to make but can save a lot of time and frustration if you can make it. It is typically seen in young males who are frequent users of marijuana, presenting with severe abdominal pain and vomiting, likely with numerous prior visits all with negative work ups. Let’s briefly review CHS

CHS Symptoms
- cyclicaly vomiting
- compulsiv bathing behaviors
- abdominal pain (despite often benign abdomen on physical exam)
Continue reading “Cannabinoid Hyperemesis Syndrome” »

Carl “Scooter” Mickman


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