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basile

Evidence-Based Medicine

Staten Island Corner: VBG for DKA?

Welcome to this month’s edition of Staten Island Corner.  The motivation for this comes from a common question that I am sure all of you have had at one point or another.  The other day during a shift there was a debate about the accuracy of ruling in or ruling Read more…

By basile, 12 years ago
Evidence-Based Medicine

Staten Island Corner: Coumadin Toxicity!

Welcome everybody to this month’s edition of Staten Island Corner.  I recently had a case that we see on a regular basis in the ED that is the motivation for this month’s topic.  Supratherapeutic INR is something we see all the time, but it is something that I feel is Read more…

By basile, 12 years ago
Evidence-Based Medicine

Staten Island Corner: Video vs. Direct Laryngoscopy

Welcome to this month’s edition of Staten Island Corner.  The subject of this month’s edition comes from a recent topic on EMRAP.  There was an interview with Dr. Ron Walls, who is a well known Emergency Medicine Physician and nationally recognized airway expert.  The topic of the discussion was the Read more…

By basile, 12 years ago
Evidence-Based Medicine

Staten Island Corner: Pre-Hospital Endotracheal Intubation?

Welcome to this month’s edition of Staten Island Corner.  I was recently on EMS rotation so the inspiration for this month’s edition comes from an EMS topic.  I decided to look into the debate of whether endotracheal intubation is the best way to manage an airway in the pre-hospital setting. Read more…

By basile, 12 years ago
Evidence-Based Medicine

Staten Island Corner: The Intubated Asthmatic

Welcome back to this month’s edition of Staten Island Corner.  I decided to review the literature on the proper initial management of intubated asthmatic patients.  Although asthma is a very common disease and something that we deal with on a daily basis in the Emergency Department, it has the potential Read more…

By basile, 13 years ago
Evidence-Based Medicine

Staten Island Corner: Hyperemesis Gravidarum

Welcome to this month’s edition of Staten Island Corner.  The inspiration for this month’s entry was a “disagreement” that I was involved with on a pediatric shift.  We had an 18 year old patient with presumed hyperemesis gravidarum.  After the initial NS IVF bolus, I asked the nurse to switch Read more…

By basile, 13 years ago
Evidence-Based Medicine

Staten Island Corner: Asthma: Enough with the Prednisone, make it Dex…

WELCOME to this month’s edition of Staten Island Corner.  For this month we have a guest appearance from the Staten Island Chief himself Dr. Caputo. …So without further adieu please read the following written by Billy:   Asthma is one of the most common reasons for patients to present for Read more…

By basile, 13 years ago
Evidence-Based Medicine

Staten Island Corner: Septic Joint

Welcome back to this month’s Staten Island Corner.  Please come up with ideas or topics that you are interested in and I will be happy to try to find some useful information and articles on the topic.  I think we will all get more out of the blog that way. Read more…

By basile, 13 years ago
Evidence-Based Medicine

Staten Island Corner: Coronary CTA

  Welcome everyone to a new edition of the EBM blog, which is now renamed Staten Island Corner (Billy and Michelle this is a plea for you two to get involved and add to this).  I am taking over for Zina and will doing this on a monthly basis.  For Read more…

By basile, 13 years ago
Search the Site
Welcome to the official blog of the Kings County/SUNY Downstate Emergency Medicine Residency!

We are the residents (and some attendings) of the Kings County Hospital Emergency Department who have put together a unique mostly resident-authored blog for medical professionals.

If you have ideas for a post or are just looking for a fun way to do some individualized learning, e-mail us at CountyEMBlog@gmail.com and come be a part of our team!

Visit our YouTube channel for our recorded monthly conference lectures
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clinicalmonsterblog


Before you Walk in the Room: Abnormal Uterine Blee
Before you Walk in the Room: Abnormal Uterine Bleeding 
Is your patient presenting with abnormal uterine bleeding? Use the mnemonic PALM-COEIN to quickly formulate a differential before you walk in the room.
#emergency #emergencymedicine #medicalstudent #emresident #resident #intern #ms4 #ms3 #foamed #awayrotation #subi #differential #mnemonic #step1 #step #step3


County EM presents a case of an 18 year old male B
County EM presents a case of an 18 year old male BIBEMS after being found collapsed during a half marathon. He is obtunded, diaphoretic, tachycardic, tachypneic, and has a rectal temp of 107F.
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Exertional Heat Stroke

Take Home Points:

1. Though there are no head-to-head comparisons, cold water immersion appears to be the most effective method of rapid cooling

2. Consider placing defibrillator pads before water immersion

3. Consider the use of a body bag for rapid initiation of cold water immersion

4. Employ an ‘all hands on deck’ strategy to obtain ice from the nearest source

Check out our story and highlight reel for direct links to the article! Also check out our website for more juicy content!


Morning Report Recap- Dr. Natassia Buckridge on Ke
Morning Report Recap- Dr. Natassia Buckridge on Ketamine vs PNB for analgesia


Before you Walk in the Room: Headaches
The key to

Before you Walk in the Room: Headaches
The key to tackling headaches? Knowing primary from secondary. 
#emergency #headache #migraine #emergencymedicine #em #emresident #medicalstudent #ms4 #ms3 #awayrotation #rotations #subi #diagnosis #foamed #step1 #step2 #step3


BYWITR: Joint Pain
Is your patient presenting with

BYWITR: Joint Pain
Is your patient presenting with joint pain? Think arthritis. Here's a way you can formulate a differential diagnosis before you walk into the room.
#emergency #emergencymedicine #medicalstudent #emresident #resident #intern #ms4 #ms3 #foamed #awayrotation #subi #differential


Slit lamp mechanics with our very own Dr. Silverbe
Slit lamp mechanics with our very own Dr. Silverberg!


Before You Walk In The Room: Eye Pain
Going to see

Before You Walk In The Room: Eye Pain
Going to see a patient with a painful eye? remember to take an anatomical approach!
#emergency #emergencymedicine #medicalstudent #emresident #resident #intern #ms4 #ms3 #foamed #awayrotation #subi #differential


County EM presents a case of an 18 year old male B
County EM presents a case of an 18 year old male BIBEMS after being found collapsed during a half marathon. He is obtunded, diaphoretic, tachycardic, tachypneic, and has a rectal temp of 107F.
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Exertional Heat Stroke

Take Home Points:

1. Exertional heat stroke is a time-sensitive diagnosis.

2. The core body temperature threshold of > 40 degrees Celsius may be inaccurate.  More attention should be focused on pathological symptoms in the right clinical context.

3. Anticipate common complications including thrombocytopenia, coagulopathy, liver damage, acute kidney injury, lactic acidosis, cardiovascular dysfunction, and rhabdomyolysis.

Check out our story and highlight reel for direct links to the article! Also check out our website for more juicy content!


Before you Walk in the Room: Sinus Tachycardia
He

Before you Walk in the Room: Sinus Tachycardia 
Heart rate not going down? Looking for the cause? 
Use the mnemonic "FHAST PACED" to quickly identify potential causes of tachycardia in your patient. 
#emergency #emergencymedicine #medicalstudent #emresident #resident #intern #ms4 #ms3 #foamed #awayrotation #subi #differential


H2H: De Winters Pattern: An OMI Equivalent for Pro
H2H: De Winters Pattern: An OMI Equivalent for Proximal LAD Occlusion
#emergency #emergencymedicine #medicalstudent #emresident #resident #intern #ms4 #ms3 #foamed #awayrotation #subi #differential #mnemonic


BYWITR: Syncope
Picked up a patient with syncope?

BYWITR: Syncope
Picked up a patient with syncope? Use this framework to formulate a differential before you walk in the room 
#emergency #emergencymedicine #medicalstudent #emresident #resident #intern #ms4 #ms3 #foamed #awayrotation #subi #differential


County EM presents a case of a 40-year-old woman w
County EM presents a case of a 40-year-old woman with a history of CAD and prior RCA stent who arrives to the ED with chest pain for one day. Her triage vitals are within normal limits but you notice the patient holding her chest in pain with diaphoresis. Besides ECG and blood work, what else can be used to risk stratify the patient for ACS?
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TTE for Regional Wall Motion Abnormalities

Take Home Points:

1. Regional wall motion abnormalities occur early, before ECG changes or pain

2. Consider TTE if ECG is non-diagnostic for OMI, especially in patients with moderate to high likelihood of OMI

3. Look at a prior TTE, if available

4. Know the “false-positive” causes of regional wall motion abnormalities

5. Learn the coronary anatomy to correlate with regional wall motion abnormalities

Check out our story and highlight reel for direct links to the article! Also check out our website for more juicy content!


Welcome to our Before you Walk in the Room series-
Welcome to our Before you Walk in the Room series-
Altered mental status
Is your patient confused or acting out of character? Identify the cause with AEIOU-TIPS, a mnemonic for altered mental states
#emergencymedicine #residency #medicalstudent #meded #foamed #intern #ms4 #ms3 #mnemonics


Welcome back to part 3 of Hypertrophic Cardiomyopa
Welcome back to part 3 of Hypertrophic Cardiomyopathy!
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Take Home Points:

1. When patients with known or suspected HCM present hypotensive, maximize preload and afterload and avoid inotropes and chronotropes as they may worsen LVOTO.

2. Patients with HCM can have poor tolerance to atrial fibrillation and rhythm control strategy with cardioversion or antidysrhythmics drugs should be considered.

3. First-line treatment to prevent recurrent of ventricular dysrhythmias in HCM patients are beta-blockers.

4. ICD placement in patients with HCM has been shown to reduce mortality and is a class 1 recommendation in those with an episode of SCD in the past, ventricular fibrillation, or sustained ventricular tachycardia. Remember to ask about SCD risk factors such as family history of SCD or unexplained syncope. 

5. Patients with symptoms should be admitted while those that are  asymptomatic with known or suspected HCM can follow up with cardiology on an out-patient basis.

Check out our story and highlight reel for direct links to the article! Also check out our website for more juicy content!


Welcome to "Did You Ask?" a segment where we talk
Welcome to "Did You Ask?" a segment where we talk about important pieces of information that you need to get on history when examining patients. 
Today we're gonna be talking about back pain one of the most common chief complaints in the ED. 
#emergency #emergencymedicine #medicalstudent #emresident #resident #intern #ms4 #ms3 #foamed #awayrotation #subi #differential #mnemonic #backpain #step1 #step2 #step3 #ms1 #ms2


Welcome back to part 2 of Hypertrophic Cardiomyopa
Welcome back to part 2 of Hypertrophic Cardiomyopathy!
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Take Home Points:

1. Ask about chest pain, shortness of breath, palpitations, and/or syncope on exertion during your interview 

2. ECG findings are not diagnostic but classic findings include LVH, pathologic ‘dagger’ Q waves, deep S waves in V1-V3, and high R wave in V4-V6 with abnormal T waves 

3. A bedside parasternal short axis view with an end-diastole wall thickness ≥ 15 mm is highly suspicious for HCM and warrants further investigation 

4. Beta blockers are first line pharmacological intervention and in those with refractory symptoms consider disopyramide or surgical intervention via myomectomy or alcohol septal reduction

Stay tuned for part 3 as we discuss treatment of emergent conditions and prevention of SCD!

Check out our story and highlight reel for direct links to the article! Also check out our website for more juicy content!


Heart 2 Heart
Identifying Wellen's Syndrome- Keep

Heart 2 Heart 
Identifying Wellen's Syndrome- Keep an eye out for reperfusion T waves in the inferior or lateral leads if you have transient reperfusion of the RCA or LCx- the same pattern can happen in any of the coronary distributions!


County EM presents a case of a 59-year-old male wi
County EM presents a case of a 59-year-old male with a past medical history of hypertension, hyperlipidemia, and gastroesophageal reflux disease was brought in by EMS to the ED with severe chest pain
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Hypertrophic Cardiomyopathy (HCM)

Take Home Points:

1. HCM includes a complex interplay of left ventricular outflow tract obstruction (LVOTO), mitral regurgitation, diastolic dysfunction, myocardial ischemia, arrhythmias, and autonomic dysfunction

2. Although classically thought of as septal hypertrophy leading to LVOTO, multiple variants have been identified. Variants including concentric, reverse septal, neutral, and apical HCM have been identified, and nearly any pattern of LV wall thickening can occur with HCM.

3. Common adverse events include sudden cardiac death, symptoms of left ventricular outflow tract obstruction, heart failure, and arrhythmias 

4. Patients with HCM are at higher risk for myocardial ischemia even in the absence of CAD. 

5. The pathophysiology of anginal chest pain and rising troponin in HCM is related to increased oxygen demand secondary to hypertrophy, microvascular dysfunction, and small coronary vessel medial hypertrophy, which causes decreased coronary flow reserve and regional myocardial ischemia. 

Stay tuned for part 2 as we discuss early identification of HCM!!

Check out our story and highlight reel for direct links to the article! Also check out our website for more juicy content!


Today we share a post on the pathophysiology and m
Today we share a post on the pathophysiology and management of priapism. The big takeways are as follows:

1) Priapism is  either ischemic or non-ischemic and this is one of the most important distinctions to make as untreated ischemic priapism leads to fibrosis and permant sexual dysfunction.

2. Cavernosal blood gas in ischemic priapism will show elevated PaCO2 > 60 mmHg, decreased PaO2 < 30 mmHg, and pH < 7.25.

3. The most important treatment for priapism is drainage. This is achieved by injecting a 20-gauge needle into the 3 o'clock or 9 o'clock (sometimes both) position to aspirate blood from the corpus cavernosum. It is important to only aspirate from these positions to avoid injury to dorsal vessels or the urethra.

4. Once drainage is complete, inject phenylephrine into the corpus cavernosum to help prevent re-accumulation.

5. Most pharmacies will give you a phenylephrine bottle with 10 mg/mL concentration. You should dilute this ten-fold: take 1 mL of phenylephrine and mix into a 9 mL saline flush, creating a new concentration of 1mg/mL, or 1000 mcg/mL. You can inject 0.5cc of your phenylephrine mixture into the corpus cavernosa using the same needle you used for drainage (limit to 3 injections).

6. Lastly, all patients with priapism should be scheduled for urgent urology follow-up. For patients with recurrent episodes, or where multiple attempts at drainage have proven unsuccessful, you can consider an emergent urology consult.

Check out our story and highlight reel for direct links to the article! Also check out our website for more juicy content!


Today we share a post on the management of intracr
Today we share a post on the management of intracranial hemorrhage. The goal in the ED is to prevent hematoma expansion, edema, and herniation. The big takeaways are as follows:

1. For patients presenting with systolic blood pressure (SBP) between 150 and 220 mmHg, acute lowering of SBP to a target of 130 to 150 mmHg is safe and reasonable 

2. Seizure prophylaxis is not routinely recommended except in lobar involvement.

3. Studies show that hypertonic saline leads to a greater reduction in ICP when compared to mannitol.

Check out our story and highlight reel for direct links to the article! Also, check out our website for more juicy content!



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