Posts by JETem

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A Case Report of Epiglottitis in an Adult Patient

Savannah Tan, BS*, Kyle Dornhofer, MD*, Allen Yang, MD*, Shadi Lahham, MD, MS*  and Lindsey C Spiegelman, MD*

DOI: https://doi.org/10.21980/J8QM09 Issue 7:1[mrp_rating_result]
At the time of presentation to the ED, laboratory results were significant for leukocytosis to 11.8 x 109 white blood cells/L and a partial pressure of carbon dioxide of 52 mmHg on venous blood gas. Computed tomography (CT) of the soft tissue of the neck with contrast showed edematous swelling of the epiglottis and aryepiglottic fold with internal foci of gas (blue arrow) and partial effacement of the laryngopharyngeal airway and scattered cervical lymph nodes bilaterally (Figure 1). Findings were consistent with epiglottitis containing nonspecific air. Additionally, the pathognomonic “thumbprint sign” (yellow arrow) was found on lateral x-ray of the neck (Figure 2). The CT findings as shown in figure 3 illustrate lateral view of the swelling of the epiglottis, gas, and blockage of the airway.
ENTVisual EM
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An Unusual Case Report of a Toddler with Metastatic Neuroblastoma Mimicking Myasthenia Gravis

Raymen Rammy Assaf, MD, MPH*^

DOI: https://doi.org/10.21980/J8G35V Issue 7:1[mrp_rating_result]
While still in the ED, MRI with and without gadolinium contrast of the brain, orbits, and cervical, thoracic and lumbar spine were obtained to evaluate for possible CNS lesions including encephalitis, myelitis, or demyelination. Imaging, however, demonstrated multiple unexpected findings: a T1 hypointense, T2 hyperintense and heterogeneously enhancing right adrenal mass measuring 2.7 x 2.1 x 3 cm (yellow asterisk) along with heterogenous enhancement at the clivus, C6, C7, T7, T8, T12, and L3 vertebral bodies (red asterisks). There were otherwise no significant intracranial signal or structural abnormalities and normal orbits.
PediatricsHematology/OncologyNeurologyVisual EM
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Not Another Presentation of Cellulitis: A Case Report of Erythromelalgia

Raymen Rammy Assaf, MD, MPH*^  and Kelly Winters, NP*^

DOI: https://doi.org/10.21980/J8BD2K Issue 7:1[mrp_rating_result]
Episodic tender, warm, erythematous swelling of the extremity experienced by this patient is typical of erythromelalgia. Erythematous streaking on the volar surface of the left forearm (red arrow) and tender, warm, erythematous blanching swelling was present on the palmar hand (yellow arrow). Most patients with erythromelalgia also have lower extremity involvement including the dorsum or sole of the foot and toes.1
PediatricsDermatologyVisual EM
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Case Report of a Man with Right Eye Pain and Double Vision

Nicolas Kahl, MD* and Maria Pelucio, MD*

DOI: https://doi.org/10.21980/J8KW7G Issue 7:1[mrp_rating_result]
ABSTRACT: A 39-year-old previously healthy male presented with three days of right eye pressure and one day of binocular diplopia.  He denied history of trauma, headache, or other neurological complaints.  He had normal visual acuity, normal intraocular pressure, intact convergence, and no afferent pupillary defect. His neurologic examination was non-focal except for an inability to adduct the right eye past midline
OphthalmologyNeurologyVisual EM

The Zipperator! A Novel Model to Simulate Penile Zipper Entrapment

Dale Till, MD*, Simran Ghuman, BS^, Luke Kim, MS^, Ryan Roleson, MD‡, Jessica Morrison, MD** and Sage Wexner, MD‡^^

DOI: https://doi.org/10.21980/J8NS8F Issue 6:4[mrp_rating_result]
After training on the Zipperator, learners will be able to: 1) demonstrate at least two techniques for zipper release and describe how methods would extrapolate to a real patient; 2) verbalize increased comfort with the diagnosis of zipper entrapment; and 3) present a plan of care for this low-volume, high-anxiety presentation.
ProceduresInnovationsUrology

Two-Screen Virtual Board Game Didactic for Teaching Wilderness and Environmental Medicine Topics to Emergency Medicine Residents

Amy L Briggs, MD*, Robert Katzer MD, MBA*, Isabel Algaze Gonzalez, MD* and Megan Boysen-Osborn, MD, MPHE*

DOI: https://doi.org/10.21980/J8J343Issue 6:4[mrp_rating_result]
By the end of this didactic, the learner will: 1) describe the basics of the presentation of each topic listed above; 2) recall the basics of management of each topic listed above; and 3) improve learners’ preparedness for the Emergency Medicine Inservice Exam and Written Board Examination
LecturesWilderness

Working with Senior Residents: How to get past “You’re doing great!”

Caitlin Schrepel, MD*, Douglas Franzen, MD, MEd* and Jamie R Shandro, MD, MPH*

DOI: https://doi.org/10.21980/J8D93J Issue 6:4[mrp_rating_result]
ABSTRACT: Audience: This content is intended for emergency medicine faculty. Introduction: Faculty at our institution noted that it can be easy to identify and address the knowledge gaps of junior learners. However, they often find different skills are needed when precepting senior residents, a sentiment shared by faculty at other institutions.1 To foster the skills needed for lifelong learning and
Faculty DevelopmentLectures

Small-Scale High-Fidelity Simulation for Mass Casualty Incident Readiness

Seanne Facho, MD*, Andrea Weiers, MD*, Amber Jones, MD*, Sage Wexner, MD* and Jessie Nelson, MD^

DOI: https://doi.org/10.21980/J84S8S Issue 6:4[mrp_rating_result]
The learners will (1) recognize state of mass casualty exercise as evidenced by verbalization or triaging by START (Simple Triage and Rapid Treatment) criteria, (2) triage several patients, including critically ill or peri-arrest acuities, according to START criteria, (3) recognize the need to limit care based on available resources, as evidenced by verbal orders or communication of priorities to team, and (4) limit emergency resuscitation, given limited resources, by only providing treatments and employing diagnostics that do not deplete limited time, staffing, and space inappropriately.
EMSSimulation