Posts by JETem

Severe Hyperkalemia

Daniel Johnson, DO^* and Dan Wiener, MD^*

DOI: https://doi.org/10.21980/J8KH1D Issue 5:3 No ratings yet.

The initial ECG obtained upon arrival shows what is commonly referred to as a sine wave pattern. This patient does have a biventricular pacemaker which would ordinarily create a wide QRS complex mimicking an intraventricular conduction delay. However, the QRS complex here is exceptionally wide, in excess of 400 milliseconds (normal: less than 120 milliseconds). As the QRS widens, alongside other deflections present on the ECG, it morphologically mimics a mathematical sine wave.

Cardiology/Vascular Visual EM

Is an X-ray a Useful Test for Esophageal Food Boluses? A Case Report

Meryl M Abrams, MD^*, Jennifer L White, MD^* and Jeffrey Gardecki, MD^*

DOI: https://doi.org/10.21980/J8Q639 Issue 5:3 No ratings yet.

The plain film radiograph of the chest demonstrated a fluid level (yellow arrow) in the distal esophagus with dilation of the esophagus proximal to that point (blue line). Neither of these findings were present on the previous visit.

Abdominal/Gastroenterology Visual EM

Case Report: Talar Neck Fracture

Wilson Frasca, MD^* and Nhan Do, MD^*

DOI: https://doi.org/10.21980/J8FP75 Issue 5:3 No ratings yet.

ABSTRACT: This report demonstrates a case of a severe talar neck fracture. Although rare, talar neck fractures have a high potential for morbidity. Typically caused by a high energy injury, this patient’s mechanism of injury was relatively minor, and presentation was not immediately concerning for such a severe fracture. Initial x-rays provided a gross demonstration of the fracture, but a

Orthopedics Visual EM

Case Report of Spontaneous Thyroid Hemorrhage Following LMA Insertion

Gregory Podolej, MD^* and Gary Bhagat, MD^*

DOI: https://doi.org/10.21980/J8XP8W Issue 5:3 No ratings yet.

Two photographs of patients neck, both showcasing no obvious erythema, bruising, or swelling which is noteworthy because there is potential for airway compromise but there was nothing visible to indicate that on exam. CTA of neck showing thyroid nodule and potential thyroid hemorrhage (outlined in orange) on the left without evidence of airway compromise at the time of CT scan. Official read by attending radiologist states there is a “heterogeneous left thyroid nodule measuring 3 cm. Findings are suggestive of multinodular goiter with possible acute hemorrhage. Adjacent tract of soft tissue stranding in the anterior left neck with mild adjacent fascial thickening. This could represent small amount of hemorrhage or could be inflammatory.”

Endocrine Visual EM

Caught on CT! The Case of the Hemodynamically Stable Ruptured Abdominal Aortic Aneurysm

Matthew Patrick Weber, MS, BS^* and Megan Stobart-Gallagher, DO^*

DOI: https://doi.org/10.21980/J8B07B Issue 5:3 No ratings yet.

The associated images demonstrate the transverse, sagittal, and coronal views of a 6.8 cm infrarenal ruptured AAA continuous with a 4 cm right common iliac aneurysm (transverse, sagittal and coronal). Active hemorrhage was seen contained within the aortic wall, and retroperitoneal bleeding can be appreciated with asymmetric enlargement of the left psoas muscle (coronal - red arrow).1 Plaque and calcifications with a residual opacified true lumen is also present (transverse – red star, sagittal – red arrow). Known as the tangential calcium sign, this is a common radiologic finding of AAAs.2

Cardiology/Vascular Visual EM

Post-Coital Sudden Cardiac Arrest Due to Non-Traumatic Subarachnoid Hemorrhage—A Case Report

Vinson Vong, MD^*, John Costumbrado, MD, MPH^*, Daniel Ng, MD^*and Brandon Phong^{^}

DOI: https://doi.org/10.21980/J8663N Issue 5:3 No ratings yet.

The electrocardiogram demonstrated sinus tachycardia with ST segment elevation in lead aVR (black arrows) and diffuse ST depressions concerning for possible ST elevation myocardial infarction (STEMI). Given the events reported and the patient’s neurologic exam without sedation, non-contrast CT of the head was ordered; imaging showed evidence of a large subarachnoid hemorrhage, mostly at the level of the Circle of Willis (black arrow) concerning for an aneurysmal bleed as well as mild generalized white matter density suggestive of cerebral edema.

Neurology Cardiology/Vascular Visual EM

A Case Report of Epidural Hematoma After Traumatic Brain Injury

Ronald Goubert, BS^*, Alisa Wray, MD, MAEd^* and Danielle Matonis, MD

DOI: https://doi.org/10.21980/J8R059 Issue 5:3 No ratings yet.

Non-contrast CT head demonstrated a right sided EDH (red arrow) with overlying scalp hematoma, left-sided subdural hematoma (blue arrow), and bilateral subarachnoid hemorrhages. No skull fractures were noted.

Trauma Neurology Visual EM

A Case Report on Miliary Tuberculosis in Acute Immune Reconstitution Inflammatory Syndrome

Erica Concors, MD^*, Hamid Ehsani-Nia, DO^* and Michael Mirza, MD^*

DOI: https://doi.org/10.21980/J81H02 Issue 5:3 No ratings yet.

A portable single-view radiograph of the chest was obtained upon the patient’s arrival to the ED resuscitation bay that showed diffuse reticulonodular airspace opacities (red arrows) seen throughout the bilateral lungs, concerning for disseminated pulmonary tuberculosis. Subsequently, a computed tomography (CT) angiography of the chest was obtained which again demonstrates this diffuse reticulonodular airspace opacity pattern (red arrows).

Infectious Disease Respiratory Visual EM

Family Game Show-style Didactic for Teaching Nervous System Disorders during Emergency Medicine Training

Alaina Brinley Rajagopal, MD, PhD^*, Gabriel Sudario, MD^*, David Weiland, MD^* and Megan Boysen Osborn, MD, MHPE^*

DOI: https://doi.org/10.21980/J8D357 Issue 5:2 No ratings yet.

By the end of this didactic exercise the learner will: 1) name 13 important neurologic conditions related to emergency medicine: TPA (tissue plasminogen activator) contraindications/TPA eligibility, optic neuritis, botulism, giant cell (temporal) arteritis, viral encephalitis, neurocysticercosis, rabies, myasthenia gravis, neurosyphilis, status epilepticus, Bell’s palsy, dementia vs. delirium, acute inflammatory demyelinating polyneuropathy (Guillain-Barré); 2) recognize five pattern words associated with each neurologic condition; 3) understand exam findings, diagnostic tests, and/or treatments for 13 important neurologic conditions.

Neurology Board Review

A Just-in-Time Video Primer on Pneumothorax Pathophysiology and Early Management

Nicholas MacDonald, BA^*, Jacob Garcia, BS^*, Gregory C Kane, MD^{^}, Xiao Chi Zhang, MD, MS^† and Dimitrios Papanagnou, MD, MPH^†

DOI: https://doi.org/10.21980/J8891J Issue 5:2 No ratings yet.

By the end of this module, participants should be able to: 1) review the normal physiology of the pleural space; 2) discuss the pathophysiology of pneumothorax; 3) describe the clinical presentation of pneumothorax; 4) identify pneumothorax on a chest radiograph; and 5) review treatment options for pneumothorax.

Respiratory Lectures