Posts by JETem

Aortic Dissection Presenting as a STEMI

Jennifer Yee, DO^* and Andrew P Kendle, MD^*

DOI: https://doi.org/10.21980/J8W647 Issue 7:3 No ratings yet.

At the conclusion of the simulation session or during the debriefing session, learners will be able to: 1) Verbalize the anatomical differences and management of Stanford type A and type B aortic dissections, 2) Describe physical exam findings that may be found with ascending aortic dissections, 3) Describe the various clinical manifestations of the propagation of aortic dissections, 4) Discuss the management of aortic dissection, including treatment and disposition.

Cardiology/Vascular Simulation

Morphine Equianalgesic Dose Chart in the Emergency Department

Savannah Tan, MD^*, Ellen Lee, PharmD^*, Stephen Lee, PharmD^*, Sangeeta S Sakaria, MD, MPH, MST^* and Jennifer S Roh, MD^*

DOI: https://doi.org/10.21980/J8RD29 Issue 7:3 No ratings yet.

By the end of this session, the learner will be able to: 1) define the term, “morphine milligram equivalents;” 2) describe the relative onset and duration of action of different pain medications often used in the emergency department; and 3) convert one opioid dose to another.

Pharmacology Lectures

Acute Flaccid Myelitis

Dane Zappa, MD^* and Linda L Herman, MD, FACEP^{^}

DOI: https://doi.org/10.21980/J8MP9G Issue 7:3 No ratings yet.

At the end of this oral board session, examinees will: 1) demonstrate the ability to obtain a complete pediatric medical history; 2) demonstrate an appropriate exam on a pediatric patient including a neurological exam; 3) investigate the broad differential diagnoses for neuromuscular weakness in a pediatric patient; 4) order the appropriate evaluation studies including an MRI; 5) interpret the use of a negative inspiratory force in determining the need for intubation and level of care upon admission; and 6) demonstrate effective communication with parents and caregivers.

Neurology Oral Boards

Residents Are Coming: A Faculty Development Curriculum to Prepare a Community Site For New Learners

Keith Willner, MD^*, Essie Reed-Schrader, MD^* and Stephen Mohney, MD^*

DOI: https://doi.org/10.21980/J87D2N Issue 7:3 No ratings yet.

Our goal is to prepare community-based EM attendings to be outstanding educators to future residents by augmenting their knowledge of current educational practice and adult learning theory, literature review, and biostatistics.

Faculty Development Administration Curricula

‘Cath’ It Before It’s Too Late: A Case Report of ECG Abnormalities Indicative of Acute Pathology Requiring Immediate Catheterization

Diane Wei, BS^*, Paul Truong, DO^{*^} and Patrick Bruss, MD^{*^}

DOI: https://doi.org/10.21980/J8HW7V Issue 7:3 No ratings yet.

A 12 lead ECG performed at the time of emergency department (ED) admission revealed regular sinus rhythm with noted T-wave inversion (blue arrows on Figure 1) in Lead aVL new when compared to an ECG performed a few months prior (see Figure 3). Two days later a second ECG was done when the patient developed acute chest pain while in the ICU (Figure 2) that showed persistent inversion in Lead aVL (blue arrows) as well as new J point deviation (JPD) in Leads II, aVF, V5 and V6; and new JPD in Leads V1 and V2 (green arrows) from her previous ECG while in the emergency department. These focal repolarization abnormalities did not qualify as an ST-elevation myocardial infarction by current guidelines.

Cardiology/Vascular Visual EM

Evaluation of ACE-inhibitor Induced Laryngeal Edema Using Fiberoptic Scope: A Case Report

Joya Singh, DO^* and Colin Danko, MD^*

DOI: https://doi.org/10.21980/J83P9T Issue 7:3 No ratings yet.

Physical exam was initially significant for swelling isolated to the right sided cheek and upper lip. There was no edema to lower lip, uvular swelling, or swelling to the submandibular space. She was speaking full sentences and did not endorse any voice changes. Initial vital signs were as follows: BP 125/77, HR 74, RR 16, and oxygen saturation of 100% on room air. Approximately 40 minutes later, after 125 mg solumedrol intravenous (IV) and 50mg diphenhydramine by mouth, swelling had spread to the entire upper lip and the patient reported spreading to her jaw (Photo 1). Although no jaw or submandibular edema was appreciated on physical exam, a flexible fiberoptic laryngoscope was used to evaluate the patient’s airways given worsening symptoms. Viscous lidocaine was applied intranasally five minutes prior to the procedure. The patient was positioned in a seated position on the stretcher. A flexible fiberoptic laryngoscope was then inserted through the nares and advanced slowly. Laryngoscopy showed diffuse edema of the epiglottis, arytenoids, and ventricular folds (see photos 2-4). Vital signs and respiratory status remained stable both during and after the procedure.

ENT Procedures Visual EM

A Case Report of May-Thurner Syndrome Identified on Abdominal Ultrasound

Michelle Brown, DO^*, Edmund Hsu, MD^*, Christopher McCoy, MD^* and Matthew Whited, MD^*

DOI: https://doi.org/10.21980/J8C64K Issue 7:3 No ratings yet.

The patient initially received a venous doppler ultrasound that showed no evidence of a right or left femoropopliteal venous thrombus. Due to the high suspicion of a DVT given the symmetric swelling to the entire limb and acute onset of pain, a CTV was ordered. The transverse view of the CTV showed chronic thrombotic occlusion of the proximal left common iliac vein associated with compression from the right common iliac artery (figure 1, transverse image of CTA), as well as thrombotic occlusion of the left internal iliac vein tributary and corresponding left ascending lumbar vein. Given the previously mentioned clinical context, these features suggested the diagnosis of May-Thurner syndrome.

Cardiology/Vascular Visual EM

Vitreous Hemorrhage Case Report

Mary Rometti, MD^*, Laryssa Patti, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J88D3B Issue 7:3 No ratings yet.

Point of care ultrasound (POCUS) revealed hyperechoic material in the vitreous consistent with a vitreous hemorrhage. On the ultrasound images, there is visible hyperechoic debris seen floating in the vitreous as the patient moves his eye. Since the vitreous is typically anechoic (black) in color on ultrasound, turning up the gain on the ultrasound machine makes these findings easier to see and often highlights abnormalities, such as this hemorrhage (see annotated still).

Ophthalmology Ultrasound Visual EM

High-Pressure Injection Injury to the Hand – A Case Report

Cesar Fortuna, MD^{*^}, Derek Prince, MD^†, Daniel Ng, MD^{^†} and John Costumbrado, MD, MPH^{^†}

DOI: https://doi.org/10.21980/J8D64W Issue 7:3 No ratings yet.

Plain radiographs of the left hand and forearm demonstrated extensive subcutaneous emphysema. The air can be seen as lucent striations tracking along the second and third fingers as well as along the dorsum of the hand and wrist. There is also diffuse soft tissue emphysema surrounding the metacarpophalangeal joints. Lab analysis did not show any significant acute abnormalities.

Orthopedics Visual EM

Management of Poisoned Patients: Implementing a Blended Toxicology Curriculum for Emergency Medicine Residents

Madeline Dwyer, MD^*, Megan Stobart-Gallagher, DO^*, Jared Kilpatrick, MD^* and Alanna O’Connell, DO^{^}

DOI: https://doi.org/10.21980/J8C937 Issue 7:2 No ratings yet.

The goal of this curriculum is to introduce EM residents to core toxicology concepts and to reinforce toxicology principles through a multimodal approach that leads to increased confidence in the management of poisoned patients on shift.

Toxicology Curriculum