By Josh Faucher, MD, JD // Edited by Michael Barrie, MD
A 24 year-old male presents to your rural ED’s fast-track area with purulent penile discharge and dysuria. These have been present for the past week, and he recently began intercourse with a new female sexual partner. They have not used barrier contraception. He denies hematuria, fevers, genital lesions, or other associated symptoms; his physical exam is within normal limits other than purulent penile discharge. Rapid urine testing is positive for Neisseria gonorrhea infection; the patient is treated empirically in the ED with one-time doses of ceftriaxone and azithromycin. He denies any other recent sexual partners. The patient’s sexual partner works full time but is uninsured, and in your rural area there are no local STD clinics that are easily accessible for partner follow-up. Your patient asks if he can have a prescription to conveniently treat possible infection in his female partner at home, saving the time and cost of an additional ED visit or delayed outpatient follow-up. Can you provide the sexual partner any treatment without seeing her directly as a patient?
Yet another great review from our Resident Dr. Anand Patel
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
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.
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.
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?
By Michael Barrie, OSU EM Assistant Professor
A great emergency medicine study in this month’s JAMA: Friedman et. al “Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: A randomized clinical trial.” This was a randomized, double-blind controlled trial to see if adding narcotics or cyclobenzaprine to naprosyn helps improve symptoms in patients with lumbar back pain compared to those that received naprosyn plus placebo. They showed there was NO benefit.
Conclusions and Relevance Among patients with acute, nontraumatic, nonradicular LBP presenting to the ED, adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at 1-week follow-up. These findings do not support use of these additional medications in this setting.
By Dr. Nicholas Kman @DrNickKman, OSU EM Associate Professor and Medical Student Clerkship Director // Editor Dr. Michael Barrie @MikeBarrieMD, OSU EM Assistant Professor
I was sitting in the study lounge at the Ohio State University College of Medicine in between lectures on September 11, 2001. Knee-deep in my second year of medical school, I could clearly remember dreading going back into the lecture hall to hear another stimulating hour on Aspergillosis. Then, Wolf Blitzer or Anderson Russell or some other CNN anchor, broke in with terrible news.
Two planes had crashed into the twin towers of the World Trade Center. Later that day, we learned of the news that another plane had struck The Pentagon while yet another crashed on its way to Washington. I remember my disbelief and strong desire to help.