Can a Nitro Slurry Fix a Food Bolus Impaction?

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Can a Nitro Slurry Fix a Food Bolus Impaction?

Esophageal food impaction (EFI) occurs at an estimated rate of 13 episodes per 100,000 people annually. Medical management is typically attempted before resorting to endoscopy to reduce procedural risks and resource use. Glucagon remains the most widely used medication. Other treatments include carbonated beverages, benzodiazepines, and, more recently, nitroglycerin. Despite glucagon being the most commonly used agent, its supporting data are limited to small studies or case reports. One older study showing over 60% efficacy lacked a comparator group and had multiple confounders. Another study suggested only minimal benefit and significant adverse effects—up to 50% vomiting—highlighting the need for better treatment options.

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Grand Rounds Recap 12.11.24

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Grand Rounds Recap 12.11.24

Another week, another great Grand Rounds! First, Dr. Lang takes us through the evidence behind our common treatment of low back pain. Next, Drs. Boyer and Segev give us a evidence guided management of the acutely ischemic limb. Next, Dr. Hajdu takes us through a difficult case of cardiac arrest in the ED. Finally, we learn all about infections of the pelvis and perineum with Dr. Guay!

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Serotonin Syndrome & NMS

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Serotonin Syndrome & NMS

It can be a challenge to differentiate NMS and Serotonin syndrome, careful attention to historical factors, a thorough medication history, and a detailed physical exam and neurologic exam is necessary to quickly diagnose these patients. This post details the presentation of each entity and highlights the differences between the two.

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Grand Rounds Recap 11.13.24

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Grand Rounds Recap 11.13.24

Welcome to another week of Grand Rounds! Join us for Sports Medicine Grand Rounds, where he discuss cases from the training room, followed by a discussion on rabies prophylaxis. Two of our wonderful R2s gave their QI/KT on acetaminophen overdose, then we had a review of landmark studies in Emergency Medicine. We had an R4 discharge/transfer/treat case discussion, and ended the day with a pediatrics lecture!

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Grand Rounds Recap 11.6.24

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Grand Rounds Recap 11.6.24

Another week, another Grand Rounds! Dr. Boggust took us through the basic of management of patients with Multiple Sclerosis in the ED. Then, Dr. Grisoli presented her Capstone on the treatment and care of patients with disabilities. Finally, Dr. Minges and the rest of the ultrasound team discussed MSK ultrasounds, with hands on session for the most frequent upper and lower extremity scans!

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Grand Rounds Recap 10.30.24

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Grand Rounds Recap 10.30.24

Join us for another great week of Grand Rounds! We started out with a great discussion of the changing workforce and how the differences between generations and leadership styles impacts our interactions with our colleagues. Then we discussed the nuances of managing a dysfunctional tracheostomy with Dr. Adan. We were taken through the pathophysiology and clinical presentation of patients with pneumomediastinum and mediastinitis with Dr. Valles. Finally, Drs. Artiga, Beyde and Vaishnav gave us hands on practice with the different types of nerve blocks that can be used in the ED!

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A New Tool to Help Screen for Sepsis in Kids?

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A New Tool to Help Screen for Sepsis in Kids?

Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. This study substituted age adjusted vital sign measures and a pediatric shock index into currently existing pediatric sepsis scoring systems to create the qPS4.When utilizing a cut off of ≧ 2 points, the qPS4 was highly sensitive and specific, and identified pediatric septic shock far sooner into a patient's course.

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Grand Rounds Recap 10.23.24

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Grand Rounds Recap 10.23.24

Join us for another exciting week of Grand Rounds! This week, we had Morbidity and Mortality conference with Dr. Gobble. This was followed by CPC with Drs. Qin and Bryant. Next, Dr. Wilson walked us through a case of methoglobinemia caused by sodium nitrite toxicity. We finished up the day with Dr. Wright’s capstone on rural emergency medicine.

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Grand Rounds Recap 9.25.2024

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Grand Rounds Recap 9.25.2024

Join us for another exciting week of Grand Rounds! This week, we had Morbidity and Mortality conference where we learned about posterior hip dislocations, hypertensive emergency, subacute combined degeneration secondary to nitrous oxide use, spinal epidural abscesses, small bowel obstructions, management of agitation in the Emergency Department, and status epilepticus. This was followed up by an R3 Taming the SRU lecture on high-grade heart block and transvenous pacemakers and a discussion on finding your niche in academic emergency medicine. We had an exciting R2 CPC case of acute salicylate toxicity, followed by intern core content with a discussion of penile disorders and urologic emergencies, and ended the day with Dr. Sobocinski's R4 capstone.

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Is Your Head Spinning? The Sudbury Vertigo Risk Score

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Is Your Head Spinning? The Sudbury Vertigo Risk Score

There is a wide variation in practice, particularly in obtaining neuro-imaging in patients presenting with vertigo. Many patients are imaged and subjected to a longer length of stay, and on the other side of the coin, some patients with serious pathology fall through the cracks. The authors of this study set out to create a risk score to apply to patients who present to the ED with vertigo which would identify the patients at risk for serious pathology (which they defined as stroke, TIA, vertebral artery dissection, or brain tumor).

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Grand Rounds Recap 8.14.24

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Grand Rounds Recap 8.14.24

Join us as one our OBGYN consultants, Dr. Pensak, takes us through the intricacies and varied management of early pregnancy loss. Then, Dr. Lang takes us through STEMI equivalent presentations as well as sneaky STEMI mimics! Finally, our education was rounded out with our pediatric triple threat. We discussed NRP and simulated resuscitation of a bradycardic neonate, practiced umbilical vein cannulation as well as considered a prolonged fever work-up in a case of Kawasaki and the intricacies of lumbar punctures in the pediatric population!

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Grand Rounds Recap 8.07.2024

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Grand Rounds Recap 8.07.2024

Join us for another week of Grand Rounds! We had a visit from Dr. Melissa Platt of the ABEM Board of Directors discussing the upcoming changes to the ABEM certification exam. Dr. Lawton presented to us about frequent fliers in the Emergency Department. Dr. Shewakramani spoke to us about sepsis metrics and operational changes that have been made in our department, and we closed with an exciting R3 Taming the SRU lecture with Dr. Artiga discussing difficult intubations.

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Grand Rounds Recap 7.31.24

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Grand Rounds Recap 7.31.24

Join us for another exciting week of Grand Rounds! Today we discussed capacity management and ED throughput, discussed best practices for bedside teaching and and giving a presentation, discussed disposition for orthopedic complaints in the community, reviewed skin adhesives and hypertensive emergency, and listened to a “year in review” of some of our most exciting ultrasound cases from the previous academic year.

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Grand Rounds Recap 7.24.24

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Grand Rounds Recap 7.24.24

We started off this week with our first morbidity and mortality conference of the year given by chief resident Dr. Moulds. Dr. LaFollette then shared clinical pearls with us from multiple case follow ups followed by Dr. Brower who discussed the evidence behind a multitude of superstitions. We finished up with a lecture from dual EM/PEM trained faculty Dr. Cindy Chang who discussed high risk, low prevalence diseases in children.

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