Nick Rigler

[Nick Rigler @rigler_nick]

An NSTEMI occurs without dynamic ECG changes, however significant or almost complete coronary occlusion can still be present in these cases due to collateral circulation. #FoaM4Cook @CookCountyEM

[Nick Rigler @rigler_nick]

The majority of patients with sarcoidosis are asymptomatic and do not require treatment. Treatment of active sarcoidosis is aimed at preservation or organ function with anti-inflammatory/anti-immune agents. #FoaM4Cook @CookCountyEM

[Nick Rigler @rigler_nick]

Hemorrhoids are classified into 4 groups depending on prolapse and reducibility. Stage I hemorrhoids are not prolapsed, while stage 4 are both prolapsed and not able to be reduced manually requiring colorectal surgery involvement. #FoaM4Cook @CookCountyEM

[Nick Rigler @rigler_nick]

Ever curious what causes the famous delta wave seen in Wolff Parkinson White? It's a fusion of the impulse that pre-excites the ventricles due to rapid conduction through 1) an accessory pathway and 2) the typical route via the AV node. #FoaM4Cook
@CookCountyEM

[Nick Rigler @rigler_nick]

Subacute thyroiditis almost always presents initially with pain over the thyroid. Persistent sinus tachycardia due to initial hyperthyroid phase can be treated with a beta blocker, either propranolol or metoprolol. #FoaM4Cook
@CookCountyEM

[Nick Rigler @rigler_nick]

Studies prove many providers have biases towards nebulizer treatment as superior to metered dose inhaler (MDI) in treatment of asthma, however they can be equally effective depending on patient circumstances. Don't forget to use a spacer! #FoaM4Cook
@CookCountyEM

[Nick Rigler @rigler_nick]

Rodenticide poisoning (i.e. ingestion of rat poison) can present initially with bleeding, often hematuria, due to anticoagulant properties. Don't forget to consider this and order coags if this is on the differential. #FoaM4Cook
@CookCountyEM

[Nick Rigler @rigler_nick]

Glucagon can be used in patients with food impaction to relax esophageal smooth muscle and try to pass food bolus. It can cause nausea, however, so consider co-administration with an anti-emetic! #FoaM4Cook
@CookCountyEM

[Nick Rigler @rigler_nick]

Asking about 1) ability to bear weight and 2) presence of full range of joint motion, are important when attempting to rule out septic arthritis (SA) using history alone. In the absence of risk factors and exam findings for SA, NPValue is high. #FoaM4Cook
@CookCountyEM

[Nick Rigler @rigler_nick]

Hematospermia can result from a variety of anatomic or infectious causes, but is often idiopathic. Ask about prior hormone supplement use (i.e. testosterone, anabolic steroids) if etiology is not clear. #FoaM4Cook
@CookCountyEM

[Nick Rigler @rigler_nick]

D-dimer can r/o aortic dissection in low risk patients only. With clinical suspicion, always get a chest CTA. Risk stratification can be used with the Aortic Dissection Detection Risk Score. A score of 0 combined w/ D-dimer < 500 has NPV of 0.1% #FoaM4Cook
@CookCountyEM. .

[Nick Rigler @rigler_nick]

Hyperthyroidism is a common cause of unexplained weight loss, but often goes undiagnosed. Always order TFTs in these patients, a positive result can prevent expensive and unnecessary work-ups. Remember - common things are common! #FoaM4Cook
@CookCountyEM

[Nick Rigler @rigler_nick]

Who gets hyperbaric O2 therapy for CO poisoning, and why? Data supporting its' use to prevent neurologic sequelae is strong but still mostly based on animal models like this one. Lots of gray area still. https://t.co/8Qgm85BTow #FoaM4Cook @CookCountyEM