Maia Winkel

Jacobi/Montefiore Emergency Medicine

[Maia Winkel @MaiaWinkel]

First steps for pt w/thyrotoxicosis: urine preg and EKG. She’s 5 weeks pregnant?? Switch her from methimazole to propylthiouracil (PTU) since methimazole is teratogenic during 1st trimester. Also, PTU is thought to be more effective in acute settings. #FoaM4Cook @CookCountyEM

[Maia Winkel @MaiaWinkel]

Think it’s a dental abscess?
Check for fluctuance and erythema
Look for dental caries or discoloration
Palpate the gum, tooth in question, and surrounding teeth
Tap on the above with a tongue blade for a more effective percussion

#FoaM4Cook @CookCountyEM

[Maia Winkel @MaiaWinkel]

Did your pt have a dumpster fall onto his finger and crush his fingertip? If the nail's intact, suture into the nail distal to the lunula and come out proximally, thereby avoiding the germinal matrix! Here's how it's done: https://t.co/b2xwjfX1SW
#FoaM4Cook @CookCountyEM

[Maia Winkel @MaiaWinkel]

Acute lithium overdose 30 minutes ago? Place an NG tube to remove gastric contents. Activated charcoal won’t work since it doesn’t bind to lithium; the ions are too small!
#FoaM4Cook @CookCountyEM

[Maia Winkel @MaiaWinkel]

To calculate the actual (not measured) sodium in hyperglycemia, add 1.6 mEq/L for every 100 mg/dL increase in serum glucose. #FoaM4Cook @CookCountyEM

[Maia Winkel @MaiaWinkel]

Quick, name 3 painful and 3 non-painful causes of acute monocular blindness! 👀😖🧐

Painful:
Acute closed-angle glaucoma
Optic neuritis
Temporal (giant cell) arteritis

Non-painful:
Retinal detachment
CRAO
CRVO

Thank you, Dr. Moskoff! @CaptWestSide
#FoaM4Cook @CookCountyEM

[Maia Winkel @MaiaWinkel]

Intubation followed by decreased breath sounds on one side? Reposition the endotracheal tube! Ideal location for distal tip of ETT: roughly 2-6cm above the carina. 🗣
#FoaM4Cook @CookCountyEM
Ref: https://t.co/NJW6Bc2HOS

[Maia Winkel @MaiaWinkel]

Perform a focused bedside abdominal US on all elderly women with abdominal pain. Remember to visualize the abdominal aorta both proximally and distally since 2 views are required! If both measure <3cm, consider it non-aneurysmal and low risk for AAA. #FoaM4Cook @CookCountyEM

[Maia Winkel @MaiaWinkel]

Trying to put an IV in a “hard stick?” Try ultrasound-guided IV insertion! First, make sure to track the vein to see its path, then do the “County walk” 😎 Follow the probe and push the IV in 1-2mm at a time until it reappears. Rinse and repeat. 💉 #FoaM4Cook @CookCountyEM

[Maia Winkel @MaiaWinkel]

Need to convert reentrant PSVT --> NSR? Both AC IVs are blown?? Got an IV in the right hand?? Lift up that hand, give 6mg adenosine rapid IV push over 1-2s, and follow immediately w/NS flush! TLC tip: let your pt know the discomfort will pass soon #FoaM4Cook @CookCountyEM

[Maia Winkel @MaiaWinkel]

Suspect hyperK+ in a pt w/PSVTs? While getting lines & equipment set up, start 'em on 5-20mg nebulized albuterol to shift K+ intracellularly! If K+ results <5.5 mEq/L, no harm done - just some dilated bronchi and bronchioles. #FoaM4Cook @CookCountyEM
Ref: UpToDate, WikiEM

[Maia Winkel @MaiaWinkel]

When the dust has settled and the seizure is over, don’t forget about the family! Bring them back to the room and spare a few moments to answer their questions. 👀🤯🧠 #FoaM4Cook @CookCountyEM