I Think I Have a Fish Bone Near My Wish Bone!

LEARNing Rounds:  Learn, Evaluate, Adopt Right Now…

I Think I Have a Fish Bone Near My Wish Bone!

By Colin Kaide MD, OSU EM Assoicate Professor // Edited by Michael Barrie MD, OSU EM Assistant Professor

Chief Complaint:  Foreign Body in throat

HPI 

This patient is a 57 y.o. female with no related past medical history who presents with foreign body sensation in her throat. Patient states this started approximately one hour ago. She was eating fish, and says that she has a fish bone stuck in her throat. She has not had anything to eat or drink since that time. She denies chest pain, shortness of breath. She states that the foreign body sensation has not moved since that time and is located in the left side of her anterior lateral neck, above the sternal notch. Denies fevers. Denies history of similar. No issues with swallowing prior to the sensation.

Atypical Chest Pain -Precordial Catch Syndrome

By Michael Barrie, OSU EM Assistant Professor

As Emergency Physicians we are experts in evaluating acute chest pain. In our sleep we can recite the dangerous causes of chest pain such as acute coronary syndrome, aortic dissection, pulmonary embolism, myocarditis, pneumothorax, etc, etc. In medical school and residency we spent a huge amount of brain power devoted to learning how to diagnose and manage dangerous causes of chest pain. But as a practicing ED doc what I actually see a majority of the time is atypical chest pain.

While we always think “worst first”, it’s worth your time to remember some of the more benign causes, such as reflux, musculoskeletal pain, esophageal spasm so you can give a patient a more specific diagnosis. Let’s take a moment to discuss one of my favorite presentations of atypical chest pain – Precordial Catch Syndrome. 

Severe CAP – Consider Steroids

Steroids for Hospitalized Patients with Community Acquired Pneumonia

By Zach Adams, OSU EM Resident // Edited by Michael Barrie, OSU EM Assistant Professor

Do steroids help improve mortality in Pneumonia? An article in the Annals of Internal Medicine attempted to set the record straight in the meta-analysis Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis

What did they find?