Crushing or transecting the chorda tympani nerve of the gerbil (Meriones unguiculatus) caused ipsilateral degeneration of taste buds in the fungiform papillae. In less than two weeks some taste fibers regenerated into the tongue and formed new taste buds and receptor cells. The recovery process was evaluated electrophysiologically in 53 gerbils by acute recording proximal to the nerve injury site. Initially the chorda tympani was electrically silent. In gerbils tested at later times spontaneous activity appeared. This was followed by responses to pressure on the tongue. Taste responses returned as early as day 11. The receptive field of regenerated taste fibers was limited to a small number of fungiform papillae. Taste responses were always associated with the presence of one or more taste buds in the receptive field. Taste buds identified as responsive to chemicals contained some fusiform cells. We found that the taste responses of single fiber, few-fiber and multi-unit preparations reflected the diversity of responses found in normal taste axons as determined by recording from 26 normal single fibers and 27 normal whole nerves. The early emergence of a variety of fiber types and responses to many chemicals in regeneration is inconsistent with the proposition that the relative chemical responsiveness of a receptor cell is strictly a function of its age; the response of a given young taste receptor is not necessarily limited to a few of the standard taste stimulants.

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A 34-year-old woman was transferred to our institution because of suspected small-bowel obstruction and abnormal ECG.The patient presented to a rural hospital emergency department with progressive abdominal pain, nausea, and emesis that began 9 hours earlier. The patient had paraplegia with subsequent colostomy after a motor vehicle accident 17 years earlier.Initial evaluation revealed heart rate 99 beats/min, blood pressure 124/84 mm Hg, oxygen saturation 96%, temperature 36.8°C, and distended abdomen with hypoactive bowel sounds. Laboratory evaluation revealed hemoglobin 13.4 g/dL, white blood cell count 14 400/mm Because of progressive abdominal distension and the abnormal ECG, she was transferred to our institution 9 hours postadmission. Surgical consultation revealed severe ileus without mechanical bowel obstruction and a recommendation for conservative management. The patient again refused a nasogastric tube. A second ECG, on arrival at this institution, showed giant J waves with marked inferolateral ST-segment elevation (Figure 1, Bottom). Serial troponin I measurements were undetectable (<0.012 ng/mL). An echocardiogram demonstrated a hyperdynamic heart with an estimated ejection fraction of 65% to 70% and no pericardial effusion. A computed tomographic coronary angiogram showed normal coronary arteries with trace pericardial fluid and no pulmonary embolism.The patient improved with relief of symptoms and return of normal gastrointestinal motility; follow-up ECG showed complete disappearance of J waves and ST-segment elevation (Figure 3). DiscussionThe serial ECGs of this young woman demonstrated progressive and dramatic J waves with ST-segment elevation in the inferolateral leads in the setting of ileus and marked gastric distension with fluid. The second ECG resembled that of acute inferolateral myocardial infarction attributable to circumflex or right coronary artery obstruction. The ECG promptly returned to normal with ileus resolution. Evaluation demonstrated normal electrolytes and body temperature and no evidence for myocardial infarction, takotsubo cardiomyopathy, pericarditis, Brugada syndrome, or other conditions known to be associated with ST-segment elevation. 1The ECG findings in this case are most consistent with the presence of giant J waves and associated ST-segment elevation. The J wave is an ECG deflection immediately after QRS termination, sometimes associated with ST-segment elevation, in which case it is generally referred to as the early repolarization pattern.2 The origin of the J wave is controversial and may represent either early repolarization or ventricular depolarization. 3 The Osborn wave is a unique ECG finding also occurring at the end of the QRS complex, first described in the setting of hypothermia, but also seen in other settings such as hypercalcemia. Osborn waves may be dramatic but are not usually associated with elevation of the entire ST segment; therefore, we do not believe this case represents an example of giant Osborn waves. 4 The ECG abnormality in this patien...

Background: Opioid-induced respiratory depression (OIRD) is a serious complication that can lead to negative outcomes. There are known risk factors for OIRD; however, a lack of national guidelines for the prevention and early detection of OIRD exists. Methods: An evidence-based practice study was conducted to create an enhanced monitoring (EM) program. The EM program consisted of risk stratification of surgical spine patients, including the use of STOP-BANG screening for obstructive sleep apnea, capnography monitoring, use of home positive airway pressure therapy, capnography alarm optimization, hospitalist consultation, nursing education, and patient education.Results: Approximately 17% (N 5 937/5,462) of surgical spine patients were enrolled in the EM program. Fifty-six percent of EM patients were monitored with capnography and had out of range end-tidal carbon dioxide levels 17% of the time. The rate of transfers to the intensive care unit (ICU) for OIRD decreased, though not statistically significant (p 5 .151). Conclusions: The EM program with risk stratification was found to reduce transfers to the ICU for OIRD. Although not statistically significant, the decreased number of transfers was clinically significant. Engagement of the interprofessional team and capnography alarm parameter optimization helped to reduce nonactionable alarms.

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