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.

October 22, 2020

Background: Acute gastroenteritis (AGE) is a very common emergency department (ED) presentation, with “approximately 1.5 million pediatric outpatient visits and 200,000 admissions” each year (Benary).   Treatment for AGE is mainly supportive, utilizing rehydration therapy and antiemetic medications.  One common and well studied antiemetic is ondansetron, which has been shown to be effective at controlling vomiting and decreasing hospitalization rates in pediatric patients.  Despite its widespread use within the emergency department, there is significant variation in the use of ondansetron as a discharge prescription, with providers noting the fear of masking a worsening condition or missed diagnosis and thus preventing a necessary return visit.  

October 1, 2020

Background Information: Cannabinoid Hyperemesis Syndrome (CHS) is characterized by the chronic use of cannabis paired with nausea, recurrent vomiting episodes and diffuse abdominal pain.1 The pathophysiology of CHS remains unclear and large systematic reviews of the literature have recommended up to 9 differing mechanisms as to why it occurs.2 The duration of cannabis use in CHS also widely varies with the majority of patients reporting daily use and beginning use early in life.2 In addition to the history of frequent cannabis use, patients’ self-reported relief of symptoms following hot showers or baths helps distinguish CHS from other cyclic vomiting syndromes. Treatment typically involves cessation of cannabis use however the authors of this randomized controlled pilot study wished to investigate the use of topical capsaicin cream when compared to placebo.

September 2, 2020

Take Home Points
  • Focus on resuscitating well by focusing on the basics
  • Recognize Massive GIB (MGIB) with a thorough exam of the patient and vital signs (Shock index >0.7 is ABNORMAL and signals impending shock)
  • Obtain large bore PIV access and prioritize transfusion over crystalloids for MGIB
  • Get consultants on board early
  • Give adjunctive medications that impact mortality (ie A 3rd generation cephalosporin in patients with variceal bleeding or a history of cirrhosis)
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