Posts by JETem

Cecal Volvulus Diagnosed with a Whirl Sign: A Case Report

Gregory K Sun, DO^* and Brian Walsh, MD^*

DOI: https://doi.org/10.21980/J8XM05 Issue 5:4 No ratings yet.

The CT image demonstrates a “whirl sign” (red arrow) which is indicative of a volvulus. This image occurs when bowel, mesentery and vasculature rotate around a transition point causing an image similar to a hurricane on a weather map. When seen on a CT scan, a whirl sign suggests a high likelihood of either a closed loop bowel obstruction or volvulus in the cecum, sigmoid or midgut. In any of the cases, seeing a whirl sign strongly increases the need for emergent surgical management.

Abdominal/Gastroenterology Visual EM

Paroxysmal Ventricular Standstill—A Case Report of all Ps and no QRS in Ventricular Asystole

Hamid Ehsani-Nia, DO^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J8SS79 Issue 5:4 No ratings yet.

In route, it was proposed that this patient was suffering from a dysrhythmia due to the transient episodes of syncope with lack of ventricular activity on telemetry. Upon close examination of the rhythm strips as well as the ECG, P waves can be visualized without any accompanying QRS complexes lasting multiple seconds (ED ECG blue arrows). Additionally, the rhythm has an intrinsic rate of 100 beats per minute and has a consistent morphology with no evidence of ventricular activity due to the lack of QRS complexes. As a result, the rhythm likely originates in the atria with no passage of impulses into the ventricles through the atrioventricular (AV) node versus an accelerated ventricular rhythm where QRS complexes would be seen.8 These rhythm strips demonstrate an example of VS. There is preserved native atrial automaticity, with an intact sinoatrial (SA) node, with a complete lack of ventricular electrical activity

Cardiology/Vascular Visual EM

Hemoptysis Due to Diffuse Alveolar Hemorrhage

Zoltan Buchwald, MD^* and Amrita Vempati, MD^*

DOI: https://doi.org/10.21980/J8ZP86 Issue 5:3 No ratings yet.

By the end of this simulation session, learners will be able to: (1) recognize worsening respiratory status of a patient with hemoptysis and intervene appropriately, (2) manage a patient with severe hemoptysis and perform appropriate ventilator management, (3) manage sinus tachycardia with QT prolongation on the ECG caused by cocaine and hypomagnesemia, (4) address various etiologies of hemoptysis, (5) discuss the causes of massive hemoptysis and management options, and (6) review ventilation strategies in an intubated hypoxic patient.

Respiratory Simulation

Improving Emergency Department Airway Preparedness in the Era of COVID-19: An Interprofessional, In Situ Simulation

Keiran J Warner, MD^*, Ashley C Rider, MD^*, James Marvel, MD^*, Michael A Gisondi, MD^*, Kimberly Schertzer, MD^* and Kelly N Roszczynialski, MD, MS^*

DOI: https://doi.org/10.21980/J8V06M Issue 5:3 No ratings yet.

At the conclusion of the simulation session, learners will be able to: 1) Understand the need to notify team members of a planned COVID intubation including: physician, respiratory therapist, pharmacist, nurse(s), and ED technician. 2) Distinguish between in-room and out-of-room personnel during high-risk aerosolizing procedures. 3) Distinguish between in-room and out-of-room equipment during high-risk aerosolizing procedures to minimize contamination. 4) Appropriately select oxygenation therapies and avoid high-risk aerosolizing procedures. 5) Manage high risk scenarios such as hypotension or failed intubation and be prepared to give push-dose vasoactive medications or place a rescue device such as an I-gel®.

Infectious Disease Procedures Respiratory Simulation

Eclampsia

Patrick G Meloy, MD^*, Megan C Henn, MD^*, Daniel Rutz, MD^{^} and Amit Bhambri, MD^†

DOI: https://doi.org/10.21980/J8M93D Issue 5:3 No ratings yet.

At the end of this oral boards session, examinees will: 1) Demonstrate ability to obtain a complete medical history including a detailed obstetric history. 2) Demonstrate the ability to perform a detailed physical examination in a postpartum female patient who presents with a seizure. 3) Investigate the broad differential diagnoses which include electrolyte imbalances, brain tumor, meningitis or encephalitis, hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome and eclampsia. 4) List the appropriate laboratory and imaging studies to differentiate eclampsia from other diagnoses (complete blood count, comprehensive metabolic panel, magnesium level, pregnancy testing, urinalysis, and computed tomography [CT] scan of the head). 5) Identify a postpartum eclampsia patient and manage appropriately (administer IV magnesium therapy, administer IV antihypertensive therapy, emergent consultation with an obstetrician). 6) Provide appropriate disposition to the intensive care unit after consulting with an obstetrician.

Ob/Gyn Oral Boards

Low Fidelity Trainer for Fiberoptic Scope Use in the Emergency Department

Garren Giles, DO^*, Dominic Diprinzio, DO^* and Jordana Haber, MD^*

DOI: https://doi.org/10.21980/J8764B Issue 5:3 No ratings yet.

By the end of this training session, learners will be able to 1) list indications, contraindication, and complications in performing fiberoptic intubations, 2) know how to use and maneuver a fiberoptic scope, and 3) be able to successfully intubate the trainer model.

Procedures Innovations Respiratory

Periodic Refresher Emails for Emergency Department Mass Casualty Incident Plans

Jessie G Nelson, MD^{*^}, Sara Hevesi, MD^†, Robert Welborn, MD^†, Krista R Carlson, MD, MS^**, Benjamin Eide, MPH^{^^}, Merideth Winkler, RN, BSN^†, Marissa K Peterson, MS^††, Elizabeth Ramey, MS^¶

DOI: https://doi.org/10.21980/J8C05WIssue 5:3 No ratings yet.

This curriculum is intended to maintain a knowledge base of MCI processes to mitigate degradation of necessary knowledge between hands-on MCI training.

EMS Administration Curricula

A Model Curriculum for a Helicopter Emergency Medicine Services (HEMS) Rotation for Resident Physicians

Jordan Imoehl, MD^{*^}, Michael T Steuerwald, MD^{*^} and Andrew D Cathers, MD^{*^}

DOI: https://doi.org/10.21980/J8GP97 Issue 5:3 No ratings yet.

The primary objective of this course is to present a standardized curriculum which allows learners to gain understanding of HEMS systems and retrieval medicine while practicing safety in the aviation environment.

EMS Curricula

Pediatric Seizure Team-Based Learning

Sara Paradise Dimeo, MD^*, Gabriel Sudario, MD^{^}, Supriya Sharma, MD^†, Lilly Bellman, MD^†, Anjalee Gallion, MD^**, Katherine Andreeff, MD^{^^} and Megan Boysen-Osborn, MD, MHPE^{^}

DOI: https://doi.org/10.21980/J8MD22Issue 5:3 No ratings yet.

By the end of this TBL session, learners should be able to: 1) Define features of simple versus complex febrile seizure, 2) Discuss which patients with seizure may require further diagnostic workup, 3) Summarize a discharge discussion for a patient with simple febrile seizures 4) Identify a differential diagnosis for pediatric patients presenting with seizure, 5) Define features of status epilepticus, 6) Review an algorithm for the pharmacologic management of status epilepticus, 7) Indicate medication dosing and routes of various benzodiazepine treatments, 8) Obtain a thorough history in an infant patient with seizures to recognize hyponatremia due to improperly prepared formula, 9) Choose the appropriate treatment for a patient with a hyponatremic seizure, 10) Describe the anatomy of a ventriculoperitoneal (VP) shunt, 11) Relate a differential diagnosis of VP shunt malfunction, 12) Compare and contrast the neuroimaging options for a patient with a VP shunt

Pediatrics Neurology Team Based Learning (TBL)

Build Your Own Eye: A Method for Teaching Ocular Anatomy and Pathophysiology

Alaina Brinley Rajagopal, MD, PhD^*, Mark Joseph Slader, BS^* and Megan Boysen Osborn, MD, MHPE^*

DOI: https://doi.org/10.21980/J8GS8W Issue 5:3 No ratings yet.

By the end of this session the participant will be able to: 1) Describe basic anatomy of the eye, 2) Build a basic model of the eye, 3) Identify which diseases are associated with which parts of the eye, 4) Identify the pathophysiology behind diseases of the eye, 5) Name correct treatment for each disease.

Ophthalmology Team Based Learning (TBL)