Posts by JETem

Placenta Previa

Angela Irene Carrick, DO*

DOI: https://doi.org/10.21980/J8J911 Issue 2:4[mrp_rating_result]
By the end of this oral boards case, the learner will be able to: 1. List the potential causes of vaginal bleeding in pregnancy after 20 weeks including placental abruption, placenta previa and vasa previa. 2. Describe the bedside stabilization and evaluation in a pregnant patient with vaginal bleeding after 20 weeks. a) Stabilize the mother (patient) including placing two large bore intravenous (IV) lines, administer an IV fluid bolus, obtaining complete blood count (CBC), coagulation studies, and type & cross matching blood. b) Transvaginal ultrasound to determine the placental location. c) Sterile speculum examination. A digital or speculum pelvic examination should NOT be performed until a transvaginal ultrasound is performed to determine placental location. The resident should understand that performing a digital or speculum exam in a patient with placenta previa or vasa previa can cause or exacerbate hemorrhage. If these two conditions are not present on ultrasound, then a sterile speculum exam may be performed to further examine the bleeding. 3. Contrast the typical presentation of placenta previa with that of placental abruption. a) Placenta Previa usually causes painless vaginal bleeding. Part of the placenta is located near or over the internal cervical orifice. b) Placental Abruption usually causes painful vaginal bleeding. There is premature separation of the placenta from the uterine lining. 4) Describe the appropriate disposition of a patient with a pregnancy over 20 weeks with vaginal bleeding. After initial workup and stabilization these women are usually admitted for fetal monitoring, observation and consultation by the obstetrician (OB/gyn).
Certifying Exam CasesOb/Gyn

Hemodialysis in the Poisoned Patient

Megan Boysen-Osborn, MD, MHPE* and Jeffrey R Suchard, MD, FACMT*

DOI: https://doi.org/10.21980/J88S68 Issue 2:4[mrp_rating_result]
By the end of this cTBL, the learner will: 1) recognize laboratory abnormalities related to toxic alcohol ingestion; 2) calculate an anion gap and osmolal gap; 3) know the characteristics of drugs that are good candidates for HD; 4) discuss the management of patients with toxic alcohol ingestions; 5) discuss the management of patients with salicylate overdose; 6) know the indications for HD in patients with overdoses of antiepileptic drugs; 7) discuss the management of patients with lithium toxicity.
Team Based Learning (TBL)Renal/ElectrolytesToxicology

Laceration Repair for Emergency Physicians

Alisa Wray, MD* and Shannon Toohey, MD, MAEd*

DOI: https://doi.org/10.21980/J8TP7K Issue 2:4[mrp_rating_result]
By the end of this educational session, the learner will: 1) understand indications and contraindications for suture repair of lacerations, 2) compare when various types of wound repair are appropriate: such as sutures, staples, tissue adhesive and tissue tape, as well as what size of suture material is appropriate depending on the location of the laceration on the body, 3) list the appropriate types and sizes of suture for various locations and types of lacerations, 4) understand the definitions of the three types of wound closure (primary, secondary and delayed primary) and when they are appropriate, 5) understand the basics of local anesthetic including which anesthetic to use and the maximum dose for each, 6) understand when sutures should be removed, 7) list various suturing techniques and their indications, and 8) improve comfort levels in performing various suturing techniques including: simple interrupted, horizontal mattress, vertical mattress, and corner repair. If desired, instructors can individually assess the learner sutures using the attached complete validated suture checklist to show proficiency in these techniques. Please see the brief wrap-up section at the end of the manuscript.
ProceduresTeam Based Learning (TBL)Trauma
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Management of Wolff-Parkinson-White Tachyarrhythmia Presenting as Syncope with Seizure-like Activity

Samuel Kaplan, BS* and Lindsey Spiegelman, MD*

DOI: https://doi.org/10.21980/J8534P Issue 2:4[mrp_rating_result]
At the end of this simulation session the learner will: 1) Recognize clinical history suggestive of cardiogenic syncope, 2) recognize clinical evidence of Wolff-Parkinson-White syndrome, 3) promptly and appropriately treat unstable WPW tachyarrhythmia.
Cardiology/VascularSimulation

Precipitous Birth

Jennifer Yee, DO* and Andrew King, MD*

DOI: https://doi.org/10.21980/J8192R Issue 2:4[mrp_rating_result]
By the end of this simulation session, the learner will be able to: 1) Recognize impending delivery, 2) identify abnormal maternal vital signs and potential associated pathologies (eg: hypertension in preeclampsia), 3) discuss the evaluation and management of postpartum bleeding, 4) discuss the principles of neonatal resuscitation, 5) appropriately disposition the patients, and 6) effectively communicate with team members and nursing staff during resuscitation of a critically ill patient.
Ob/GynPediatricsSimulation

Pediatric Toxic Shock Syndrome

Jennifer Yee, DO* and Andrew King, MD*

DOI: https://doi.org/10.21980/J8WK8J Issue 2:4[mrp_rating_result]
By the end of this simulation session, the learner will be able to: 1) Recognize toxic shock syndrome. 2) Review the importance of a thorough physical exam. 3) Discuss management of toxic shock syndrome, including supportive care and the difference in antibiotic choices for streptococcal and staphylococcal toxic shock syndrome. 4) Appropriately disposition a patient suffering from toxic shock syndrome. 5) Communicate effectively with team members and nursing staff during a resuscitation of a critically ill patient.
Infectious DiseasePediatricsSimulation
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Bedside Ultrasound for the Diagnosis of Peritonsillar Abscess

Harshal Bhakta, BS,* Maili Alvarado, MD^ and Daryn Towle, MD*

DOI: https://doi.org/10.21980/J8N33N Issue 2:4[mrp_rating_result]
The first video is an intraoral ultrasound using the high frequency endocavitary probe demonstrating an anechoic fluid collection adjacent to the patient’s enlarged left tonsil. The second video shows real-time ultrasound-guided successful drainage of the PTA.
UltrasoundENTInfectious DiseaseVisual EM
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Bilateral Hip Dislocation in Unrestrained Driver

Samer Assaf, MD* and Ghadi Ghanem*

DOI: https://doi.org/10.21980/J8HD0C Issue 2:4[mrp_rating_result]
The initial radiograph of the pelvis revealed bilateral hip dislocations. Small bony fragments were noted in the right hip joint, suggestive of an underlying fracture. The sacroiliac joints and the pelvic ring were intact. In the emergency department, bilateral hip reductions were performed using the Captain Morgan technique.1 The post-reduction film showed reduction of the bilateral hip dislocations with extensive comminuted and displaced fractures of the right and left acetabula.
OrthopedicsVisual EM