Posts by JETem

Tracheoinnominate Artery Fistula

Emily M Tarver, MD^*, Anna A Lerant, MD, CHSE^{^}, Jeffrey D Orledge, MD^*, Benjamin P Stevens, MD^‡, and Gina D Jefferson, MD, MPH, FACS^‡

DOI: https://doi.org/10.21980/J8K05R Issue 6:3 No ratings yet.

By the end of this simulation, 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, 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.

A Case Report of Glycogenic Hepatopathy

Dane Brown, MD^* and Theresa Mead, DO, RDMS^*

DOI: https://doi.org/10.21980/J8SQ0Z Issue 6:3 No ratings yet.

The ultrasound images reveal hepatomegaly and an increased echogenicity of the liver parenchyma that is diffuse. The increased echogenicity can be best appreciated by a comparison to surrounding structures. It is important to note that the increased echogenicity is non-focal and consistent throughout the entire liver in multiple views. These findings can be consistent with nonalcoholic steatohepatitis as well as glycogenic hepatopathy.

Endocrine Visual EM

A Case Report of a Large Goiter Resulting in Tracheal Deviation

Thomas Powell, MD^* and Geremiha Emerson, MD^*

DOI: https://doi.org/10.21980/J80645 Issue 6:3 No ratings yet.

In the image, one can see significant tracheal deviation around the right side of the mass (black arrows). This degree of deviation would make ventilation in a paralyzed patient extremely difficult, if not impossible.

Endocrine Visual EM

Case Report—Pediatric Brugada Phenotype from Accident Cocaine Ingestion

Patrick Bruss, MD^*, Sarah Norris, DO^*, Kaylene Pagan, MD^*, Richard Cousino, DO^*, Allison Grim^*, and Gregory Reinhold, DO^*

DOI: https://doi.org/10.21980/J8VH28 Issue 6:3 No ratings yet.

Initial EKG was concerning for type I Brugada pattern with an incomplete right bundle branch block in V1 & ST segment elevation terminating in an inverted T wave in V2. There are also signs of sodium channel toxicity with a widened QRS complex, tachycardia and a terminal R wave present in aVR where the R wave is bigger than the S wave or the R wave is over 3mm in aVR.

Cardiology/Vascular Visual EM

A Case Report of Neonatal Vomiting due to Adrenal Hemorrhage, Abscess and Pseudohypoaldosteronism

Raymen Rammy Assaf, MD, MPH^* and Mary Jane Piroutek, MD^{^}

DOI: https://doi.org/10.21980/J8QQ0B Issue 6:3 No ratings yet.

An ultrasound (US) of the abdomen was obtained to evaluate for possible pyloric stenosis (see US transverse/dopper imaging). While imaging showed a normal pyloric channel, it revealed an unexpected finding: a complex cystic mass arising from the right adrenal gland (yellow outline), measuring 5.8 by 4.0 by 6.4 cm with calcifications peripherally and mass effect on the kidney without evidence of vascular flow (blue arrow). Computed tomography (CT) of the abdomen/pelvis with IV contrast was subsequently obtained and measured the lesion as 2.8 by 4.6 by 4 cm without evidence of additional masses, lymphadenopathy or left adrenal gland abnormality (see CT axial, coronal, and sagittal imaging).

Endocrine Visual EM

Case Report of Unusual Facial Swelling in an 8-Month-Old

Amanda E Mulcrone, MD^*, Zobiya Z Momin, MD^{^} and Corrie E Chumpitazi, MD, MS^*

DOI: https://doi.org/10.21980/J8M06F Issue 6:3 No ratings yet.

Facial ultrasound revealed local inflammatory changes such as increased echogenicity and heterogeneity in the soft tissues of the right cheek, suggestive of soft tissue edema. There was evidence of a prominent right parotid gland with increased heterogeneity suggestive of a traumatic injury. Additionally, facial ultrasound demonstrated a 6mm ill-defined anechoic collection within the right cheek without increased doppler flow (green arrow), thought to represent a focal area of edema instead of an abscess.

Pediatrics Renal/Electrolytes Visual EM

Case Report: Thoracic Aortic Dissection in a Previously Healthy Male with an Unusual Inciting Factor

Peter L Vuong, DO^*, Edward J Durant, MD^*, and Christopher B Branham, DO^*

DOI: https://doi.org/10.21980/J8G92S Issue 6:3 No ratings yet.

A non-contrast computed tomography (CT) scan was negative for a suspected ureteral stone. However, there were aortic calcifications visualized at the infrarenal level that were notable given the patient’s age (red arrow). Given this finding in conjunction with the patient’s symptoms, bedside transabdominal ultrasonography was performed which revealed an intraluminal echogenic flap within the aorta near the common iliac arteries. CT angiography (CTA) with delayed contrast protocol revealed an extensive Stanford type A aortic dissection with involvement of the aortic root (purple arrow), brachiocephalic trunk, ostia of the left subclavian artery, descending aorta (blue arrow), bilateral common iliac arteries, and left internal iliac artery.

Cardiology/Vascular Visual EM

A Low-Cost Facial and Dental Nerve Regional Anesthesia Task Trainer

Andrew Eyre, MD, MSHPed^{*^} and Valerie Dobiesz, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J8RP9Q Issue 6:2 No ratings yet.

By the end of this educational session, learners should be able to: 1) describe and identify relevant anatomy for supra-orbital, infra-orbital, mental, and inferior alveolar nerves and 2) successfully demonstrate supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks using a partial task trainer.

Procedures ENT Innovations

Teaching about the Wild: A Survival Course as a Novel Resident Educational Experience

Geoffrey Comp, DO^*, Rachel Munn, DO^{^}, Renee Moffitt, DO^† and Eric Cortez, MD^{^^}

DOI: https://doi.org/10.21980/J8N06RIssue 6:2 No ratings yet.

By the end of the session the learner will be able to: 1) differentiate at least three different methods for water purification 2) describe how to erect a temporary survival shelter 3) construct a survival pack for personal use emphasizing multi-use items 4) demonstrate how to make a fire without a direct flame supply.

Small Group Learning Wilderness

Escape the EM Boards: Interactive Virtual Escape Room for GI Board Review

Megan Gillespie, DO^*

DOI: https://doi.org/10.21980/J8H63FIssue 6:2 No ratings yet.

By the end of this didactic activity, learners will be able to: 1) identify causes of upper gastrointestinal bleeding; 2) recall test-taking buzzwords for infectious causes of diarrhea; 2) acknowledge the correct hepatitis B titers that correspond with various clinical scenarios; 3) describe the management for alkali caustic ingestions; 4) determine the components of Maddrey Discriminant Function Score, Charcot’s triad, Ranson’s Criteria for Pancreatitis, and Glasgow-Blatchford Score; 5) diagnose specific gastrointestinal diseases from a clinical description; 6) choose the correct gastrointestinal diagnosis based on clinical image findings; 7) demonstrate teamwork in solving problems.

Abdominal/Gastroenterology Small Group Learning