{"id":1471,"date":"2017-05-03T20:01:08","date_gmt":"2017-05-04T00:01:08","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1471"},"modified":"2017-05-03T20:01:08","modified_gmt":"2017-05-04T00:01:08","slug":"ep-23-pneumomediastinum-pericarditis-sirs-multiple-sclerosis-ramsay-hunt-syndrome-brues-and-more","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-23-pneumomediastinum-pericarditis-sirs-multiple-sclerosis-ramsay-hunt-syndrome-brues-and-more\/","title":{"rendered":"Podcast Ep 23: Multiple Sclerosis, SIRS, BRUEs, Pericarditis, &amp; More"},"content":{"rendered":"\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/thereveal\/s\/media.blubrry.com\/roshcast\/s\/content.blubrry.com\/roshcast\/Ep_23_Roshcast_Emergency_Board_Review.mp3\"><\/audio><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>We aim above the mark to hit the mark.<\/p><cite>-Ralph Waldo Emerson<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to Episode 23! It was great running into a few listeners at CORD last week and hearing your feedback. This week, we start off with an OB\/GYN related pharmacology review before jumping into the new material. Hope you enjoy!<\/h6>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"201\" height=\"74\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"\" class=\"wp-image-818\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>Cervicitis is treated with ceftriaxone 250 mg IM and azithromycin 1 g PO.<\/li><li>Bacterial vaginosis is treated with metronidazole twice daily for 7 days.<\/li><li>Oxytocin or the prostaglandins can both be used in cases of maternal hemorrhage after delivery.<\/li><\/ul>\n\n\n\n<p><strong>Now onto this week\u2019s podcast<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 1<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"743\" height=\"483\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Pneumomediastinum.jpg\" alt=\"\" class=\"wp-image-1475\" srcset=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Image-Pneumomediastinum.jpg 743w, https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Image-Pneumomediastinum-300x195.jpg 300w, https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Image-Pneumomediastinum-600x390.jpg 600w\" sizes=\"auto, (max-width: 743px) 100vw, 743px\" \/><\/figure><\/div>\n\n\n\n<p>A 16-year-old man presents to the ED complaining of 3 days of nasal rhinorrhea, cough, myalgias, and generalized malaise. After a coughing episode yesterday, he developed pleuritic chest pain radiating to the left neck. His vital signs are BP 130\/70 mm Hg, HR 76, RR 16, T 36.6\u00b0C, and pulse oximetry 98% on room air. You obtain the chest radiograph seen above. Which of the following is the most appropriate next step in management?<\/p>\n\n\n\n<p><span>A. Discharge<\/span> <span>home<\/span> <span>with<\/span> <span>close<\/span> <span>follow<\/span><span>&#8211;<\/span><span>up<\/span><\/p>\n\n\n\n<p><span>B. Endoscopy<\/span><\/p>\n\n\n\n<p><span>C. Needle<\/span> <span>decompression<\/span><\/p>\n\n\n\n<p><span>D. Tube<\/span> <span>thoracostomy<\/span><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 2<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"479\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-EKG-Pericarditis.jpg\" alt=\"\" class=\"wp-image-1473\" srcset=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Image-EKG-Pericarditis.jpg 800w, https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Image-EKG-Pericarditis-300x180.jpg 300w, https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Image-EKG-Pericarditis-600x359.jpg 600w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><\/figure><\/div>\n\n\n\n<p>A 17-year-old man with no past medical history presents complaining of constant chest pain for 5 days. He states that he had a cold 2 weeks ago and feels like he never got better. His vitals are T 36.8\u00b0C, HR 91, BP 122\/75, RR 18, and oxygen saturation 99%. A 12-lead ECG is performed as seen above. What is the appropriate immediate management for this patient?<\/p>\n\n\n\n<p><span>A. Aspirin<\/span><span> 325 <\/span><span>mg<\/span> <span>and<\/span> <span>activation<\/span> <span>of<\/span> <span>the<\/span> <span>cardiac<\/span> <span>catheterization<\/span> <span>lab<\/span><\/p>\n\n\n\n<p><span>B. Azithromycin<\/span><span> 500 <\/span><span>mg<\/span> <span>by<\/span> <span>mouth<\/span><span>, <\/span><span>followed<\/span> <span>by<\/span><span> 250 <\/span><span>mg<\/span> <span>once<\/span> <span>a<\/span> <span>day<\/span> <span>for<\/span><span> 4 <\/span><span>days<\/span><span>&nbsp;<\/span><\/p>\n\n\n\n<p><span>C. Ibuprofen<\/span> <span>and<\/span> <span>prompt<\/span> <span>follow<\/span><span>&#8211;<\/span><span>up<\/span> <span>with<\/span> <span>his<\/span> <span>primary<\/span> <span>care<\/span> <span>doctor<\/span><span>&nbsp;<\/span><\/p>\n\n\n\n<p><span>D. Serum<\/span> <span>d<\/span><span>&#8211;<\/span><span>Dimer<\/span> <span>test<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Acute-Pericarditis.jpg\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 3<\/strong><\/p>\n\n\n\n<p>An 84-year-old woman with new-onset altered mental status is sent to the ED from her assisted living facility. According to the facility staff, she has had a productive cough for two days. Her vital signs are blood pressure 90\/60 mm Hg, heart rate 92 beats per minute, respiratory rate 25 breaths per minute, temperature 38.3\u00b0C, and oxygen saturation 95% on room air. Laboratory results reveal a WBC of 11,000. A chest radiograph shows a right lower lobe infiltrate. Which aspect of this patient\u2019s presentation is consistent with systemic inflammatory response syndrome?<\/p>\n\n\n\n<p><span>A. Blood<\/span> <span>pressure<\/span><\/p>\n\n\n\n<p><span>B. Heart<\/span> <span>rate<\/span><\/p>\n\n\n\n<p><span>C. Infiltrate<\/span> <span>on<\/span> <span>chest<\/span> <span>radiograph<\/span><\/p>\n\n\n\n<p><span>D. White<\/span> <span>blood<\/span> <span>cell<\/span> <span>count<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-SIRS-Sepsis-Septic-Shock.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 4<\/strong><\/p>\n\n\n\n<p>A 27-year-old woman presents with a complaint of transient vision loss in her right eye. She states that she has had multiple similar episodes in the past 6 months. She also complains of incomplete bladder emptying, intermittent tremors and intermittent weakness in her left arm. The patient has a family history of multiple sclerosis. Which of the following is the best diagnostic test for the suspected diagnosis?<\/p>\n\n\n\n<p><span>A. CSF<\/span> <span>testing<\/span> <span>for<\/span> <span>myelin<\/span> <span>basic<\/span> <span>protein<\/span><\/p>\n\n\n\n<p><span>B. CT<\/span> <span>scan<\/span> <span>of<\/span> <span>the<\/span> <span>spine<\/span><\/p>\n\n\n\n<p><span>C. MRI<\/span><\/p>\n\n\n\n<p><span>D. Serum<\/span> <span>oligoclonal<\/span> <span>bands<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Multiple-Sclerosis.jpg\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 5<\/strong><\/p>\n\n\n\n<p>Which of the symptoms are most suggestive of Ramsay Hunt syndrome?<\/p>\n\n\n\n<p><span>A. Bilateral<\/span> <span>petechiae<\/span> <span>of<\/span> <span>the<\/span> <span>palate<\/span><\/p>\n\n\n\n<p><span>B. Ear<\/span> <span>pain<\/span><span>, <\/span><span>facial<\/span> <span>paralysis<\/span><span>, <\/span><span>hearing<\/span> <span>loss<\/span><\/p>\n\n\n\n<p><span>C. Lymphangitis<\/span> <span>with<\/span> <span>thrombus<\/span> <span>formation<\/span> <span>in<\/span> <span>the<\/span> <span>internal<\/span> <span>jugular<\/span> <span>vein<\/span><\/p>\n\n\n\n<p><span>D. Photophobia<\/span> <span>and<\/span> <span>unilateral<\/span> <span>thoracic<\/span> <span>vesicular<\/span> <span>rash<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Ramsay-Hunt-Syndrome.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 6<\/strong><\/p>\n\n\n\n<p>A father brings his 2-week-old newborn to the ED after a gagging episode at home where the infant \u201cturned blue.\u201d The newborn was sleeping in his father\u2019s arms when he started choking, turned blue, and went limp. The father turned the baby over, did 5 back blows, and performed CPR for 5 minutes until the newborn started crying. On exam, the newborn appears sleepy but is easily arousable. Vital signs are HR 160, RR 30, T 37.6\u00b0C, and pulse oximetry is 99% on room air. Which of the following is the next best step in management?<\/p>\n\n\n\n<p><span>A. Admit<\/span> <span>to<\/span> <span>hospital<\/span> <span>for<\/span> <span>further<\/span> <span>workup<\/span><\/p>\n\n\n\n<p><span>B. Endotracheal<\/span> <span>intubation<\/span><\/p>\n\n\n\n<p><span>C. Epinephrine<\/span><span> (1:10 000) <\/span><span>IV<\/span><\/p>\n\n\n\n<p><span>D. Send<\/span> <span>home<\/span> <span>with<\/span> <span>reassurance<\/span><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"201\" height=\"74\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"\" class=\"wp-image-818\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li><span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/pneumomediastinum\" target=\"_blank\">Pneumomediastinum<\/a><\/strong><\/span> requires no treatment and patients may be <strong>safely discharged<\/strong>.<\/li><li><strong><span style=\"text-decoration: underline\"><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/pneumomediastinum\" target=\"_blank\">Pneumomediastinum<\/a><\/span><\/strong>&nbsp;often results from <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/ruptured-alveoli\" target=\"_blank\">ruptured alveoli<\/a><\/strong><\/span>, commonly after a strenuous <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/valsalva-maneuver\" target=\"_blank\">Valsalva maneuver<\/a><\/strong><\/span>. &nbsp;It can also be caused by <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/boerhaave-syndrome\" target=\"_blank\">Boerhaave syndrome<\/a><\/strong><\/span>.<\/li><li><strong><span style=\"text-decoration: underline\"><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/hamman\u2019s-sign\" target=\"_blank\">Hamman\u2019s sign<\/a><\/span><\/strong>&nbsp;refers to the <strong>crunching sound<\/strong> heard on&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/auscultation-of-the-mediastinum\" target=\"_blank\">auscultation of the mediastinum<\/a><\/strong><\/span> in patients with <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/pneumomediastinum\" target=\"_blank\">pneumomediastinum<\/a><\/strong><\/span>.<\/li><li><span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/pericarditis\" target=\"_blank\">Pericarditis<\/a><\/strong><\/span>&nbsp;can be seen on EKG with <strong>diffuse ST elevations without reciprocal changes<\/strong> along with <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/diffuse-PR-depressions\" target=\"_blank\">diffuse PR depressions<\/a><\/strong><\/span>. &nbsp;It often <strong>follows a <\/strong><span style=\"text-decoration: underline\"><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/URI\" target=\"_blank\">URI<\/a><\/span>.<\/li><li>First-line <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/treatment\" target=\"_blank\">treatment<\/a><\/strong><\/span> for&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/pericarditis\" target=\"_blank\">pericarditis<\/a><\/strong><\/span> is <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/high-dose-ibuprofen\" target=\"_blank\">high-dose ibuprofen<\/a><\/strong><\/span>. &nbsp;Alternatively,&nbsp;<strong><span style=\"text-decoration: underline\"><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/high-dose-aspirin\" target=\"_blank\">high-dose aspirin<\/a><\/span><\/strong> or&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/indomethacin\" target=\"_blank\">indomethacin<\/a><\/strong><\/span> may be used. <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/colchicine\" target=\"_blank\">Colchicine<\/a><\/strong><\/span> may be used in&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/refractory-cases\" target=\"_blank\">refractory cases<\/a><\/strong><\/span> or for <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/prophylaxis\" target=\"_blank\">prophylaxis<\/a><\/strong><\/span>.<\/li><li>The&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/SIRS-criteria\" target=\"_blank\">SIRS criteria<\/a><\/strong><\/span> are met if&nbsp;two of the following conditions are met:&nbsp;a <strong>heart rate &gt; 90<\/strong>, a <strong>temperature &gt; 38\u00b0 C or &lt; 36\u00b0 C<\/strong>, a <strong>respiratory rate &gt; 20 or a <span>PaCO\u2082<\/span> &lt; 32<\/strong>, or a <strong>WBC &gt; 12,000 or &lt; 4,000<\/strong>.<\/li><li><span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/multiple-sclerosis\" target=\"_blank\">Multiple sclerosis<\/a><\/strong><\/span>&nbsp;classically presents with <strong>symptoms <\/strong>that are<strong> scattered in time<\/strong>. &nbsp;They can range from <strong>motor<\/strong> to <strong>sensory<\/strong> and can include <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/bladder-dysfunction\" target=\"_blank\">bladder dysfunction<\/a><\/strong><\/span>.<\/li><li><span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/multiple-sclerosis\" target=\"_blank\">Multiple sclerosis<\/a><\/strong><\/span>&nbsp;is preferably <strong>diagnosed<\/strong> on <span style=\"text-decoration: underline\"><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/MRI\" target=\"_blank\">MRI<\/a><\/span> although&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/CSF-oligoclonal-bands\" target=\"_blank\">CSF oligoclonal bands<\/a><\/strong><\/span> may be helpful.<\/li><li><span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/multiple-sclerosis\" target=\"_blank\">Multiple sclerosis<\/a><\/strong><\/span>&nbsp;is <strong>treated<\/strong> with <strong>high-dose <span style=\"text-decoration: underline\"><a href=\"\/tag\/methylprednisolone\">methylprednisolone<\/a><\/span><\/strong> followed by a <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/prednisone\" target=\"_blank\">prednisone<\/a><\/strong><\/span> taper.<\/li><li><span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/ramsey-hunt-syndrome\" target=\"_blank\">Ramsey Hunt syndrome<\/a><\/strong><\/span>&nbsp;is characterized by a triad of <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/unilateral-facial-paralysis\" target=\"_blank\">unilateral facial paralysis<\/a><\/strong><\/span>, <strong><span style=\"text-decoration: underline\"><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/herpetiform-vesicular-eruptions\" target=\"_blank\">herpetiform vesicular eruptions<\/a><\/span><\/strong>, and <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/vestibulocochlear-dysfunction\" target=\"_blank\">vestibulocochlear dysfunction<\/a><\/strong><\/span>. &nbsp;Its caused by a&nbsp;<strong><span style=\"text-decoration: underline\"><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/herpes-zoster-infection\" target=\"_blank\">herpes zoster infection<\/a><\/span><\/strong> and is&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/treated\" target=\"_blank\">treated<\/a><\/strong><\/span> with&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/steroids\" target=\"_blank\">steroids<\/a><\/strong><\/span> and <strong><span style=\"text-decoration: underline\"><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/antivirals\" target=\"_blank\">antivirals<\/a><\/span><\/strong>.<\/li><li>The gram-negative anaerobic bacillus&nbsp;<span style=\"text-decoration: underline\"><strong><em><a rel=\"noreferrer noopener\" aria-label=\"Fusobacterium necrophorum (opens in a new tab)\" href=\"\/tag\/fusobacterium-necrophorum\" target=\"_blank\">Fusobacterium necrophorum<\/a><\/em><\/strong><\/span> causes <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/lemierre\u2019s-syndrome\" target=\"_blank\">Lemierre\u2019s syndrome<\/a><\/strong><\/span>. <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/lemierre\u2019s-syndrome\" target=\"_blank\">Lemierre\u2019s syndrome<\/a><\/strong><\/span> is a <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/lymphangitis\" target=\"_blank\">lymphangitis<\/a><\/strong><\/span>, which can lead to&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/thrombus-formation\" target=\"_blank\">thrombus formation<\/a><\/strong><\/span> within the <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/internal-jugular-vein\" target=\"_blank\">internal jugular vein<\/a><\/strong><\/span>.<\/li><li>A&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/BRUE\" target=\"_blank\">BRUE<\/a><\/strong><\/span> is an&nbsp;<span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/unexplained-frightening-episode\" target=\"_blank\">unexplained frightening episode<\/a><\/strong><\/span> characterized by <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/apnea\" target=\"_blank\">apnea<\/a><\/strong><\/span>, <span style=\"text-decoration: underline\"><strong><a href=\"\/tag\/color-change\">color change<\/a><\/strong><\/span>, <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/muscle-tone-change\" target=\"_blank\">muscle tone change<\/a><\/strong><\/span>, <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/choking\" target=\"_blank\">choking<\/a><\/strong><\/span>, or <span style=\"text-decoration: underline\"><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/gagging\" target=\"_blank\">gagging<\/a><\/strong><\/span>, and fear that the child has died. &nbsp;Most children require&nbsp;<span style=\"text-decoration: underline\"><strong><a href=\"\/tag\/admission\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">admission<\/a><\/strong><\/span> although an etiology will only be found in 50% of cases.<\/li><\/ul>\n\n\n\n<p>So that wraps up Episode 23.&nbsp; Don&#8217;t forget to <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/itunes.apple.com\/us\/podcast\/roshcast\/id1156487141?mt=2\" target=\"_blank\">subscribe<\/a> so Roshcast episodes are downloaded automatically as they are released. Follow us on Twitter <a href=\"https:\/\/twitter.com\/Roshcast\">@Roshcast<\/a>&nbsp;for updates, high-yield images, and pearls in 140 characters or less. We\u2019ll also be at <a href=\"https:\/\/www.saem.org\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">SAEM<\/a> in two weeks, so feel free to pull us aside and let us know what you think.&nbsp; We are constantly striving to make Roshcast as high yield as possible and welcome all feedback!<\/p>\n\n\n\n<p>Until next time,<br>Jeff and Nachi<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Welcome back to Episode 23! It was great running into a few listeners at CORD last week and hearing your feedback. This week, we start off with an OB\/GYN related pharmacology review before jumping into the new material. Hope you enjoy!<\/p>\n","protected":false},"author":11,"featured_media":1479,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2088,2129,2173,2174,2180,2196,2205,2254,2279,2280,2302,2330,2377,2410,2416,2463,2514,2689,2692,2748,2793,2794,2796,2800,2801,2853,2869,2887,2959,2993,3032,3061,3069,3074,3113,3265,3284,3326,3359,3368,3382,3414,3434,3435,3447,3496,3537,3538,3571,3580,3651,3652,3680,3681,3704,3705,3714,3731,3751],"coauthors":[],"class_list":["post-1471","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-admission","tag-alveoli","tag-antiviral","tag-antivirals","tag-apnea","tag-aspirin","tag-auscultation-of-the-mediastinum","tag-bladder-dysfunction","tag-boerhaave","tag-boerhaave-syndrome","tag-brue","tag-cardiology","tag-choking","tag-colchicine","tag-color-change","tag-csf-oligoclonal-bands","tag-diffuse-pr-depressions","tag-fusobacterium-necrophorum","tag-gagging","tag-hammans-sign","tag-herpes-zoster","tag-herpes-zoster-infection","tag-herpetiform-vesicular-eruptions","tag-high-dose-aspirin","tag-high-dose-ibuprofen","tag-ibuprofen","tag-indomethacin","tag-internal-jugular-vein","tag-lemierres-syndrome","tag-lymphangitis","tag-methylprednisolone","tag-mri","tag-multiple-sclerosis","tag-muscle-tone-change","tag-neurology","tag-pediatrics","tag-pericarditis","tag-pneumomediastinum","tag-pr-depression","tag-prednisone","tag-prophylaxis","tag-pulmonology","tag-ramsey-hunt","tag-ramsey-hunt-syndrome","tag-refractory-cases","tag-ruptured-alveoli","tag-sirs","tag-sirs-criteria","tag-st-elevation","tag-steroids","tag-thrombus","tag-thrombus-formation","tag-treated","tag-treatment","tag-unexplained-frightening-episode","tag-unilateral-facial-paralysis","tag-uri","tag-valsalva-maneuver","tag-vestibulocochlear-dysfunction"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v21.7 (Yoast SEO v26.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Podcast Ep 23: Multiple Sclerosis, SIRS, Pericarditis - RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 23), the first question and answer style emergency medicine podcast. 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