Posts by JETem

Altered Mental Status: Epilepsy, Acute Psychosis, Intoxication or Delirium Tremens?

Shannon Toohey, MD, MA*

DOI: https://doi.org/10.21980/J8G592Issue 1:2[mrp_rating_result]
At the end of this simulation session the learner will: 1) Recognize signs and symptoms of delirium tremens (DT); 2) promptly treat DT with benzodiazepines and supportive care; 3) appropriately manage a patient with DT and effectively communicate with nurses and other team members during the resuscitation of an acutely ill patient.
ToxicologySimulation
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Hill-Sachs Deformity

Jessa Baker* and Shannon Toohey, MD*

DOI: https://doi.org/10.21980/J8Z59DIssue 1:2[mrp_rating_result]
In the post-reduction film, there is a lateral depression in the humeral head (arrow, a Hill-Sachs deformity). A Hill-Sachs deformity is a cortical depression (fracture) in the humeral head that forms as the humeral head hits the glenoid rim during the dislocation.
OrthopedicsVisual EM
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Perforated Duodenal Ulcer

Jessa Baker*, Jonathan Patane, MD* and Carrie Chandwani, MD*

DOI: https://doi.org/10.21980/J8TG64Issue 1:2[mrp_rating_result]
In the chest radiograph, there was obvious free air under the both the right diaphragm (above the liver) and the left diaphragm, consistent with pneumoperitoneum.
Abdominal/GastroenterologyVisual EM
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Trimalleolar Fracture

Christopher Gilani* and Shannon Toohey, MD, MA*

DOI: https://doi.org/10.21980/J8PP46 Issue 1:2[mrp_rating_result]
Anteroposterior (AP), lateral, and oblique x-ray views were obtained. The AP view revealed a displaced spiral fracture of the lateral malleolus (red) and a vertical fracture of the medial malleolus (blue). The lateral view revealed a displaced fracture of the posterior malleolus, tibial plafond (yellow), and the oblique view showed widening of the distal tibiofibular syndesmosis (green). CT scans confirmed trimalleolar fracture, annotated with the same colored lines (red, lateral malleolus; blue, medial malleolus; yellow, posterior malleolus).
OrthopedicsVisual EM
Hyperkalemia ECG JETem 2016

Hyperkalemia on ECG

Bryson Hicks, MD*

DOI: https://doi.org/10.21980/J8K017Issue 1:2[mrp_rating_result]
Initial ECG shows tall, peaked T waves, most prominently in V3 and V4, as well as QRS widening. These findings are consistent with hyperkalemia, which was promptly treated. Follow-up ECG post-treatment shows narrowing of the QRS complexes and normalization of peaked T waves.
Cardiology/VascularVisual EM
Perilunate Dislocation, XRay. JETem 2016

Perilunate Dislocation

John Jiao, MHS* and Shannon Toohey, MD, MA*

DOI: https://doi.org/10.21980/J8F59RIssue 1:2[mrp_rating_result]
In the left lateral wrist x-ray, the lunate is dislocated from the rest of the wrist bones but still articulates with the radius. The capitate does not sit within the distal articulation of the lunate and is displaced dorsally. Additionally, a line drawn through the radius and lunate fails to intersect with the capitate. This is consistent with a perilunate dislocation. This is compared to a lunate dislocation, where the lunate itself is displaced and turned ventrally (spilled teacup) and the proximal aspect does not articulate with the radius.
OrthopedicsVisual EM
Femoral Neck Fracture, AP Xray. JETem 2016

Femoral Neck Fracture

Jonathan Lee* and Shannon Toohey, MD, MA*

DOI: https://doi.org/10.21980/J89G6GIssue 1:2[mrp_rating_result]
In the anteroposterior view bilateral hip x-ray, there is an evident loss of Shenton’s line on the left when compared to the normal right, indicative of a fracture in the left femoral neck. This correlates with findings seen on pelvic CT, which reveals both a subcapital fracture and transcervical fracture. The neck of the femur is displaced superiorly relative to the head of the femur while the head of the femur remains in its anatomical position within the acetabulum.
OrthopedicsVisual EM
Traumatic Aortic Injury. Sag CT 1, Annotated. JETem 2016

Traumatic Aortic Injury

Brianna Miner*, Megan Boysen Osborn, MD, MHPE* and Shannon Toohey, MD, MA*

DOI: https://doi.org/10.21980/J85P4JIssue 1:2[mrp_rating_result]
The initial chest x-ray showed an abnormal superior mediastinal contour (blue line), suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows) compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow). There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows).
TraumaCardiology/VascularVisual EM