Ortho Questions

Hip Fracture-Is MRI or CT more sensitive for occult fracture
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> Hip fractures occur almost exclusively in older adults; plain radiographs are the appropriate initial imaging test, with a sensitivity of 90% – 98%. What is the sensitivity of CT for radiograph-occult hip fractures? Of MRI?
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> The Answer is:
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> CT has a 58% – 80% sensitivity for radiograph-occult hip fractures; MRI has a sensitivity of 99% – 100% (Annals of EM, epub, 10/2/18).

 

Glucagon for Esophageal Foreign Body

Is Glucagon Worth the Trouble?

Most GI doctors will still ask for it. It may be worth it if 4% can avoid endoscopy

Sanjay Arora MD and Michael Menchine MD Take Home Points 14% of patients with symptomatic esophageal foreign body impaction had resolution of symptoms with administration of glucagon compared to 10% of controls. 12.6% of patients had vomiting. More than half of the patients in the study were given other medications soon before or after glucagon. Bodkin, RP et al. Effectiveness of glucagon in relieving esophageal foreign body impaction: a multicenter study. Am J Emerg Med. 2016 Jun;34(6):1049-52. PMID: 27038694. The bottom line: 14% of patients with symptomatic esophageal foreign body impaction had resolution of symptoms with administration of glucagon compared to 10% of controls. Esophageal foreign body impactions are rare but time consuming. The final common pathway is endoscopy. Management is varied. Don’t use meat tenderizer. Some give soda or use nitroglycerin or glucagon. Glucagon is thought to relax the lower esophageal sphincter. The authors conducted a retrospective observational study at two different academic EDs. Successful removal was defined as documentation of resolution of symptoms at 60 minutes. They also recorded other medications administered, need for endoscopy and adverse events. They identified 127 patients that received glucagon and selected 29 patients with esophageal foreign body who did not get glucagon to serve as controls. Most patients received 1 mg of glucagon IV and the success rate was 14.2%. Vomiting occurred in 12.6% of patients. More than half of the patients were also given other medications soon before or after glucagon. 10% of patients in the control group had resolution of symptoms without endoscopy. What does this mean? They reported it didn’t work better than controls. However, their control selection may have introduced bias. This was not a randomized controlled trial. Most GI doctors will still ask for it. It may be worth it if 4% can avoid endoscopy