Cardiology/Vascular

Journal Court: A Novel Approach to Incorporate Medicolegal Education into an Emergency Medicine Journal Club

Kevin McGurk, MD^*, Mary Jordan, MD^* and Bradley Davis, DO^*

DOI: https://doi.org/10.21980/J8093TIssue 10:1 No ratings yet.

By the end of this exercise, participants should: 1) identify the four necessary elements for a malpractice claim, 2) understand the basic structure of medical malpractice litigation, and 3) critically analyze medical literature representing diverging viewpoints or conclusions.

Drowning Complicated by Hypothermia

Alexander Close, MD^*and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J8QS7P Issue 10:1 No ratings yet.

At the conclusion of the simulation session, learners will be able to: 1) obtain a relevant focused history, including circumstances of drowning and/or cold exposure; 2) outline different clinical presentations of hypothermia, loosely correlated with core temperature readings; 3) discuss management of hypothermia, including passive external rewarming, active external rewarming, active internal rewarming, and extracorporeal blood rewarming; 4) discuss pathophysiology of drowning; 5) identify appropriate disposition of patients who present after drowning; and 6) identify appropriate disposition of hypothermic patients.

Current Issue Cardiology/Vascular Simulation Wilderness

Wolff A et al. Right atrial thrombosis. Parasternal long US 3 annotated

A Case Report of Right Atrial Thrombosis Complicated by Multiple Pulmonary Emboli: POCUS For the Win!

Andrea Wolff, MD^*, Evan Leibner, MD^* and Jill Gualdoni, MD^{^}

DOI: https://doi.org/10.21980/J8TM07 Issue 10:1 No ratings yet.

Pulmonary POCUS was performed by the ED physician (GE Venue, C1-5-RS 5MHz curvilinear transducer), and lung examination was unremarkable with no pleural effusion, pneumothorax, or infiltrate. Subxiphoid views (GE Venue, 3Sc-RS 4MHz phased-array transducer) were obtained because this patient’s COPD with severe pulmonary hyperexpansion made parasternal and apical 4-chamber views suboptimal. A large thrombus can be seen within the right atrium (movie 1, images 1, 2). This has a serpiginous, rounded appearance and is mobile, appearing to swirl within the right atrium with intermittent extrusion through the tricuspid valve. A pacemaker wire is also visible within the right ventricle as a non-moving, hyperechoic, linear structure with posterior enhancement artifact. Pericardial effusion is not present.

Visual EM Cardiology/Vascular Current Issue Ultrasound

Going in Blind: A Common Scenario in an Uncommon Situation

Ethan Hartman, MD^* and Kimberly Sokol, MD, MS, MACM^*

DOI: https://doi.org/10.21980/J8RS8C Issue 9:4 No ratings yet.

By the end of this simulation, learners will be able to (1) evaluate and treat a patient experiencing myocardial infarction and subsequent cardiac arrest during a power outage, (2) describe the local protocols for managing patient care during a power outage, (3) demonstrate the ability to coordinate a medical team during a simulated power outage in an emergency department with limited resources, (4) manage a cardiac arrest patient by following Advanced Cardiac Life Support (ACLS) protocols for bradycardia and ventricular fibrillation, and (5) justify the urgency of transfer to a certified ST segment elevation myocardial infarction center/cardiac intensive care unit, referencing the recommended 120-minute door-to-balloon time.

Cardiology/Vascular Miscellaneous (stats, etc)Simulation

A Realistic, Low-Cost Simulated Automated Chest Compression Device

Jessica Joyce, BS^*, Elyse Fults, MD^{^}, Julia Rajan, BS^†, Alexandra Plezia, MA^**, Carolyn Clayton, MD^{^} and Sara M Hock, MD^{^}

DOI: https://doi.org/10.21980/J8M63C Issue 9:2 No ratings yet.

By the end of this educational session using a resuscitation trainer or high-fidelity manikin, learners should be able to: 1) recognize appropriate application of simulated ACCD to an ongoing resuscitation case; 2) demonstrate proper positioning of simulated ACCD in manikin model and 3) integrate simulated ACCD to provide compressions appropriately throughout cardiac arrest scenario.

Cardiology/Vascular Innovations Procedures

Electrical Storm/Refractory Ventricular Tachycardia

Ashley R Tarchione, MD^* and Amrita Vempati, MD^{^}

DOI: https://doi.org/10.21980/J8TS80 Issue 9:2 No ratings yet.

By the end of this simulation, learners should be able to: 1) recognize unstable ventricular tachycardia and initiate ACLS protocol, 2) practice dynamic decision making by switching between various ACLS algorithms, 3) create a thoughtful approach for further management of refractory ventricular tachycardia, 4) interpret electrocardiogram (ECG) with ST-segment elevation (STE) and left bundle branch block (LBBB), 5) appropriately disposition the patient and provide care after return of spontaneous circulation (ROSC), 6) navigate a difficult conversation with the patient’s husband when she reveals that the patient’s wishes were to not be resuscitated.

Cardiology/Vascular Simulation

Managing STEMIs without a Catheterization Lab: A Simulated Scenario to Improve Emergency Clinician Recognition and Execution of Thrombolysis in the Setting of Rural STEMI Management

Scott Schoenborn, MD,^{*^} Anthony F Steratore, MD,^{*^} Adam Hoffman, CHSE,^{*^} Thomas C Marshall, MD,^{*^} Erica B Shaver, MD,^{*^} and Christopher S Kiefer, MD^{*^}

DOI: https://doi.org/10.21980/J8K933 Issue 9:2 No ratings yet.

By the end of this simulation, learners will be able to: 1) diagnose ST elevation myocardial infarction accurately and initiate thrombolysis in the rural setting without timely access to cardiac catheterization; 2) engage the simulated patient in a shared decision-making conversation, clearly outlying the benefits and risks of thrombolysis; 3) identify the indications and contraindications for thrombolysis in ST elevation myocardial infarction; 4) arrange for transfer to a tertiary care center following completion of thrombolysis.

Cardiology/Vascular Simulation

Hypertensive Emergency Team-Based Learning

Khoa Nguyen, MD^*, Jordan Gawon Shin^{^}, and Jessica Andrusaitis, MD, MS^*

DOI: https://doi.org/10.21980/J8BP90 Issue 9:2 No ratings yet.

By the end of this TBL session, learners should be able to: 1) define features of asymptomatic hypertension versus hypertensive emergency, 2) discuss which patients with elevated blood pressure may require further diagnostic workup and intervention, 3) identify a differential diagnosis for patients presenting with elevated blood pressures, 4) recognize the features of different types of end-organ damage, 5) review an algorithm for the pharmacologic management of hypertensive emergencies, 6) indicate dosing and routes of various anti-hypertensive medications, 7) choose the appropriate treatment for a patient who is hypertensive and presenting with flash pulmonary edema, 8) identify an aortic dissection on computed tomography (CT), 9) choose the appropriate treatment for a patient who is hypertensive and presenting with an aortic dissection, 10) identify intracranial hemorrhage on CT, 11) choose the appropriate treatment for a patient who is hypertensive and presenting with an intracranial hemorrhage, and 12) describe the intervention for warfarin reversal.

Cardiology/Vascular Team Based Learning (TBL)

Calcium Channel Blocker Overdose

Jessica G Andrusaitis, MD, MS^* and Alan Givertz, MD^{^}

DOI: https://doi.org/10.21980/J8CQ07Issue 9:1 No ratings yet.

At the end of this oral board session, examinees will: (1) demonstrate ability to evaluate a patient with undifferentiated shock with bradycardia and discuss the differential diagnosis, (2) recognize the signs and symptoms of calcium channel blocker overdose, (3) demonstrate ability to manage treatment of a patient with calcium channel overdose.

Cardiology/Vascular Oral Boards Toxicology

Ventricular Tachycardia

Rohit Menon, MD^*, Geremiha Emerson, MD^* and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J8KD2R Issue 8:4 No ratings yet.

At the conclusion of the simulation session, learners will be able to: 1) identify the different etiologies of VT, including structural heart disease, acute ischemia, and acquired or congenital QT syndrome; 2) describe confounding factors of VT, such as electrolyte abnormalities and sympathetic surge; 3) describe how to troubleshoot an unsuccessful synchronized cardioversion, including checking equipment connections, increasing delivered energy, and changing pad placement; 4) compare and contrast treatments of VT based on suspected underlying etiology; 5) describe reasons to activate the cardiac catheterization lab other than occlusive myocardial infarction; and 6) identify appropriate disposition of the patient to the cardiac catheterization lab.

Cardiology/Vascular Simulation