Posts by JETem

Guillain-Barrè

Jennifer Yee, DO*, Andrew M King MD* and Geremiha Emerson, MD*

DOI: https://doi.org/10.21980/J8TH06 Issue 3:2[mrp_rating_result]
At the conclusion of the simulation session, learners will be able to: 1) Recognize the clinical signs and symptoms associated with Guillain-Barré syndrome, including muscle weakness and hyporeflexia. 2) Identify abnormal vital signs secondary to dysautonomia. 3) Discuss evaluation for impending respiratory failure, including bedside pulmonary function testing. 4) Discuss the management of Guillain-Barré, including management of dysautonomia and respiratory failure, as well as definitive management with plasmapheresis versus intravenous immunoglobulin. 5) Appropriately disposition the patient to the intensive care unit. 6) Effectively communicate with team members and nursing staff during resuscitation of a critically ill patient
NeurologySimulation

Sepsis Secondary to an Abdominal Wound Infection

Alisa Wray, MD*

DOI: https://doi.org/10.21980/J8PS60 Issue 3:2[mrp_rating_result]
At completion of this case learners should be able to: 1) Recognize and differentiate between systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock. 2) Prepare an appropriate differential diagnosis for a patient with sepsis. 3) Demonstrate appropriate fluid resuscitation and antibiotic therapy for a septic patient. 4) Demonstrate appropriate vasopressor therapy for a septic patient. 5) Understand and apply the Surviving Sepsis Guidelines.
Infectious DiseaseAbdominal/GastroenterologySimulation

Chest Pain with Acute Coronary Syndrome

Alisa Wray, MD*

DOI: https://doi.org/10.21980/J8K04C Issue 3:2[mrp_rating_result]
At the end of this case learners should be able to prepare a differential for patients with chest pain, provide appropriate medications for a patient with chest pain, recognize an ST segment elevation MI, and appropriately disposition a patient with acute myocardial infarction (AMI).
Cardiology/VascularSimulation
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An Unusual Case of Pharyngitis: Herpes Zoster of Cranial Nerves 9, 10, C2, C3 Mimicking a Tumor

Jason Cheng, DO*, Gregory Reinhold, DO* and Rahmon Zuckerman, DO*

DOI: https://doi.org/10.21980/J8B05K Issue 3:2[mrp_rating_result]
On exam, the patient was sitting upright while holding an emesis basin filled with saliva. His voice was noticeably hoarse. Examination of the head and neck revealed vesicular eruptions on the left scalp in the V1 dermatome and on the left mastoid process (Images 1 and 2). Physical exam also shows vesicular eruptions on the left posterior oropharynx that did not cross midline (Image 3).
ENTVisual EM
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Ramsay Hunt Syndrome

John Costumbrado, MD, MPH* and Ryan Brenchley, MD*

DOI: https://doi.org/10.21980/J85S7QIssue 3:2[mrp_rating_result]
Left-sided cranial nerve VII palsy with flattened forehead creases, inability to keep the left eye open, and drooping of the corner of mouth. Vesicular lesions were found in and posterior to the left ear in a unilateral, dermatomal distribution.
ENTVisual EM
Creative Commons images

Retinal Detachment

Adnan Riaz, MD*, Chirag Shah, MD* and Grant Wei, MD*

DOI: https://doi.org/10.21980/J8204QIssue 3:2[mrp_rating_result]
Bedside ocular ultrasound revealed a serpentine, hyperechoic membrane that appeared tethered to the optic disc posteriorly with hyperechoic material underneath. These findings are consistent with retinal detachment (RD) and associated retinal hemorrhage.
OphthalmologyUltrasoundVisual EM
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Necrotizing Soft Tissue Infection

Sahil Aggarwal, BS* and Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J8X92TIssue 3:2[mrp_rating_result]
Computed tomography (CT) of the abdominal and pelvis with intravenous (IV) contrast revealed inflammatory changes, including gas and fluid collections within the ventral abdominal wall extending to the vulva, consistent with a necrotizing soft tissue infection.
Infectious DiseaseVisual EM
Creative Commons images

Spontaneous Pneumomediastinum: Hamman Syndrome

Tushank Chadha, BS* and Ethan Kunstadt, MD*

DOI: https://doi.org/10.21980/J8NS72 Issue 3:2[mrp_rating_result]
The initial CT scans showed extraluminal gas surrounding the distal esophagus as it traversed the posterior mediastinum, concerning for possible distal esophageal perforation that prompted surgery and GI consultations. There was no evidence of a drainable collection or significant fat stranding. The image also showed an intraluminal stent traversing the gastric antrum and gastric pylorus with no indication of obstruction. Circumferential mural thickening of the gastric antrum and body were consistent with the patient’s history of gastric adenocarcinoma. The shotty perigastric lymph nodes with associated fat stranding, along the greater curvature of the distal gastric body suggested local regional nodal metastases and possible peritoneal carcinomatosis. The thoracic CT scans showed extensive pneumomediastinum that tracked into the soft tissues of the neck, which given the history of vomiting also raised concern for esophageal perforation. There was still no evidence of mediastinal abscess or fat stranding. Additionally, a left subclavian vein port catheter, which terminates with tip at the cavoatrial junction of the superior vena cava can also be seen on the image.
RespiratoryVisual EM