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Core EM
Core EM is the official blog and podcast of the NYU/Bellevue EM Residency.
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Core EM Sep 22
Presence of intra-ovarian vascularity and ovarian arterial flow on pelvic Doppler sono DOES NOT rule out ovarian torsion (although absence of venous flow is highly sensitive).
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Core EM Sep 21
There’s a lot of natural beauty right around NYC…and, unfortunately, a few tickborne illnesses. Get out there, be safe, and remember to ask patients about exposures. NY DOH site on ticks & diseases (bacterial! viral! parasitic!) they carry:
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Core EM Sep 20
Pediatric hydrocarbon exposures -Decontaminate! -Major toxicity is aspiration pneumonitis – severe cases may require mech ventilation, ECMO -Children who are asymptomatic and have a normal CXR after 6 hrs obs can likely be d/c’ed -Call your poison control center for guidance 😎
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Josh Trebach, MD Sep 17
Dr. Goldfrank giving us an immersive tour through 🌱 plants and toxicology☠️! We are officially Goldfrank’s Garden Gang! 😎
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Core EM Sep 18
When a pediatric case has you stumped, a thorough social history might give you the answer—remember to ask about diet, habits, travel/exposures, living conditions, caregivers, etc.
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Core EM Sep 17
Not all hypoxia is COVID19. A recent case of methemoglobinemia induced by amyl nitrite (poppers) sent us to this table from Goldfrank’s Toxicologic Emergencies on common hereditary and acquired causes.
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Core EM Sep 16
ECG changes in hypokalemia: -Increased P wave amplitude; prolonged PR -T wave flattening/inversion; ST depression -Pseudo-prolonged QTc 2/2 prominent U wave (our patient had other reasons for true QTc prolongation: hydroxychloroquine toxicity and hypoMg)
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Y. Jay Lin Sep 2
Weekly Conference: Asthma Exacerbation w/ Dr. Imas PGY2
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Core EM Aug 31
Journal Review: Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study
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Core EM Aug 25
Core Content: Maisonneuve Fractures
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Core EM Aug 24
Remember to give antibiotics to cirrhotic patients with upper GI bleeds NNT = 22 to prevent 1 death NNT= 4 to prevent 1 hospital-acquired bacterial infection
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Y. Jay Lin Aug 23
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Core EM Aug 20
Replying to @EMHighAK
100%. Hard to find a justification for its use.
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Core EM Aug 20
Nitroglycerin Pharmacokinetics IV - Onset: Immediate - Peak effect: Immediate - Duration of action: 3-5 mins SL Tab - Onset: 1-3 mins - Peak effect: 5 mins - Duration of action: >25 mins Paste - Onset: 15-30 mins - Peak effect: 60 mins - Duration of action: 7 hours
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Core EM Aug 17
Positive Likelihood Ratios for Upper GI Bleeds (from Srygley in JAMA 2012) - Prior history of UGIB = 6.2 - Cirrhosis = 3.1 - Warfarin use = 2.3 - Black stool on history = 5.1-5.9 - Melena on exam = 25 - BUN >30 = 7.5 - Crit < 20 = 2.6 30-39 = 0.46 >40 = 0.26
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Core EM Aug 16
Cocaine CP - Cocaine use markedly increases risk of MI - Transient 24-fold increase in the first hour after use - 2/3 of MIs occur within 3 hours of cocaine use Proposed mechanisms: - Cocaine promotes coronary artery thrombosis - Vasoconstriction & spasm - Increased demand
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Core EM Aug 14
Le Fort I Fracture: - Transverse fx through the maxilla - Pt may complain of malocclusion when clenching jaw - Most require surgical repair - Abx if sinus involvement (Grade 2C rec) - 1.4% have concomitant c-spine fracture/dislocation - Avoid Covid swabs
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Core EM Aug 10
Daily Core Content ☕ Unstable Spinal Fractures - Mnemonic: “Jefferson Bit Off a Hangman’s Thumb” J - Jefferson’s fracture B - Bifacet dislocation O - Odontoid (type II and type III) A - Atlantoaxial or atlantooccipital dislocation H - Hangman’s C2 pedicular fx T - Teardrop fx
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Core EM Aug 9
Replying to @Core_EM
Tish: Even you? Me: Especially me.
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Core EM Aug 9
Replying to @Core_EM
Me: Listen. Every time you're given a choice between disappointing someone else and disappointing yourself, your duty is to disappoint that someone else. Your job, throughout your entire life, is to disappoint as many people as it takes to avoid disappointing yourself
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