LEARNing Rounds: Lessons Learned From An Unanticipated Difficult Airway or “Oops, I Need Fresh Underwear!”

Learn, Evaluate, Adopt…Right Now!

Colin G. Kaide, MD, FACEP, FAAEM // Editor Michael G. Barrie MD

LEARN airway word document version of this resource

Case

This patient was an obese male in his 50’s who developed respiratory failure in the ED.  Intubation by a senior resident and a very experienced attending using first GlideScope® (GS) then direct laryngoscopy (DL) were unsuccessful.  They placed a size 5 LMA and were able to successfully oxygenate the patient.  I was called to assist with the airway.  They said they could visualize the cords with DL and with the GS.  They were unable to guide the ETT into position because of what was described as a large amount of “redundant tissue” and some anatomic issue that prevented 2 experienced doctors from guiding the ETT thru the cords.

Continue reading

Beta Blocker and Calcium Channel Blocker Overdose

Leslie Adrian, MD, OSU EM PGY-1 // Michael Barrie, MD OSU EM

 

You get a call from triage, a 34 year old female is in the waiting room, presenting to ED with chief complaint of intentional ingestion. You briefly examine her; she is well appearing but tearful with a HR of 70 and BP 120/79 and is alert and oriented. She admits to taking thirty of her friend’s blood pressure medication one hour ago, she does not know what it was called, but thinks it ended with an “-olol.” You put her on the monitor, order ingestion labs and then receive a call that a level 1 stroke patient has arrived and needs to be intubated.

15 minutes later, you get a frantic call from the psychiatric nurse stating that your patient’s HR is 30 her blood pressure is 70/40, and she is altered but protecting her airway. You put the patient on oxygen and start fluids immediately, but what do you do next?

Continue reading

Is Expedited Partner Therapy Ready for Your Emergency Department?

 

JoshuaFaucherBy 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?

Continue reading

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.

Continue reading

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. 

Continue reading