J Emerg Med
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Anterior dislocation of the temporomandibular joint (TMJ) occurs when the condylar head slips out of the glenoid fossa and is locked anterior to the articular eminence. Dislocation typically occurs in the setting of wide mouth opening and increased ligament flexibility, but trauma or anatomical variations of the condyle and articular eminence may contribute as well. In cases of muscle spasm following dislocation, local anesthetic, or sedation can be used to relieve muscle tension and reduce pain, thus facilitating successful TMJ reduction. ⋯ Multiple reduction techniques are compared, discussing the advantages and disadvantages of each. A novel decision-making algorithm is offered, detailing positioning, approach selection, use of local anesthesia, sedation, and aftercare instructions.
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Promethazine was first approved in 1951 and has since been used as a treatment option for a variety of indications. A histamine H1 receptor competitive antagonist with antihistaminic, sedative, anti-kinetotic, antiemetic, and antimuscarinic effects, promethazine is utilized for the treatment of nausea and vomiting, a common reason for emergency department (ED) visits. ⋯ Promethazine offers a suitable alternative antiemetic for use in the ED due to its distinct mechanism of action. Injectable promethazine, however, must be used with caution to minimize risk of serious patient harm in the event of intra-arterial or perivascular extravasation when given parenterally.
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Fluoroscopy is the gold standard for evaluation of gastrostomy tube (GT) placement, though it is costly and resource-intensive. Point-of-care ultrasound (POCUS) has potential as a low-risk alternative to confirm GT placement. ⋯ POCUS demonstrated a high sensitivity and concordance for GT/GJ balloon placement, with low interrater agreement with fluoroscopy. POCUS may not add additional clinical benefit in routine evaluation of GTs over current standards of care. However, POCUS may serve as a useful screening test in settings where fluoroscopy is unavailable or pH is unobtainable.
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Hyperbaric medicine is a subspecialty that many emergency physicians may not encounter frequently in their daily practice. As such, we hope to provide a review, where we present an overview of hyperbaric oxygen therapy, complications from the therapy, and a description of how the treatments are administered. We also discuss seven emergency indications that may benefit from transfer to a hyperbaric facility for treatment. ⋯ This review aims to describe hyperbaric oxygen therapy, identify conditions that may benefit from treatment with hyperbaric oxygen, and discuss management of patients with those conditions as it pertains to an emergency physician.