Infectious Disease

Improving Emergency Department Airway Preparedness in the Era of COVID-19: An Interprofessional, In Situ Simulation

Keiran J Warner, MD^*, Ashley C Rider, MD^*, James Marvel, MD^*, Michael A Gisondi, MD^*, Kimberly Schertzer, MD^* and Kelly N Roszczynialski, MD, MS^*

DOI: https://doi.org/10.21980/J8V06M Issue 5:3 No ratings yet.

At the conclusion of the simulation session, learners will be able to: 1) Understand the need to notify team members of a planned COVID intubation including: physician, respiratory therapist, pharmacist, nurse(s), and ED technician. 2) Distinguish between in-room and out-of-room personnel during high-risk aerosolizing procedures. 3) Distinguish between in-room and out-of-room equipment during high-risk aerosolizing procedures to minimize contamination. 4) Appropriately select oxygenation therapies and avoid high-risk aerosolizing procedures. 5) Manage high risk scenarios such as hypotension or failed intubation and be prepared to give push-dose vasoactive medications or place a rescue device such as an I-gel®.

A Case Report on Miliary Tuberculosis in Acute Immune Reconstitution Inflammatory Syndrome

Erica Concors, MD^*, Hamid Ehsani-Nia, DO^* and Michael Mirza, MD^*

DOI: https://doi.org/10.21980/J81H02 Issue 5:3 No ratings yet.

A portable single-view radiograph of the chest was obtained upon the patient’s arrival to the ED resuscitation bay that showed diffuse reticulonodular airspace opacities (red arrows) seen throughout the bilateral lungs, concerning for disseminated pulmonary tuberculosis. Subsequently, a computed tomography (CT) angiography of the chest was obtained which again demonstrates this diffuse reticulonodular airspace opacity pattern (red arrows).

Infectious Disease Respiratory Visual EM

Necrotizing Fasciitis

Rishan Desta, MD^* and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J84M1D Issue 5:2 No ratings yet.

At the conclusion of the simulation session, learners will be able to: 1) Describe the spectrum of clinical presentations of necrotizing fasciitis. 2) Identify the microbial etiology of necrotizing fasciitis. 3) Describe the empiric antibiotics appropriate for necrotizing fasciitis. 4) Describe benefits and limitations of various imaging studies when working up necrotizing fasciitis.

Infectious Disease Simulation

Primary Measles Encephalitis

Milap Mehta, MD^*, Maegan Reynolds, MD^{^} and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J80S75 Issue 5:2 No ratings yet.

At the conclusion of the simulation session, learners will be able to: 1) Obtain a relevant focused history, including immunization status, associated symptoms, sick contacts, and travel history. 2) Develop a differential for fever, rash, and altered mental status in a pediatric patient. 3) Discuss management of primary measles encephalitis, including empiric broad spectrum antibiotics and antiviral treatment. 4) Discuss appropriate disposition of the patient from pediatric emergency departments, community hospitals, and freestanding emergency departments, including appropriate time to call for transfer and the appropriate time to transfer this patient during emergency department (ED)workup. 5) Review types of isolation and indications for each.

Infectious Disease Neurology Simulation

Fitz Hugh Curtis Case Report

Savannah Loehr, BS^* and Cindy Bitter, MD, MPH, MA^{^}

DOI: https://doi.org/10.21980/J82K9G Issue 5:2 No ratings yet.

A sagittal view from computed tomography (CT) of the abdomen and pelvis demonstrated fat stranding beneath the inferior margin of the liver (outlined in red). The axial view showed fat stranding adjacent to the ascending colon without significant colon wall thickening (arrow). Fat stranding can occur as a hazy increased attenuation (brightness) or a more distinct reticular pattern.

Ob/Gyn Infectious Disease Visual EM

Peritonsillar Abscess Model for Ultrasound Diagnosis Using Inexpensive Materials

Mustafa N Rasheed, BS^*, Keel E Coleman, MD^* and Timothy J Fortuna, MD^*

DOI: https://doi.org/10.21980/J86G9P Issue 5:1 No ratings yet.

By the end of this instructional session learners should be able to: 1) identify and discuss the indications, contraindications, and complications associated with peritonsillar abscesses, 2) properly identify and measure a PTA through ultrasound, and 3) competently perform ultrasound-guided peritonsillar abscess drainage on a simulator and remove fluid.

ENT Infectious Disease Innovations Procedures

Spinal Epidural Abscess

Christine T Luo, MD, PhD^* and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J8T938 Issue 5:1 No ratings yet.

After this simulation case, learners will be able to diagnose and manage patients with spinal epidural abscesses. Specifically, learners will be able to: 1) Obtain a detailed history, including past infectious, surgical, procedural and social history to evaluate for epidural abscess risk factors; 2) describe clinical signs and symptoms of spinal epidural abscesses and understand that initial clinical presentations can be variable; 3) perform a focused neurological exam including evaluation of motor, sensory, reflexes, and rectal tone; 4) order appropriate laboratory testing and imaging modalities for spinal epidural abscess diagnosis, including a post-void bladder residual volume; 5) select appropriate antibiotics for empiric treatment of spinal epidural abscess depending on patient presentation; 6) disposition the patient to appropriate inpatient care.

Infectious Disease Orthopedics Simulation

Case Report: Acute Supraglottitis

Jamie Robin Chu, MD^* and Jonathan G Rogg, MD, MBA^{^}

DOI: https://doi.org/10.21980/J8006V Issue 5:1 No ratings yet.

On arrival, radiographs of the neck soft tissues were obtained, which showed a markedly enlarged epiglottic shadow (red arrow) concerning for epiglottitis. A computed tomography scan of the neck soft tissues with contrast was then obtained which revealed edematous mucosal thickening of the oropharynx (blue arrow) and supraglottic larynx (green arrow) including the epiglottis (purple arrow) concerning for acute infectious pharyngitis and supraglottic laryngitis with severe narrowing of the supraglottic laryngeal lumen, as well as associated extensive inflammation and edema of the superficial and deep left neck spaces. The patient’s white blood cell count was elevated to 25.7x109/L with 87% neutrophils. Her rapid strep test was positive. Otolaryngology was consulted and performed a bedside flexible laryngoscopy which showed significant edema of the epiglottis (orange arrow), vocal cords (white arrow), and arytenoids (black arrow), left greater than right. Based on the findings and concern for impending respiratory failure, the patient received an awake fiberoptic intubation by anesthesia at the bedside.

Infectious Disease ENT Visual EM

Emergency Medicine Curriculum Utilizing the Flipped Classroom Method: Infectious Disease and Immunology

Benjamin Ostro, MD^*, Andrew King, MD^*, Laura Branditz, MD^*, Daniel R Martin, MD, MBA^*, Daniel Bachmann, MD^*, Ashish Panchal, MD, PhD^* and Michael Barrie, MD^*

DOI: https://doi.org/10.21980/J8DD1T Issue 4:3 No ratings yet.

We aim to teach the presentation and management of infectious disease and immunological emergencies through the creation of a flipped classroom design. The topics include sepsis, sexually transmitted infections (STIs), tropical diseases, angioedema and anaphylaxis, transplant-related emergencies, and collagen vascular diseases. 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. The goal of our curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents.

Infectious Disease Curriculum

Point-Of-Care Ultrasound for the Diagnosis of Extensor Tenosynovitis

James A Frank, MD^*, Joshua Lupton, MD^* and Bryson Hicks, MD^*

DOI: https://doi.org/10.21980/J8Q050Issue 4:3 No ratings yet.

Point-of-care ultrasound of the dorsal aspect of the left hand reveals a heterogenous hypoechoic fluid collection surrounding the extensor tendons (axial view) within the retinaculum consistent with edema. Longitudinal view shows anechoic fluid within the tenosynovium which is located between the anisotropic extensor tendon and linear hyperechoic synovial sheath. Longitudinal view also shows some cobblestoning, or tissue edema, superficial to the anisotropic extensor tendon. The patient’s contralateral right dorsal hand was scanned in a longitudinal view and shows no cobblestoning or hypoechoic fluid under the synovial sheath. The patient was diagnosed with tenosynovitis, and started on intravenous antibiotics.

Orthopedics Infectious Disease Ultrasound Visual EM