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GERD not an emergency but it is medicine
Reflux affects up to 40% of Americans on a monthly basis. In 90% of patients with severe GERD a hiatal hernia is present. Repetitive reflux can lead to Barrett’s esophagus which is a replacement of the...
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Oral Rehydration
A review from the CDC on oral rehydration due to diarrhea: Children with mild to moderate dehydration should have their estimated fluid deficit rapidly replaced. These updated recommendations include...
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Ultrasound in Appendicitis
Studies of ultrasound for detecting appendicitis have sensitivities of 44 to 90% and specificity from 88 to 100%. RLQ ultrasound is technically difficult/operator dependent which explains the low...
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Cdiff
3% of healthy adults are asymptotically colonized with C difficile.Colonization rates are 50% in patients residing in long-term care facilities. 1%–2% of all hospitalized patients develop symptomatic...
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Surgery vs. EM residents and appendicitis
The accuracy of emergency medicine and surgical residents in the diagnosis of acute appendicitis. During the study period, second-, third-, and fourth-year EMRs and second- and third-year SRs...
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Alvarado Score
The Alvarado score consists of MANTRELS: Migration of pain, Anorexia, Nausea and vomiting, Tenderness in the right lower quadrant, Rebound tenderness, Elevation of temperature, Leukocytosis, and Shift...
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CT and Appendicitis
CT scans for appendicitis have a reported sensitivity of 87-100% and specificity of 89-98% depending on the technique i.e., non/iv/oral/rectal contrast. Rectal contrast is likely the most sensitive,...
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Disloged G and J tubes
Is it a G or J tube? Look at the tube, ask, or obtain old records. If no surgical scar is present at the stoma, the tube is likely a G tube or G tube with J extension. How old … Continue reading →
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Abx vs. Surgery in Appendicitis
And another since appendicitis is a common condition requiring emergency surgery. Use of antibiotics alone for treatment of uncomplicated acute appendicitis: A systematic review and meta-analysis. In...
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Diverticulitis
Diverticulitis is frequently mild when small perforations are walled off by pericolic fat and mesentery. Larger perforations can lead to abscess formation and, rarely, intestinal rupture or...
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Intussusception in the Adult
In 90% of cases in adults the lead point for intussusception is a pathological lesion. The lesion causing intussusception is malignant in 80% of cases involving the colon and in 33% of cases involving...
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The pelvic and the pain
Do all women with abdominal pain need a pelvic examination: From WJEM: A prospective cohort study of a convenience sample of 183 women that presented with abdominal pain or vaginal bleeding were...
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Anal fissures
The condition is painful and the exam is no fun. Some back ground and treatment of anal fissure. Posterior midline should be evaluated first, as it is the site of up to 90% followed by the anterior...
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Ondansetron, Promethazine, and Droperidol – What are the warnings about?
All of the anti-emetics listed above are great at controlling nausea and vomiting. However, they all have side effects that have caused a lot of scrutiny. Ondansetron (Zofran) is a serotonin 5-HT3...
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External Hemorrhoid
Without treatment external hemorrhoids will resolve on their own. Although, conservative treatment with sitz baths, and topical corticosteroids improve symptoms and may speed resolution. Excision of...
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Neonatal hyperbilirubinemia
Unconjugated hyperbilirubinemia: Interpretation of bilirubin levels is in infant age in hours. The most common cause is physiological jaundice followed by breast milk jaundice (both non-pathologic)....
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Abdominal Compartment Syndrome
Abdominal compartment syndrome (ACS) is recognized with growing frequency as the cause of morbidity such as metabolic acidosis, decreased urine output, and decreased cardiac output. Broad categories of...
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Fecal occult blood test (FOBT)
Oral iron supplementation does not cause false-positive result Most vegetables contain peroxidase and may cause a false positive e.g., broccoli, turnips, radish, cauliflower Partly cooked or large...
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Ultrasound in SBO
Should we start to use ultrasound for rapid diagnosis of small bowel obstruction? In a study from European Journal of Emergency Medicine: Emergency room residents were compared to radiology residents...
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Acalculous Cholecystitis
5 to 10% of acute cholecystitis is due to acalculous cholecystitis. It is associated with more serious morbidity (gangrene 50%, perforation 10%) and higher mortality (40%). It is usually a condition of...
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