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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.

The Normotensive Pulmonary Embolism Patient

Early death (within 7-30 days) in PE patients is concerning. It is relatively easy to identify high-risk PE patients, defined by abnormal vitals SBP < 90 or drop in SBP by 40 for at least 5 min.

Normotensive patients with poor prognostic indicators include (statistically significant odds ratios):
- SBP between 90-100 (OR 2.45)
- HR > 110 (OR 1.87)
- elevated cardiac enzymes (OR 2.49)
- RV dysfunction (abnormal RV function on echo or RV dilation on echo or CT) (2.28)

Patients who have biomarkers for heart strain and RV dysfunction may benefit from some form of interventional therapy:
- lower (half) dose fibrinolytic therapy for patients < 75 years of age
- local, catheter-delivered, ultrasound-assisted thrombolysis

Other things to note:
- intubation increases intrathoracic pressure, which may decrease venous return and further worsen R sided dysfunction
- extracorporeal membrane oxygenation can help temporize heart and lung collapse where available but is not definitive management
- heparin is still mainline therapy for normotensive patients with PE but without any indications of RV dysfunction or no elevated biomarkers

Sanchez O, Planquette B, Meyer G. Management of massive and submassive pulmonary embolism: focus on recent randomized trials. Curr Opin Pulm Med. 2014 Jul 15.

Criteria for St Segment Elevation

Different criteria exist based on gender, age, and ethnicity:

- new 1 mm of STE in 2 contiguous leads except for V2-V3
- 2 mm of STE in V2-V3 in men > or = 40
- 2.5 mm of STE in V2-V3 in men < 40
- 1.5 mm STE in V2-V3 in women
- strongly consider serial EKG with chest pain patients

many examples of STEMIs and non-STEMIs

Circulation.2009; 119: e241-e250Published online before print February 19, 2009,doi: 10.1161/​CIRCULATIONAHA.108.191096 (details differences w/ ethnicity)
Am Heart J. 2013 Jan;165(1):50-6. doi: 10.1016/j.ahj.2012.10.027. Epub 2012 Nov 21.  (evidence for serial EKGs)

Young Female with Hemoptysis

A 24 year old female from Europe presents with progressive shortness of breath and hemoptysis. O2 sat is 94%. CXR is clear. PSH includes silicone implants in gluteal area. Meds include OCPs. Travel from Eastern Europe 2 months ago. D-dimer is negative. CTA is negative for embolus. What is the diagnosis?

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A Pediatric Pearl

This week, PECARN published a study that determined that isolated loss of consciousness (LOC) is not a strong enough predictive factor for a clinically significant traumatic brain injury, which they define as requiring intubation, extended inpatient observation, and/or neurosurgical intervention (rate of  0.5% (95% CI, 0.2-0.8; 13 of 2780). The rate is slightly higher for children younger than 2 years old than for those 2 or older.

Therefore, their updated recommendation is to NOT do a head CT in pediatric patients who present with isolated LOC after head trauma and none of the other PECARN predictors.

PECARN, a multi-institutional research organization, has a database of over 60,000 pediatric patients and has published over 60 peer-reviewed articles in pediatric emergency medicine.

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Complications of Dental Caries – Visual Diagnosis

A 45 year old male comes in with swelling of the tongue, fever to 102F, and O2 sat of 92% at triage. Patient states he has been having dental pain for the past two days.


Ludwig's Angina

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