The Bottom Line 2: Anorectal abscess & Fournier’s Gangrene

This post is a continuation of a previous post about anorectal issues in the ED. Here, we will discuss anorectal abscess, surrounding complications, and necrotizing infections. Anorectal Abscess Anorectal abscesses are thought to occur from the plugging of anal glands, resulting in infection and purulent collection that spreads along one of several potential spaces.1 Abscesses are classically divided into four […]

The Bottom Line: Hemorrhoids and Anal Fissures in the ED

Anorectal issues commonly present to the Emergency Department (ED), however, the evidence around many of these conditions is sparse and practice varies widely. ED providers should have a grasp on the management and disposition of common anorectal complaints. In part one of this two-part series we will be focusing on issues related to hemorrhoids and anal fissures. Where relevant, we […]

A Bloody Mess: an Update on UGIB Management in the ED

Acute upper gastrointestinal bleeding (UGIB) is an all-too-frequent presentation that can scare the pants off of even the most seasoned Emergency Physician.  Severity of presentation can vary greatly, from simple bleeds related to gastritis to exsanguinating variceal bleeds. Common etiologies of UGIB, with frequency in parentheses, include (1): Peptic ulcer disease (31-67%) Gastritis or duodenitis (7-31%) Erosive esophagitis (4-24%) Variceal […]

The Biliary Tree of Life: A review of common gallbladder and biliary diseases in the ED

Gallstone diseases are common and can lead to various intraabdominal emergencies. Gallstones are found in approximately 6% of men and 9% of women in the United States [1]. Epidemiological studies in Scandinavia reported even higher prevalence, finding 13-18% of men and 15-25% of women had gallstones [2]. Common risk factors for developing gallstones include [3]: Female Obesity Rapid /cyclic weight […]

Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial

Journal Club Summary Methodology Score: 3/5 Usefulness Score: 2.5/5 Question and Methods: This tertiary-care centre, placebo controlled RCT examined whether nasally inhaling isopropyl alcohol provides better nausea relief than normal saline. Findings: At 10 mins, inhaled isopropyl alcohol offers increased nausea relief compared to normal saline (effect size of 3) with no significant differences in pain or rescue anti-emetic use. […]