January 13, 2021

Take Home Points
  • Nausea and Vomiting has an exceedingly large differential - don’t just anchor on GI presentations
  • H&P important - Duration, frequency, content, and associated symptoms
  • Alcohol swab -> If no line and want quick treatment give swab
  • Ondansetron -> oral you can give without hesitation but if giving IV check QTC / electrolytes and give slowly
  • Droperidol / Haloperidol -> Works really well, QTc prolongation has been overhyped and dont give to parkinsons patient.

January 7, 2021

Background/Introduction: Emergency department visits related to cannabis use appear to be increasing nationally secondary to continued trends of legalization, decriminalization, or less restrictive medical cannabis use laws in many states. The number of individuals with daily cannabis use in the United States increased from 5.1 million in 2005 to 8.1 million in 2013 (Bollom 2018). With an increase in the accessibility and consumption of cannabis, there has also been an increase in the utilization of emergency departments for potential adverse effects of cannabis use, particularly gastrointestinal adverse effects. For example, in Colorado, the emergency department visits for cyclic vomiting nearly doubled after liberalization of medical marijuana (Kim 2015). Studies attempting to look at nationwide sampling have noted that the number of persistent vomiting related hospitalization related to cannabis use had a significantly increased trend, with a 286% increase over a 5-year period (Patel 2019). This has led to a renewed interest in the understanding of cannabis hyperemesis syndrome, first well-described in 2004, and recently defined by the Rome IV criteria (Allen 2004). The effective management of cannabis hyperemesis syndrome is still being elucidated as commonly used antiemetics are often ineffective for acute exacerbations. The role of haloperidol as an off-label treatment is being explored but anecdotal evidence suggests it may be an effective adjunct in the treatment of cannabis hyperemesis syndrome.

December 3, 2020

Background Information:

Nausea and/or vomiting are chief complaints that account over 4 million emergency department (ED) visits each year.1 Multiple studies have shown aromatherapy in the form of isopropyl alcohol “prep” pads to be effective in postoperative nausea and vomiting.2,3 More specifically in the ED, a single randomized controlled trial showed nausea relief with inhaled isopropyl alcohol when compared to placebo.4 The authors of this study decided to take it one step further in this placebo-controlled randomized control trial by comparing aromatherapy to oral ondansetron in ED patients with nausea and vomiting

December 2, 2020

Take Home Points
  • Be sure to consider mesenteric ischemia in any elderly patient with abdominal pain or lower gastrointestinal (GI) complaints.  Remember, the presentation can be tricky to find and they may have a reassuring abdominal exam.
  • Ask about artherosclerotic risk factors, history of cardiovascular disease including atrial fibrillation and prior embolic events, and a history of intestinal angina to help clue you in to the diagnosis.
  • Lab abnormalities could include leukocytosis, lactemia or elevated d-dimer.  But normal labs cannot exclude this disease.
  • The money is in the CTA.  Get it as fast as possible because time is bowel.
  • Consult your surgeons and interventional radiologists eary, because again TIME IS BOWEL

November 12, 2020

Background: The well-established, standard treatment for acute appendicitis is surgical appendectomy.  However, recent research has challenged the dominance of the surgical approach in looking at antibiotics alone. The available literature on non-operative treatment of appendicitis (NOTA) has important limitations: exclusion of patients with appendicoliths, small sample size and predominance of open appendectomy over laparoscopic appendectomy. While data on NOTA is intriguing, it is clear that additional studies are needed.