This is EM cases, EM Quick Hits podcast, where our team of experts and educators bringing clear, concise, and condensed, practice-changing knowledge on all those EM topics you may not be totally comfortable with.

Cases, the latest evidence, procedural tips and tricks, pitfalls to avoid, and the key take-home points and references on the EMCases website.

Quick, let's get on with it.

EM cases is part of Shremi, the Schwartz-Risman Emergency Medicine Institute.

That's the nonprofit organization dedicated to improving EM care

through high-quality research and education. The opinions expressed on this podcast are intended

for general information and educational purposes only and should not be used to diagnose, treat,

or prevent any medical condition, nor should they be used as a substitute for medical advice

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The CT scan shows a small bowel obstruction.

It's not surprising.

The patient had been through this before she knew that was the diagnosis.

The disposition is easy.

The surgeon is happy to accept.

But when you tell the patient the CT result, a look of dread comes over her face. You aren't going to shove that

tube up my nose again. That hurts. In my mind, the use of NG tubes for bowel obstruction is

an anachronism. I grew up hearing about literature that said NG tubes provided no benefit,

but they are routinely rated as one of the

most painful things we do to our patients. But every time I call surgery, put an NG tube in is the

very first thing that comes out of the surgeon's mouth. So I figured it was time to look through

this evidence for myself. It turns out, there really is no evidence.

...