Trick of the Trade: Deflate an Undeflatable Gastrostomy Tube

A 54-year-old female with a past medical history of throat cancer presents for gastrostomy tube (G-tube) replacement. The initial G-tube was placed 3 years ago. Most recently, the patient had the G-tube changed 7 months ago. She presents to the Emergency Department because the G-tube is leaking from the tubing that is external to the skin. When you attempt to deflate the cuff, you are unsuccessful.

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By |2020-02-13T22:46:36-08:00Feb 19, 2020|Gastrointestinal, Tricks of the Trade|

IDEA Series: Just-in-Time Training for Diagnostic Paracentesis

AP wrist radiograph

According to the National Health And Nutrition Examination Survey, approximately 630,000 adults in the United States have cirrhosis of the liver, 69% of which are reportedly unaware of having liver disease. A diagnostic paracentesis is a simple procedure for identifying spontaneous bacterial peritonitis in cirrhotic patients with ascites. A just-in-time training (JITT) model incorporating low-fidelity equipment readily available in the ED can facilitate procedural teaching of the diagnostic paracentesis.

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By |2019-12-21T13:00:22-08:00Dec 18, 2019|Academic, Gastrointestinal, IDEA series|

SAEM Clinical Image Series: Uncommon Cause of Right Groin Pain

Amyand’s hernia CTA 48-year-old male presents with 2 weeks of severe right lower quadrant abdominal pain and inguinal pain. The patient had similar pain 2 weeks ago, was referred to a surgery clinic, but was lost to follow up. The pain has been progressively worsening over the last 2 days. It’s now severe, associated with nausea and vomiting, does not radiate, and it is worsened with coughing and sneezing. He also endorses polyuria for an unknown length of time. His last bowel movement was 3 days ago. He denies diarrhea, constipation, hematochezia, melena, dysuria, hematuria, or recent trauma.

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By |2019-12-12T21:43:29-08:00Dec 16, 2019|Gastrointestinal, SAEM Clinical Images|

SAEM Clinical Image Series: Bellybutton Mass

BellyButton Mass umbilical granuloma

A 4 week-old female infant presents due to yellow discharge from her umbilicus and mom noticing a red mass coming from the umbilical area after changing her diaper today. She is a healthy infant born at 40 weeks by vaginal delivery without complications and weighed 6 lbs 1 oz at birth. She is feeding 4 oz of formula every 3-4 hours. She received immunizations at birth and has an established pediatrician.

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SAEM Clinical Image Series: Mysterious Blood Sample

Mysterious Lab hypertriglyceridemia

34-year-old female with a history of hypertension, diabetes mellitus, and pancreatitis presents for epigastric and left upper quadrant abdominal pain. Her symptoms started yesterday evening and have been worsening since onset. She reports chronic epigastric pain that waxes and wanes for several years since her first episode of pancreatitis in 2014. Yesterday she had an abrupt onset of nausea that accompanied the pain without emesis. The pain worsened and is now currently 10/10 in severity. She describes it as severe and deep. She has no bloody or dark stool. She denies any heavy alcohol use, changes in medications, or drug use.

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By |2019-11-06T18:36:53-08:00Nov 7, 2019|Gastrointestinal, SAEM Clinical Images|

SAEM Clinical Image Series: Foreign Body Ingestion

foreign body ingestion

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Chief complaint: Foreign Body Ingestion

History of Present Illness:

A 4-year-old male presents to the Pediatric ED for evaluation of swallowed foreign body.

The mother reports the patient was at his grandmother’s house playing near a cabinet when they witnessed him put a small unknown object in his mouth and swallow. Family denies vomiting, difficulty breathing, change in behavior, abdominal pain, or any additional symptoms at this time.

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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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