Posts by JETem

An Atraumatic, Idiopathic Case Report of Intraperitoneal Bladder Dome Rupture

Kylie Prentice, BS^*, Alisa Wray, MD, MAEd^* and Danielle Matonis, MD^*

DOI: https://doi.org/10.21980/J85S83 Issue 6:4 No ratings yet.

On regular CT scan imaging, the urinary bladder is partially distended with contrast with no focal wall thickening or intraluminal hematoma. There is an intraperitoneal bladder rupture with site of rupture likely at the dome of the bladder. The bladder is outlined in red, and the bladder rupture boundaries are outlined in yellow, showing the urine as free fluid escaping into the intraperitoneal space. We also provide these findings in an axial CT in video format. On CT cystography, there is a significant amount of contrast-enhanced urine noted within the visualized peritoneal spaces. The small amount of air present anteriorly is related to the catheterization because a Foley balloon is present within the bladder. These findings are annotated with the peritoneal spaces outlined in yellow, the air in the blue outline, and the bladder in the red outline. All of these CT cystography findings are also presented in an axial view in video format.

Urology Visual EM

Ureteral Obstruction and Ureteral Jet Identification—A Case Report

Chad Bambrick, MD^*, Dalia Khader, MD^* and Therese Mead, DO^*

DOI: https://doi.org/10.21980/J8206G Issue 6:4 No ratings yet.

A point-of-care ultrasound of the urinary tract was performed, evaluating the kidneys and bladder. When imaging her kidneys, right-sided hydronephrosis was noted with a normal appearance to the left kidney. To further evaluate, a curvilinear probe was placed on her bladder with color doppler to assess for ureteral jets. Ureteral jets are seen as a flurry of color ejecting from each of the ureters as urine is released from the ureterovesical junction. In a healthy patient, this finding should be seen ejecting from both ureters every 1-3 minutes as the kidneys continue to filter the blood and create urine to be stored in the bladder. In our patient, however, ureteral jets were only noted on the left side (arrow), which was significant in further verifying our suspicion of right ureteral obstruction.

Ultrasound Urology Visual EM

A Culinary Misadventure: A Case Report of Shiitake Dermatitis

Chia-Yuan Michael Lee, DO^* and Michael T Dalley, DO^*

DOI: https://doi.org/10.21980/J8X936 Issue 6:4 No ratings yet.

Close visual examination revealed erythematous linear papules on her upper and lower back. No bullae, drainage, or sloughing of the skin was present. The rest of her body, including palms, soles, and mucosa, was spared.

Dermatology Visual EM

Case Report of an Empyema Identified on Lung Ultrasound

Michelle Brown, DO^*, Carly Heffernan, BS^* and Alisa Wray, MD, MAEd^*

DOI: https://doi.org/10.21980/J8SH2N Issue 6:4 No ratings yet.

Using a curvilinear ultrasound probe, images of the patient were obtained from the left mix-axillary line. These images demonstrate a loculated left-sided pleural effusion (outlined in the attached ultrasound image in blue) that was moderate in size, concerning for an empyema. The diaphragm on the right (red) of the image outlines the inferior margin of the collection of pus, which is seen in the inferior aspect of the left lung. Unfortunately, rib shadows on the left side of the image prevent the full empyema from being captured in this single image. As a result of the bedside ultrasound, however, the patient was rapidly diagnosed with an empyema and was initiated on antibiotics, which is further discussed below. After his bedside ultrasound was completed, his chest x-ray revealed the expected left-sided pleural effusion. Additionally, a CT angiogram of the chest was ordered to rule out a pulmonary embolism, which was negative for an embolism but does redemonstrate the left-sided loculated pleural effusion (outlined on the CT axial and coronal images in blue).

Respiratory Visual EM

Implementation of a Medical Education Rotation for Senior Emergency Medicine Residents

Deena Ibrahim Bengiamin, MD^*, Lizveth Fierro, MD^*, Molly Estes, MD^*, Michael Kiemeney, MD^* and Timothy Patrick Young, MD^*

DOI: https://doi.org/10.21980/J8BH17 Issue 6:3 No ratings yet.

Our objectives were to provide our senior residents with exposure to various aspects of the field of MedEd, to further develop their teaching skills and to encourage them to consider a career in academic emergency medicine.

Curriculum Administration

A Novel Virtual Emergency Medicine Residents-as-Teachers (RAT) Curriculum

Shannon Marie Burke, MD^*, Thaddeus Schmitt, MD^*, Corlin Jewell, MD^* and Benjamin Holden Schnapp, MD, MEd^*

DOI: https://doi.org/10.21980/J86S71 Issue 6:3 No ratings yet.

The goals of this curriculum are to provide residents with an introduction to teaching techniques that can be utilized on-shift to facilitate an excellent educational experience for junior learners while balancing the resident’s patient care responsibilities.

Administration Curricula

Pediatric Simulation-Based Prehospital Training Course in Botswana

Nicolaus W Glomb, MD, MPH^*, Marideth C Rus, MD^{^}, Adeola Adekunbi Kosoko, MD^‡, Sharmistha Saha, MD^**, Kristen Murphy, MD^{^}, Cara B Doughty, MD^{^}, Cafen Galapi, RN^{^^}, Bushe Laba, EMT-P^{^^}, and Manish I Shah, MD^{^}

DOI: https://doi.org/10.21980/J8306S Issue 6:3 No ratings yet.

The objective of this educational project was to design, implement, and evaluate a curriculum relevant to an EMS system based in a LMIC, so that it could be a basis for curricula for use in similar contexts. The educational goal is to improve prehospital providers performance in common pediatric resuscitations.

Curricula Pediatrics Simulation

Modified Manikin for Tracheoinnominate Artery Fistula

Emily M Tarver, MD^*, Gina D Jefferson, MD, MPH^{^}, Patrick Parker^‡, Kristina Readman^‡, Susana M Salazar Marocho, BDS, PhD^** and Anna A Lerant, MD, CHSE^‡^{^^}

DOI: https://doi.org/10.21980/J8Z93H Issue 6:3 No ratings yet.

By the end of this educational session, learners will be able to: 1) perform a focused history and physical exam on any patient who presents with bleeding from the tracheostomy site; 2) describe the differential diagnosis of bleeding from a tracheostomy site, including a TIAF; 3) demonstrate the stepwise management of bleeding from a suspected TIAF, including cuff hyperinflation and the Utley Maneuver; 4) verify that definitive airway control via endotracheal intubation is only feasible in the tracheostomy patient when it is clear, upon history and exam, that the patient can be intubated from above; and 5) demonstrate additional critical actions in the management of a patient with a TIAF, including early consultation with otolaryngology and cardiothoracic surgery as well as emergent blood transfusion and activation of a massive transfusion protocol.

Innovations Procedures Respiratory

Meningococcal Meningitis with Waterhouse-Friderichsen Syndrome

Jonathan Kelley, DO^* and Amrita Vempati, MD^*

DOI: https://doi.org/10.21980/J8TH1K Issue 6:3 No ratings yet.

By the end of this simulation session, learners will be able to: (1) manage a patient with altered mental status (AMS) with fever while maintaining a broad differential diagnosis, (2) recognize the risk factors for meningococcal meningitis, (3) manage a patient with worsening shock and perform appropriate resuscitation, (4) develop a differential diagnosis for thrombocytopenia and elevated international normalized ratio (INR) in an altered febrile hypotensive patient with rash, (5) manage the bleeding complications from WFS, (6) discuss the complications of meningococcal meningitis including WFS, and (7) review when meningitis prophylaxis is given.

Infectious Disease Neurology Simulation

Eclampsia

Thomas J Yang, MD^*, Rohit B Sangal, MD, MBA^* and Lauren W Conlon, MD^{^}

DOI: https://doi.org/10.21980/J8PS8R Issue 6:3 No ratings yet.

By the end of this simulation session, learners will be able to: 1) demonstrate care of a gravid patient with altered mental status; 2) demonstrate care of a gravid patient with seizures; 3) recognize care involved in assessment of fetal status; 4) execute appropriate subspecialty consultation; 5) recognize the clinical signs and symptoms of eclampsia; 6) distinguish different treatment options for eclampsia; 7) identify magnesium toxicity and reversal agent; and 8) differentiate the spectrum of preeclampsia.

Ob/Gyn Simulation