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Otolaryngology/Dental

Morning Report: Globe Rupture

Thanks to Dr. Wang for today’s Morning Report!   Globe Rupture Occurs when a blunt object impacts the orbit Ruptures are commonly at the site where sclera is thinnest – insertion of the extraocular muscles or at the limbus History Type of object Time of injury Contact lenses? Prior history Read more…

By Jay Khadpe MD, 10 yearsAugust 4, 2015 ago
EM Principles

Can’t see, can’t read, can’t be bored – Review

Serena Williams strolls into your ED complaining of right eye pain for 2 days. She tells you that her right eye started hurting 2 day ago, after a tennis ball hit her face while practicing to dominate the US Open and win the 2015 Serena Slam. Since then she developed pain, photophobia, Read more…

By Kylie Birnbaum, 10 years ago
Ultrasound and Radiology

Morning Report: Ocular Ultrasound

Here’s Dr. Brevil with today’s Morning Report!   Ocular Ultrasound Since the anterior and posterior chambers of the eye contain vitreous fluid, the eye is an ideal acoustic window for ultrasound imaging Normal Anatomy: Iris separates lens and anterior chamber   Retinal Detachment Atraumatic RD in 1/10,000 Presence of unilateral Read more…

By Jay Khadpe MD, 10 yearsJuly 28, 2015 ago
Morning Report

Morning Report: Lateral Orbital Canthotomy

Thanks to Dr. Wang for today’s Morning Report!   Lateral Orbital Canthotomy   Indications: Retrobulbar hemorrhage Increase IOP (IOP >40mm Hg) Proptosis   Contraindications: Globe rupture Hyphema Tear-drop-shaped pupil Peaked or irregularly shaped pupil   Procedure: Positioning: patient in the supine position. Possibly restrained or undergo conscious sedation Local anesthesia Read more…

By Jay Khadpe MD, 10 yearsJuly 14, 2015 ago
EM Principles

Pirate Baby’s Never Bored Review

It’s a busy weekday shift in the Peds ED on Jolly Roger Island. A captain brings in his 11 day old newborn scallywag, concerned about her left eye being ‘swollen, crusty, and oozing pus.’ He notes that she cries anytime he tries to touch it. Her vital signs are On exam Read more…

By Kylie Birnbaum, 10 years ago
Infectious Disease Otolaryngology/Dental

Morning Report: Eye Infections

Here’s Dr. Alsup with today’s Morning Report!   Eye Infections   Orbital septum -Connective tissue extension of the orbital periosteum -Extends into the upper and lower eyelids   Periorbital / Preseptal Average age: 2 yo Result of local trauma, including insect bites Spread from contiguous structures, as in conjunctivitis, hordeolum, Read more…

By Jay Khadpe MD, 11 yearsOctober 23, 2014 ago
Otolaryngology/Dental

Morning Report: Eye Foreign Body Removal

Today’s Morning Report is presented by Dr. Shin!   Eye Foreign Body Removal   Immediately refer to an ophthalmologist in case of the following: o      Hyphema o      Diffuse corneal damage (focal or diffuse opacity) o      Scleral or corneal laceration o      Lid edema o      Posttraumatic dilation of pupil or abnormal shape Read more…

By Jay Khadpe MD, 11 yearsJune 27, 2014 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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