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Archive for February, 2013


Kevin Munjal via
8:50 PM (18 minutes ago)

to EMFaculty, emresidents, Cindy, Veronica, Boden-Albala, Dwayne, Leigh
Hi everyone,

Following up on the brief inservice given at conference this week:


What is DESERVE?

Discharge Educational Strategies for Reduction of Vascular Events

Basically, it is an enhanced discharge and follow up experience for your patients. The study will randomize patients to either receive the special experimental program or usual care. If the intervention shows benefits, you will have helped your patients and possibly improve the way we care for all patients with TIA or minor strokes.

How to Refer a Patient?

Universal Pager available 24 hours a day / 7 days a week: 917-205-2440

Which Patients are Eligible?

Please refer all patients in the adult ED for whom you are concerned about mild stroke or TIA.

You do not need to worry about inclusion and exclusion criteria. The Study Research Team will ask you pertinent questions or obtain the information from the chart.
For those interested, they will exclude patients who are <18, have dementia, end stage cancer, significant disability prior to the event or otherwise unable to provide consent. They require the patient to have a vascular risk factor such as HTN, smoking, but a single measurement in the ED above 130/85 is good enough. They will likely capture patients admitted for stroke once they are in the hospital, but they do not mind finding out about these patients from you either. The real benefit, though, is when you let them know early about a patient who ends up getting discharged. When should I refer a patient? The earlier the better! Consider calling when: You have evaluated a patient and are considering TIA or Stroke in the differential You are writing your "provider note" and you use the template "Neurological Deficit or CVA" You decide to call Neurology for a neurological complaint that might be a TIA or Stroke You decide to get a head CT for a neurological complaint that might be a TIA or Stroke Neurology wants the patient to get an MRI which means the patient and family need something to do while waiting other than bug you every 15 minutes about how long they have been waiting for the MRI. Why can't Neurology make these referrals? The ED does not always call Neurology for every TIA You know how long it takes Neurology to see your patients. Once neurology sees them, if the patient is ready to be discharged, there probably won't be enough time to enroll them. How long does enrollment take? 30 min - 90 min depending on multiple factors. Will this mess with my ED throughput? No!! The DESERVE Team staff will be flexible around the patients clinical care needs. They will do enrollment and education at the bedside and pause for any clinical staff that need to interact with the patient or for patient transportation. If the patient is to be discharged and they have not completed their process, they will take the patient to a non-clinical area to complete enrollment. Any questions or issues, you can e-mail me or the Project Coordinator: Leigh Quarles at Thanks, -- Kevin G. Munjal, MD, MPH Assistant Professor, Associate Medical Director of Prehospital Care, Department of Emergency Medicine Mount Sinai Medical Center

Written by phil

February 16th, 2013 at 2:10 am

Posted in Stroke/TIA

Peds Sickle Cell Crisis

Please be aware of the following recommendations for Pediatric pain control, in particular for our sickle cell patients, discussed at the most recent pain meeting:

Anesthesia pain team can now be called at any time to begin management of a pediatric sickle cell patient who is in pain. This team may begin a PCA pump for the patient.
If the physician covering the anesthesia consult service (resident) is resistant to the addition of a basal rate, and the patient has a history of requiring one, the physician requesting the consult may ask to speak to the fellow.
Once the patient is admitted to P4, the team managing the PCA/analgesia will be decided on a case by case basis (heme/onc vs pediatrics vs anesthesia)

As per Jeff Glassberg ,who attended:
The Chief of Anesthesia expects that the response to our consultation request be immediate and that the fellow or resident actually appear in person in our ED within 15 minutes of being called. Consultation recommendations over the phone are to be discouraged.

Please note that the goal is adequate pain control not only for those pts that are being admitted but also for those who are in the ED in pain, so that they may have the possibility of being discharged to home.



Written by phil

February 5th, 2013 at 9:54 pm

Posted in Peds,Sickle Cell

STEMI notifications

Hi Everyone,

A significant change to EMS Policy regarding STEMI was announced by FDNY and supported by the Regional EMS Advisory Committee on which I serve and takes effect today, February 1st.

There will NOT be a STEMI notification made for new or presumably new LBBB.
STEMI notifications will now ONLY be made if the ST elevations are greater than 2mm in two or more contiguous leads.
They will still direct STEMI’s greater than 1mm in two or more contiguous leads to PCI centers

Because we all complain about too many false positive activations!

What does this mean for you?

1. STEMI notifications will only be called for massive STEMI’s! You should call a STEMI alert through AMAC based on prehospital notification.

2. You must appreciate that you will receive pt’s having an acute STEMI with no advanced notification and must be prepared to mobilize resources quickly.
– As always, our nursing staff will rapidly triage these patients to the RESUS room.
– Physician staff should rapidly respond to the overhead page, receive handoff from the EMS Providers and call an AMAC STEMI alert if you agree with the ECG interpretation by the prehospital providers. You can repeat the ECG with our machines but only if you believe it is necessary and will not delay care.


Kevin G. Munjal, MD, MPH
Assistant Professor, Associate Medical Director of Prehospital Care,
Department of Emergency Medicine
Mount Sinai Medical Center

Written by phil

February 5th, 2013 at 8:51 pm

Posted in Uncategorized