Trick of Trade: Topical lidocaine jelly to make constipation relief less painful

constipation

Severe constipation, requiring fecal disimpaction and rectal enemas, can be excruciatingly painful for patients. Administering sedatives and opioids to help alleviate this pain poses a challenge, because many of the patients are elderly and tend to be more sensitive to these medications. Furthermore, there may be increased vagal tone when straining, leading to hypotension and bradycardia and which can result in defecation-related syncope. 1 Also, opioids can exacerbate constipation. Herein we present 2 cases and tricks on achieving better pain control.

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Strep Pharyngitis in Children: Review of the 2012 IDSA Guidelines

strep pharyngitis

Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.

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2019-07-13T06:57:00-07:00

IDEA Series | “Saving Society” Podcast Series Teaches Residents Reflective Practice Through Debriefing

The Problem

Idea Series Logo debriefing

Emergency physicians (EPs) experience professional burnout more than 3 times that of the average physician.​1​ In a recent study, the prevalence of burnout among emergency medicine residents was found to be an astounding 76.1%, suggesting that burnout begins as early as residency training.​2​ The emotional impact of witnessing suffering and death and the high-stakes, stressful environment of the ED likely contribute to burnout among trainees.

One potential protective factor against burnout is the strategic use of debriefing to mitigate work-related stress. Debriefing involves taking the opportunity to discuss and reflect upon a recent experience with a group of peers who share an understanding of the experience’s context. Debriefing can create a space for peers to provide mentorship, support and feedback to each other, thereby reducing work-related stress.​3,4​

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2019-07-12T19:59:19-07:00

SplintER Series: Ankle Dislocation | Leg Day #4

Welcome to Leg Day #4 of the SplintER Series! Ankle dislocations are an emergent condition in the Emergency Department (ED) that requires expert-level examination and management. We review the pertinent and subtle sports medicine examination and management techniques that will help you feel in control from time of presentation to disposition. 

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SAEM Clinical Image Series: Fishing in Papua New Guinea

Fishing in Papa crocodile bite

[Click for larger view]

Chief Complaint: Right lower extremity injury while spear fishing

History of Present Illness: A 33-year-old male went river fishing with a homemade spear and diving mask in Papua New Guinea. He felt sudden pain and tugging to the right lower extremity. He was near shore and grabbed a tree root. He held on for dear life as he was being pulled back into the water. It felt as if his foot had been torn off. He did not let go of the tree root and eventually the pulling force ceased. He got out of the water and walked 2 miles unassisted before finding help and hospital transport.

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2019-07-12T23:48:12-07:00

SplintER Series: A Case of Traumatic Wrist Pain After Fall on Outstretched Hand

lunate dislocation xray

A 46 year-old male presents with wrist pain after sustaining a mechanical fall and catching himself on his outstretched hand. An anteroposterior (left) and lateral (right) plain films of the wrist are obtained (photo credit).

What is the diagnosis (hint – there are 2 findings), injury classification system, associated findings, and the recommended management plan?

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SAEM Clinical Image Series: Distended Bowels

Distended Bowels Ogilvie syndrome

[Click for larger view]

Chief Complaint: Abdominal distention

History of Present Illness: A 36-year-old male with a history of cerebral palsy, gastrointestinal dysmotility, epilepsy, hypertension, gastroesophageal reflux disease, and insomnia presents to the ED after referral by his family physician for a 3-day history of abdominal distention. Due to the patient’s neurological disorder, he is unable to communicate but is accompanied by his mother who provides his medical history. The patient’s mother states that he had a loose bowel movement this morning, which is normal for him. He has had a history of bowel problems since the age of 14. Two months previously the patient was admitted for abdominal distention and had a rectal tube placed which relieved his symptoms. The patient has not experienced nausea, vomiting, or changes in bowel movements.

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2019-06-30T17:08:12-07:00