Infectious Disease
Bridging Hospital Resource Variability: Adapting the Escape Room to Integrate Procedure Teaching for Emergency Medicine Trainees in India
DOI: https://doi.org/10.21980/J8CK98By the end of the escape room, learners should be able to: 1) describe the mechanism of action of antiretroviral therapies available in India, 2) prescribe initial antiretroviral therapy to a patient presenting to the emergency department with a new diagnosis of HIV, 3) develop a differential diagnosis for a patient with HIV presenting to the ED with chest pain, 4) identify common dermatologic manifestations of opportunistic infections in patients with HIV, 5) identify computerized tomography scan and lumbar puncture features for central nervous system infections seen in patients with Acquired Immunodeficiency Syndrome (AIDS), 6) identify red flag features and appropriate workup for a patient with HIV presenting with a headache to the ED, 7) interpret images obtained during a Rapid Ultrasound for Shock and Hemorrhage (RUSH) exam, 8) identify cardiac tamponade and perform a pericardiocentesis, and 9) communicate and collaborate as a team to manage a complex, unstable patient with HIV in the ED.
A Man With Chest Pain After An Assault – A Case Report
DOI: https://doi.org/10.21980/J8J93SOn exam, we found a suspected chest wall abscess with surrounding erythema (blue arrow). The patient underwent CT of the chest which showed a comminuted displaced midsternal fracture (yellow arrow) with moderate fluid and air anteriorly (red arrow), consistent with an abscess. His laboratory results had no significant abnormalities.
Septic Abortion Complicated by Disseminated Intravascular Coagulation
DOI: https://doi.org/10.21980/J8GH1GAt the conclusion of the simulation session, learners will be able to: 1) Obtain a relevant focused history including pregnancy history, medication use, and past medical history. 2) Develop a differential for fever and vaginal bleeding in a pregnant patient. 3) Discuss management of septic abortion, including empiric broad-spectrum antibiotics and obstetric consultation for source control with dilation and curettage (D&C). 4) Discuss expected laboratory findings of disseminated intravascular coagulation (DIC). 5) Discuss management of DIC, including identification of underlying etiology and supportive resuscitation with blood products. 6) Review the components of blood products. 7) Identify appropriate disposition of the patient to the intensive care unit (ICU).
Septic Arthritis of the Acromioclavicular Joint: A Case Report
DOI: https://doi.org/10.21980/J8VP9NMagnetic resonance imaging (MRI) with contrast was obtained of the shoulder and ankle, and results from both scans showed findings consistent with septic arthritis complicated by intraarticular abscesses. The MRI of the patient’s left acromioclavicular joint is shown as both a T1-weighted sequence in sagittal view and T2-weighted sequence in coronal view. The images show effusion (the dark fluid denoted by the red arrow) with an adjacent fluid collection (blue arrow). A T2-weighted MRI in coronal view of the patient’s right ankle showing multiple effusions (green arrows) and a fluid collection along the medial tibial cortex and subcutaneous tissues (yellow arrow).
A Case Report of Invasive Mucormycosis in a COVID-19 Positive and Newly-Diagnosed Diabetic Patient
DOI: https://doi.org/10.21980/J81M1GOn physical exam, when the patient was asked to try and look to her right, the right eye failed to move laterally/abduct (blue arrow). Additionally, when asked to look straight ahead, the eye was slightly adducted (red arrow). There was a lack of motion of the right eye in abduction when the patient was asked to look to her right (yellow arrow).
A Patient with Generalized Weakness – A Case Report
DOI: https://doi.org/10.21980/J8593CThe CT of the abdomen and pelvis showed evidence of a large subcapsular rim-enhancing fluid collection with multiple gas and air-fluid levels along the right kidney measuring 8 x 4 cm axially and 11 cm craniocaudally (blue outline) with mass effect on the right renal parenchyma (yellow outline). Another suspected fluid collection adjacent to the upper pole of the right kidney measuring 4 x 3.4 cm was noted (red outline). Bilateral pyelonephritis was suggested without hydronephrosis or nephrolithiasis. The findings suggested complicated pyelonephritis with emphysematous abscess and hematoma formation.
Flipping Tickborne Illnesses with Infographics
DOI: https://doi.org/10.21980/J83H12After participation in this module, learners will be able to 1) list the causative agents for Lyme Disease, Babesiosis, Tularemia, Ehrlichiosis, Anaplasmosis, Tick Paralysis, Rocky Mountain Spotted Fever, and Powassan Virus, 2) identify different clinical features to distinguish the different presentations of tickborne illnesses, and 3) provide the appropriate treatments for each illness.
Case Report of Herpes Zoster Ophthalmicus with Concurrent Parotitis
DOI: https://doi.org/10.21980/J8R93NThe presence of soft tissue stranding about the parotid gland suggested an underlying inflammatory or infectious process of the parotid gland. Cellulitis was considered as a possible diagnosis as well, given the presence of soft tissue stranding in the dermis that is adjacent to the parotid gland. Fortunately, no enhancement was seen in local muscles, fascia, or bones to suggest a myositis, fasciitis, or osteomyelitis. By using the anatomy of the patient and understanding the changes that occur on CT when inflammation is present, the appropriate depth and location of infection can be made, allowing for appropriate treatment regimens.
The Continued Rise of Syphilis: A Case Report to Aid in Identification of the Great Imitator
DOI: https://doi.org/10.21980/J8R93NImages taken of the bilateral palmar skin lesions at our institution showed multi-centimeter, well-demarcated, friable, verrucous, crusted plaques with overlying fine yellow crust. Lesions such as these are suspicious for syphilitic gummas seen with cutaneous tertiary syphilis.
A Case of Community-Acquired Tuberculosis in an Infant Presenting with Pneumonia Refractory to Antibiotic Therapy
DOI: https://doi.org/10.21980/J8X07MChest radiographs during the initial presentation at seven weeks of life demonstrated right lower lobe (RLL) air space opacity on both PA and lateral views, compatible with pneumonia (referenced by yellow and green arrows, respectively). Repeat chest radiograph performed 12 days after the initial imaging revealed persistent right lower lobe opacity and right hilar fullness, seen as an opacified projection off of the mediastinal border as compared with the prior image, concerning for lymphadenopathy (designated by the aqua arrow). On the third presentation, computed tomography (CT) of the chest with intravenous contrast found persistent right lower lobe consolidation, innumerable 2-3 mm nodules, and surrounding ground glass opacities. This is best visualized as scattered areas of hyperdensity in the lung parenchyma. Axial images confirmed the presence of right hilar as well as subcarinal lymphadenopathy (indicated by white and pink arrows, respectively). Magnetic resonance imaging (MRI) of the brain with IV contrast was performed which showed a punctate focus of enhancement in the left precentral sulcus compatible with a tuberculoma (denoted with red arrow).