Posts by JETem

Emergency Medicine Curriculum Utilizing the Flipped Classroom Method: Infectious Disease and Immunology

Benjamin Ostro, MD*, Andrew King, MD*, Laura Branditz, MD*, Daniel R Martin, MD, MBA*, Daniel Bachmann, MD*, Ashish Panchal, MD, PhD* and Michael Barrie, MD*

DOI: https://doi.org/10.21980/J8DD1T Issue 4:3[mrp_rating_result]
We aim to teach the presentation and management of infectious disease and immunological emergencies through the creation of a flipped classroom design. The topics include sepsis, sexually transmitted infections (STIs), tropical diseases, angioedema and anaphylaxis, transplant-related emergencies, and collagen vascular diseases. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. The goal of our curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents.
Infectious DiseaseCurriculum
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Point-Of-Care Ultrasound for the Diagnosis of Extensor Tenosynovitis

James A Frank, MD*, Joshua Lupton, MD* and Bryson Hicks, MD*

DOI: https://doi.org/10.21980/J8Q050Issue 4:3[mrp_rating_result]
Point-of-care ultrasound of the dorsal aspect of the left hand reveals a heterogenous hypoechoic fluid collection surrounding the extensor tendons (axial view) within the retinaculum consistent with edema. Longitudinal view shows anechoic fluid within the tenosynovium which is located between the anisotropic extensor tendon and linear hyperechoic synovial sheath. Longitudinal view also shows some cobblestoning, or tissue edema, superficial to the anisotropic extensor tendon. The patient’s contralateral right dorsal hand was scanned in a longitudinal view and shows no cobblestoning or hypoechoic fluid under the synovial sheath. The patient was diagnosed with tenosynovitis, and started on intravenous antibiotics.
OrthopedicsInfectious DiseaseUltrasoundVisual EM
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Point-of-care Ultrasound in the Diagnosis and Monitoring of Bladder Hematoma vs. Hemorrhage

Esther Kim, BS* and Shadi Lahham, MD, MS*

DOI: https://doi.org/10.21980/J8092FIssue 4:3[mrp_rating_result]
Bladder POCUS demonstrated 500mL of post void residual fluid, indicative of retention. Half of the volume is hyperechoic (red circle); this is likely the bladder wall hematoma. Could also consider sonographic artifact, bladder mass, or cystitis.1-2
GenitourinaryUltrasoundVisual EM
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Asymptomatic CT Iodinated Contrast Extravasation of the Upper Extremity

Eric Liao, MD* and John Costumbrado, MD, MPH*

DOI: https://doi.org/10.21980/J8VK87 Issue 4:3[mrp_rating_result]
The two radiographs demonstrate extravasation of radiopaque iodinated contrast in the lower left upper extremity with most seen in the left antecubital fossa and left proximal forearm. Extravasation is seen in the subcutaneous and subfascial tissue.
Visual EMOrthopedics
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Oral Herpes Zoster

Daniel Polvino, MD*, Grant Wei, MD* and Christopher Bryczkowski, MD*

DOI: https://doi.org/10.21980/J8QS69Issue 4:3[mrp_rating_result]
Physical exam findings revealed vesicular lesions on the lip, hard and soft palates which did not cross the midline. The lesions appeared in the distribution of the maxillary branch (V2) of the trigeminal nerve, consistent with herpes zoster.
DermatologyInfectious DiseaseVisual EM
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Ruptured AAA Presenting with Unresponsiveness and Cardiac Arrest

Lana S Shaker, MD*, Michael W Ullo, MD* and Aislinn Black, DO, MPH*

DOI: https://doi.org/10.21980/J8M34QIssue 4:3[mrp_rating_result]
Axial CT images from the CT chest, abdomen and pelvis revealed a large infra-renal abdominal aortic aneurysm measuring 7.3 x 8.2 x 10 cm with extensive mural thrombus (single white arrow) that has ruptured, with active extravasation (black arrow) of contrast into the aneurysm sac and retroperitoneum with large right retroperitoneal hematoma (multiple white arrows).
Cardiology/VascularVisual EM
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Spontaneous Intracranial Hemorrhage in Severe Hemophilia A: A Rare Cause of Seizure in a Young Child

Sharon Kook Won, MD* and Andrea T Cruz, MD, MPH*

DOI: https://doi.org/10.21980/J8G91D Issue 4:3[mrp_rating_result]
A computed tomography (CT) scan of the head without contrast was obtained out of concern for intracranial pathology due to the patient’s young age and the witnessed focal seizure.  The CT showed a 4.2 x 1.2 x 1.5 cm acute extra-axial intracranial right frontoparietal hemorrhage favoring epidural over subdural hemorrhage given its lenticular shape. There was no underlying fracture, herniation or midline shift identified.
Hematology/OncologyNeurologyVisual EM
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Open Fracture of the Patella

Zara Khan, BS*, Devan Pandya, MD^ and John Costumbrado, MD, MPH^

DOI: https://doi.org/10.21980/J8BK9Z Issue 4:3[mrp_rating_result]
X-ray of the right knee showed evidence of an acute comminuted fracture of the patella (red arrows) with a suprapatellar joint effusion with gas (blue arrow). There was no evidence of joint dislocation or other osseous lesions.
OrthopedicsVisual EM