Core Emergency Medicine

Posterior Circulation Stroke

Diagnosis and management of this often missed, potentially devastating neurological disease.

Post-Infectious Glomerulonephritis

A look at this post-infectious process that can range from asymptomatic hematuria to florid renal failure and acute nephrotic syndrome.

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Episode 173.0 – Blunt Neck Trauma

We go into one of the more complex injuries – blunt neck trauma.

Hosts:
Audrey Bree Tse, MD
Brian Gilberti, MD

Episode 172.0 – Ankle Sprains

We dissect one of the most common injuries we see in the ER -- ankle sprains

Hosts:
Brian Gilberti, MD
Audrey Bree Tse, MD

Core Procedures See More →

Elbow Dislocation

An overview of elbow dislocations, how to examine them, and suggested techniques for reduction by Dr. Laura Weber

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Push-Dose Pressors

A brief video reviewing how to prepare and administer push-dose epinephrine and push-dose phenylephrine.

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Dec102019

“There are some things you learn best in calm, and some in storm.”

– Willa Cather

Over the past several years, I’ve thought a lot about what to say during the immediate moments after a failed cardiac arrest or traumatic resuscitation. When the rush of adrenaline comes to a screeching halt and all that is left is a deafening silence,
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Nov262019

The new version of the PEM CARS iBook (V3.0, 2019) has been released! 200 comprehensive, critical article reviews on PEM literature available for free.

Download the PDF

Access the Apple Book

Congratulations and many thanks to the NYU/Bellevue Pediatric Emergency Medicine fellows and faculty that have put in a considerable amount of effort to make this happen.  
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Sep272019

Hi CoreEM Community-

This isn’t a usual blogpost but we just wanted to let you know that NYU Bellevue EM Department is looking to hire new faculty for 2020!!!  It’s an amazing place here with a chance to work with some fantastic residents and inspiring colleagues and treat an impressive breadth of patients,
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Core Journal Club See More →

: Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial.

Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatrics, 2019

Recommendations that “rest is best” for concussions are based on animal research and consensus opinion. Recent evidence suggests that strict limitation of activity may not be beneficial.
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Core Cases More Cases →

CC

Nausea, vomiting, and abdominal pain

HPI

Acid-Base Workshop: At the beginning of the conference year, multiple faculty members ran a workshop on acid-base abnormalities where we worked on identifying acid-base disturbances, determining primary respiratory or metabolic abnormalities, causes of such disturbances, and if compensation was appropriate. Perhaps one of the most challenging types of patients we encounter with an acid-base disturbance is an acidemic patient who we believe requires intubation. Below you will find a variety of resources on acid-base disturbances and more specifically, intubation and ventilation in this patient population. Read the case, consider reviewing the resources below, and think how you would approach this tenuous patient.


The Case:

A 23 yo F with a PMH of poorly controlled T1DM presents to your ED complaining of nausea, vomiting, and abdominal pain. She ran out of her insulin 3 days ago and didn’t have the funds to refill it. Her FS is 415 on POC testing.

Physical Exam

Vitals: 123/80, HR 120s, O2 98%, RR 32, Temp 98.2

General: sleepy but arousable to voice

HEENT: dry mucous membranes

Chest: CTAB, kussmaul breathing

Cardiac: regular rhythm, tachycardic

Abdomen: soft, NTND

Extremities: MAE

Labs

VBG: 7.03/14/65, Calculated Bicarb 5

BMP: 132/4.3/99/3/20/.09>423


What next?

You hang fluids and start an insulin drip, but the patient becomes progressively lethargic and has vomited twice despite anti-emetics. You decide you need to intubate. What next?

Questions

  1. What are the risks of intubating this patient?

  2. What would be your intubation strategy? Method, intubation medications, and things to pay attention to?

  3. Would you consider giving any additional medications (apart from paralytics or sedation medications) prior to intubating? If so, why, and what would be the dosing?

  4. What would be your ventilator settings?

More Info

Basics:

Aliem- Deciphering Acid Base Disorders

Case Content:

Case of the Month, Acidemia

Intubation/Ventilation FOAM:

Critical Care Updates: Resuscitation Sequence Intubation – pH Kills (Part 3 of 3) Podcast 3 – Laryngoscope as a Murder Weapon (LAMW) Series – Ventilatory Kills – Intubating the patient with Severe Metabolic Acidosis Simplifying Mechanical Ventilation – Part 3: Severe Metabolic Acidosis

Peer Reviewed:
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