Posts by JETem

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A Case Report on Detecting Porcelain Gallbladder form Wall-Echo-Shadow Sign on Point-of-Care Ultrasound

Fares Al-Khouja, MS*, Proma Mazumder^, John Moeller, MD† and Shadi Lahham, MD, MS†

DOI: https://doi.org/10.21980/J8164G Issue 6:2[mrp_rating_result]
Point-of-care ultrasound (POCUS) was performed by the emergency physician. Gallbladder ultrasound (US) should be performed using a curvilinear probe. If the patient’s body habitus does not allow for the use of a curvilinear probe, a phased array probe may be used. To find the gallbladder with ultrasonography, two approaches are commonly used. Many physicians prefer the “subcostal sweep” in which the probe is placed on the xiphoid process in a sagittal plane and swept along the inferior costal margin until the gallbladder is visualized. If this does not adequately locate the gallbladder, the “X minus 7” approach may be used. In this approach, the probe is placed on the xiphoid (X) process in a transverse view and moved 7 centimeters (minus 7) to the patient’s right. This technique is useful for patients with a larger body habitus. If the gallbladder is still not visualized, placing the patient in left lateral decubitus position or asking them to take a deep breath and hold may help the ultrasonographer locate the gallbladder. The US revealed mild hepatic biliary duct dilation with cholelithiasis and sludge, but no additional evidence to suggest cholecystitis. The US image showed a dilated common bile duct at 0.94 cm and calcifications. Visualization of the gallbladder wall is essential in differentiating between a positive wall-echo-shadow (WES) sign and a porcelain gallbladder. While a hypoechoic gallbladder wall is indicative of a WES sign, a hyperechoic wall layer will indicate a calcified gallbladder wall, suggesting a porcelain gallbladder. In image 1, the hyperechoic gallbladder wall can be visualized (white arrow), suggesting the presence of porcelain gallbladder and distinguishing it from a positive WES sign.
Abdominal/GastroenterologyUltrasoundVisual EM
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Auricular Perichondritis after a “High Ear Piercing:” A Case Report

Diego Federico Craik Tobar, MD* and Adeola Adekunbi Kosoko, MD*

DOI: https://doi.org/10.21980/J8WH16 Issue 6:2[mrp_rating_result]
On physical examination, there was erythema, swelling, warmth, and general exquisite tenderness of the superior aspect of the left pinna (the outer ear) but excluding the ear canal, lobe, tragus, and crus. There was no facial involvement. There was no fluctuance about the ear and no drainage of fluid. The preauricular lymph nodes were enlarged and tender, but the anterior cervical lymph nodes were not tender. There was no mastoid tenderness, protrusion of the ear, or interruption of the postauricular crease.
ENTInfectious DiseaseVisual EM

An Ultrasound-Guided Regional Anesthesia Elective for Emergency Medicine Residents

Ryan V Tucker, MD*, Robert Huang, MD*, William J Peterson, MD*, Brendan W Munzer, MD* and Molly Thiessen, MD^

DOI: https://doi.org/10.21980/J8TP9B Issue 6:1[mrp_rating_result]
ABSTRACT: Audience: This ultrasound-guided regional anesthesia elective is designed for emergency medicine residents. Length of Curriculum: The proposed length of this curriculum is over one week. Introduction: Ultrasound-guided regional anesthesia (UGRA) is a useful tool in the emergency department (ED) for managing painful conditions, and many programs have identified that these are useful skills for emergency providers; however, only about
ProceduresCurriculaUltrasound

Case Based Questions For Teaching EM Pharmacotherapy

David Eichenberger, MD*, Gary Pollock, MD*, Luke Huber, MD*, Aaron Brown, MD* and David Zimmerman, PharmD^

DOI: https://doi.org/10.21980/J8PW61 Issue 6:1[mrp_rating_result]
Our goals were to teach residents clinical applications of EM pharmacotherapy including drug selection and consideration of alternatives, interactions, and adverse effects, as well as to prepare them for pharmacotherapy questions on board examinations.
PharmacologyCurricula

Design and Implementation of a Low-Cost Priapism Reduction Task Trainer

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

DOI: https://doi.org/10.21980/J8K64F Issue 6:1[mrp_rating_result]
By the end of this educational session, learners should be able to 1) Verbalize the difference between low-flow and high-flow priapism 2) Describe the landmarks for a penile ring block and cavernosal aspiration/injection 3) Demonstrate the appropriate technique for performing a penile ring block, cavernosal aspiration, and cavernosal injection.
InnovationsProceduresUrology

Botulism

John Thompson, MD*, Zane Horowitz, MD* and Adam Blumenberg, MD*^

DOI: https://doi.org/10.21980/J8FD0R Issue 6:1[mrp_rating_result]
By the end of this simulation learners will be able to: 1) develop a differential for descending paralysis and recognize the signs and symptoms of botulism; 2) understand the importance of consulting public health authorities to obtain botulinum antitoxin in a timely fashion; 3) recognize that botulism will progress during the time period antitoxin is obtained. Early indications of respiratory compromise are expected to worsen during this time window. Secondary learning objectives include: 4) employ advanced evaluation for neurogenic respiratory failure such as physical examination, negative inspiratory force (NIF), forced vital capacity (FVC), and partial pressure of carbon dioxide (pCO2), 5) discuss and review the pathophysiology of botulism, 6) discuss the epidemiology of botulism.
ToxicologyNeurologySimulation

HIT-Heparin Induced Thrombocytopenia Simulation Case

Shaza Aouthmany, MD*, Alyssa Siano, BS*, De ante’ Russ, MD*, and Mark Bustillo, DO*

DOI: https://doi.org/10.21980/J89Q0M Issue 6:1[mrp_rating_result]
After completing this simulated case, participants will be able to: 1) Obtain a detailed history that includes recent medications, medical, surgical, and social history to evaluate for HIT risk factors, 2) perform an adequate neurovascular exam including evaluation of motor function, sensation, skin color, pulses, and capillary refill, 3) order appropriate laboratory testing and imaging for diagnosis of thrombocytopenia and arterial occlusion, including bed side doppler or ultrasound, 4) discuss and recognize the symptoms of HIT and the contraindications of platelet and heparin administration in the emergency department, 5) avoid administration of heparin in the emergency department setting and recognize that platelets may worsen thrombus formation and lead to limb amputation, 6) select appropriate medications for treatment and determine appropriate disposition for a patient presenting with HIT, 7) demonstrate interpersonal communication with patient and family, 8) recognize that HIT with thrombosis is a potential complication in hospitalized patients and outpatient settings and is associated with high mortality rates. 
Hematology/OncologySimulation

Posterior Reversible Encephalopathy Syndrome (PRES)

William Ciozda, MD* and Adeola Adekunbi Kosoko, MD*

DOI: https://doi.org/10.21980/J85W6C Issue 6:1[mrp_rating_result]
By the end of the simulation, the learner will be able to: 1) manage an acute seizure 2) discuss imaging modalities to diagnose PRES 3) discuss medical management of PRES.
NeurologySimulation