EM Quick Hits 31 NG Tubes in SBO, Hyperacute T-Waves, Malignant Otitis Externa, CCTA in NSTEMI and Low-risk Chest Pain, Canadian Syncope Score

Topics in this EM Quick Hits podcast Justin Morgenstern on the evidence for nasogastric tubes in small bowel obstruction (0:52) Jesse MacLaren on hyperacute T-waves and occlusion myocardial infarction (7:53) Brit Long on malignant otitis externa (12:14) Salim Rezaie on coronary CT angiography vs. invasive angiography in NSTEMI patients (18:23) Justin Morgenstern on coronary CT angiography in low-risk chest pain (26:17) Hans Rosenberg on Canadian syncope score (33:08) Podcast production, editing and sound design by Anton Helman. Podcast content, written summary & blog post by Raymond Cho and Anton Helman Cite this podcast as: Helman, A. Morgenstern, J. MacLaren, J. Long, B. Rezaie, S. Rosenberg, H. EM Quick Hits 31 - NG Tubes in SBO, Hyperacute T Waves, Malignant Otitis Externa, CCTA, Syncope. Emergency Medicine Cases. August 2021. https://emergencymedicinecases.com/em-quick-hits-august-2021/. Accessed [date]. Is there evidence for nasogastric tube placement in management of small bowel obstruction? * Nasogastric (NG) tubes are routinely placed in the ED to decompress the stomach when a small bowel obstruction (SBO) is diagnosed; however, there is no good evidence for the routine use of NG tubes in this situation, and they are rated as one of the most painful procedures in EM by patients * There are no RCTs looking at the use of NG tubes in SBO; however, observational data suggests worse outcomes with NG tubes than without * Fonseca 2013: 290 patients admitted with an SBO, 20% of them were managed without an NG tube. Use of an NG tube resulted in longer time to resolution, longer stay in hospital and higher rates of complications. Non-operative management was successful in 2/3 of patients regardless of NG tube placement * Berman 2015: 181 patients admitted with an SBO, 1/2 were managed without an NG tube. No association between use of an NG tube and mortality, surgery or bowel resection. NG tube placement was associated with longer hospital stay * Prophylactic NG tubes in post-op ileus is also a common practice; however, a systematic review of 28 studies found that ileus resolved faster in patients without NG tubes Bottom Line: there is no high-quality evidence for the routine use of NG tubes in SBO. Observational data suggests that routine NG tube placement in SBO and post-op ileus results in worse outcomeEM s. Patients also report that NG tubes are among the most painful procedures done in the ED. Expand to view reference list * Berman, D. J., Ijaz, H., Alkhunaizi, M., Kulie, P. E., Vaziri, K., Richards, L. M., & Meltzer, A. C. (2017). Nasogastric decompression not associated with a reduction in surgery or bowel ischemia for acute small bowel obstruction. The American Journal of Emergency Medicine, 35(12), 1919-1921. * Fonseca, A. L., Schuster, K. M., Maung, A. A., Kaplan, L. J., & Davis, K. A. (2013). Routine Nasogastric decompression in small bowel obstruction: Is it really necessary? The American Surgeon, 79(4), 422-428. * Nelson, R., Tse, B., & Edwards, S. (2005). Systematic review of prophylactic nasogastric decompression after abdominal operations. British Journal of Surgery,