Cardiology/Vascular

A Low-Cost, Reusable Ultrasound Pericardiocentesis Simulation Model

Jonathan dela Cruz, MD^*, Tyler Fulks, MD^*, Mark Baker, MD^*, Jason Kegg, MD^*, Richard Austin, MD^*, Jimmy Jain, MD^*, Michael Boehler, MS^*, Sharon Kim, PhD^{^}, and Cassie Jaeger, PhD^{^}

DOI: https://doi.org/10.21980/J8TD1J Issue 4:4 No ratings yet.

Through the use of this model and skill session, learners will be able to: 1) discuss the indications, contraindications, and complications associated with ultrasound guided pericardiocentesis; 2) demonstrate an ability to obtain subxiphoid and parasternal long views of the heart; 3) demonstrate an ability to identify pericardial fluid in these two views; and 4) demonstrate proper probe and needle placement to successfully perform an ultrasound guided pericardiocentesis in these two views.

Henoch-Schönlein Purpura in the Adult

Ivan Virovets, DO^* and Danielle Biggs, MD^*

DOI: https://doi.org/10.21980/J8QH08 Issue 5:1 No ratings yet.

The images show a raised, palpable, purpuric rash on the lower extremities, surrounded by a mild, 1+ non-pitting edema. Several of the lesions are exfoliated with serous discharge. There is no surrounding erythema, fluctuance, or lymphangitis to suggest cellulitis. There was no tenderness to palpation; however, pruritus was exacerbated on palpation.

Dermatology Cardiology/Vascular Visual EM

ECG Stampede

Benjamin L Cooper, MD^*, Jonathan A Giordano, DO^*, Catherine E Reynolds, MD^*, and Tom T Fadial, MD^*

DOI: https://doi.org/10.21980/J8PP93 Issue 4:4 No ratings yet.

ECG Stampede is a unique educational program comprised of a comprehensive, video-based curriculum with accompanying student and instructor guides. ECG Stampede also features an engaging game accessible via modern browsers and dedicated mobile applications for iOS and Android devices. The gamified model presents learners with a batch of ECGs for which they must assign one of four triage acuities.

Cardiology/Vascular Innovations

Atypical Presentation of Abdominal Aortic Aneurysm

Michael Rohinton Mirza, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J82W6F Issue 4:4 No ratings yet.

Bedside ultrasound revealed an abdominal aortic aneurysm (AAA) with concern for dissection vs thrombus/hematoma due to an area of echogenicity within the lumen of the vessel, since normal blood vessels (including the aorta) have lumens that are uniformly anechoic. An intimal flap concerning for dissection appears as a hyperechoic stripe within the lumen of the vessel on ultrasound, often with a hypoechoic and/or anechoic area appreciated underneath the flap, indicating a separate area of blood flow. If this visualized area is of significant size, color doppler can be used to confirm blood flow on both sides of the flap. Given his bedside ultrasound findings, the patient underwent emergent computed tomography scan and was found to have an enlarged infrarenal abdominal aortic aneurysm, with acute intramural hematoma, extending into bilateral common iliac arteries.

Cardiology/Vascular Visual EM

Thoracic Aortic Aneurysm Measured by Point of Care Ultrasound Suprasternal Notch View

Hamid Ehsani-Nia, DO^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J8Z64V Issue 4:4 No ratings yet.

Point-of-care cardiac echocardiogram demonstrated a dilated ascending aorta (illustrated in red) measuring approximately 4 cm in the parasternal long axis (PLAX). A dilated aortic arch (illustrated in green) also measuring approximately 4 cm was appreciated using the suprasternal notch view (SSNV). A follow-up computed tomography angiogram (CTA) was performed, validating bedside ultrasound measurements.

Uncategorized Cardiology/Vascular Visual EM

A Story About Mesenteric Ischemia

Annahieta Kalantari, DO^*

DOI: https://doi.org/10.21980/J8J33Q Issue 4:3 No ratings yet.

We aim to teach the presentation and management of cardiovascular emergencies through the creation of a flipped classroom design. 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. In doing so, a goal of the curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents.

Abdominal/Gastroenterology Cardiology/Vascular Small Group Learning

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 No ratings yet.

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/Vascular Visual EM

Levamisole Induced, Cocaine Associated Vasculitis

Jaymin Patel, MD^*, Jason Mefford, MD^{^} and John Richards, MD^*

DOI: https://doi.org/10.21980/J8K35S Issue 4:3 No ratings yet.

An asymmetric pattern of palpable purpura with bullae was noted on bilateral lower extremities with smaller patches on bilateral upper extremities. There was no tenderness or crepitus.

Dermatology Cardiology/Vascular Visual EM

Right Atrial Thrombus

Michael Berkenbush, MD, NRP^*, Mei-Yung Chan, MD^* and Amanda Esposito, MD^*

DOI: https://doi.org/10.21980/J8F93V Issue 4:3 No ratings yet.

History of present illness: A 77-year-old male presented to the emergency department with shortness of breath. Symptoms progressively worsened over the last 4-5 days, and on arrival was associated with chest tightness. He denied any medical conditions, smoking, or pertinent family history. He has not seen a primary care physician in “many years.” Upon arrival he was in mild

Cardiology/Vascular Visual EM

Point-of-Care Ultrasound for the Diagnosis of Systolic Heart Failure

Amal Shafi, BS^*, Maili Alexandria Drachman, MD^{^}, Michelle Bui, BS^* and Tushank Chadha, BS^*

DOI: https://doi.org/10.21980/J8HD1R Issue 4:2 No ratings yet.

Bedside ultrasound with the phased array probe was used to obtain a parasternal long axis view which demonstrated poor contractility and a severely decreased ejection fraction (EF). M-mode was placed over the anterior leaflet of the mitral valve to create a tracing depicting both the E-wave of early diastole (green arrow) and the A-wave from the atrial kick (blue arrow). The shortest distance between the septum and the mitral valve on the M-mode tracing gives the patient’s E-Point Septal Separation (EPSS) (pink arrow). EF can be estimated using the formula EF=75.5-2.5 x EPSS (in mm). This patient’s EPSS was measured to be 20mm which estimates that she had an EF of 25.5%.

Visual EM Cardiology/Vascular