Posts by JETem

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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[mrp_rating_result]
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.
ENTProceduresVisual EM
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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[mrp_rating_result]
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/VascularVisual EM
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Vitreous Hemorrhage Case Report

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

DOI: https://doi.org/10.21980/J88D3B Issue 7:3[mrp_rating_result]
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).
OphthalmologyUltrasoundVisual EM
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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[mrp_rating_result]
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.
OrthopedicsVisual 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[mrp_rating_result]
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.
ToxicologyCurriculum

Peritonsillar Abscess Simulator: A Low-Cost, High-Fidelity Trainer

Chad R Keller, DO*, Ivanna Nebor, MD*, David Choi, MD, FRCSC*, Kattia Moreno, MD* and Yash J Patil, MD, MPH*

DOI: https://doi.org/10.21980/J85M0B Issue 7:2[mrp_rating_result]
By the end of this training session, learners will be able to: 1) locate the abscess, 2) perform needle aspiration, and 3) develop dexterity in maneuvering instruments in the small three-dimensional confines of the oral cavity without causing injury to local structures.
ProceduresENTInnovations

Breaking Bad News in the Emergency Department

Susan Siraco, BA*, Cindy Bitter, MD, MPH, MA^ and Tina Chen, MD^ 

DOI: https://doi.org/10.21980/J81W7H Issue 7:2[mrp_rating_result]
At the conclusion of these two simulation cases, learners will be able to 1) recognize signs of poor prognosis requiring emergent family notification, 2) take practical steps to contact family using available resources and personnel, 3) establish goals of care through effective family discussion, 4) use a structured approach, such as GRIEV_ING, to deliver bad news to patients’ families, and 5) name the advantages of family-witnessed resuscitation.
Miscellaneous (stats, etc)Simulation

Infant Botulism

Victoria Morris, MD*, Robert Wians, MD, MPH*, Jessica Wilson, MD* and Gowri Stevens, MD* 

DOI: https://doi.org/10.21980/J8X35W Issue 7:2[mrp_rating_result]
After this simulation learners should be able to: 1) develop a differential diagnosis for the hypotonic infant, 2) recognize signs and symptoms of infant botulism, 3) recognize respiratory failure and secure the airway with appropriate rapid sequence intubation (RSI)  medications, 4) initiate definitive treatment of infant botulism by mobilizing resources to obtain antitoxin, 5) continue supportive management and admit the patient to the pediatric intensive care unit (PICU), 6) understand the pathophysiology and epidemiology of infant botulism, 7) develop communication and leadership skills when evaluating and managing critically ill infants. 
PediatricsSimulationToxicology