Infectious Disease
Empyema
DOI: https://doi.org/10.21980/J86P9RThe chest X-ray shows a large fluid collection in the right lung demonstrated by the opacification that blunts the costophrenic angle on the right side. There is also a meniscus present, which is generally indicative of fluid. Chest computed tomography (CT) demonstrated an infiltrate with a mixture of densities within the same collection, consistent with a loculated effusion and concerning for an empyema.
Pediatric Toxic Shock Syndrome
DOI: https://doi.org/10.21980/J8WK8JBy the end of this simulation session, the learner will be able to: 1) Recognize toxic shock syndrome. 2) Review the importance of a thorough physical exam. 3) Discuss management of toxic shock syndrome, including supportive care and the difference in antibiotic choices for streptococcal and staphylococcal toxic shock syndrome. 4) Appropriately disposition a patient suffering from toxic shock syndrome. 5) Communicate effectively with team members and nursing staff during a resuscitation of a critically ill patient.
Bedside Ultrasound for the Diagnosis of Peritonsillar Abscess
DOI: https://doi.org/10.21980/J8N33NThe first video is an intraoral ultrasound using the high frequency endocavitary probe demonstrating an anechoic fluid collection adjacent to the patient’s enlarged left tonsil. The second video shows real-time ultrasound-guided successful drainage of the PTA.
Subcutaneous Emphysema in Non-Necrotizing Soft Tissue Injury
DOI: https://doi.org/10.21980/J8432MX-Rays of the elbow revealed diffuse striated lucencies throughout the soft tissue, consistent with extensive subcutaneous air throughout the superficial and deep tissues. There was no evidence of a fracture.
Erythema Migrans
DOI: https://doi.org/10.21980/J8QW7QHistory of present illness: A 28-year-old male presented to the emergency department with a chief complaint of two weeks of headache, chills, and numbness in his hands. He reported removing a tick from his upper back approximately two weeks ago, but did not know how long the tick had been embedded. His review of symptoms was otherwise unremarkable. Significant findings:
Chancre of Primary Syphilis
DOI: https://doi.org/10.21980/J83342Physical examination revealed a non-tender, erythematous lesion on the glans penis, two similar adjacent satellite lesions, as well as tender inguinal lymphadenopathy. No penile discharge was noted.
Using Bedside Ultrasound to Rapidly Differentiate Shock
DOI: https://doi.org/10.21980/J8S047A RUSH exam demonstrated hyperdynamic cardiac contractility and collapse of the inferior vena cava (IVC) with probe compression more than 50% suggesting hypovolemia likely secondary to sepsis. Incidentally, Morrison’s pouch revealed a large right renal cyst but no signs of free fluid. A computed tomography of abdomen/pelvis showed a 10.8 x 9.5 cm right renal cyst and left lower lobe pneumonia.
Pediatric Sepsis Case Scenario
DOI: https://doi.org/10.21980/J8MK5XPediatric sepsis is a low-frequency, high impact condition. Nurses and physicians do not see it often, but must recognize and treat children with sepsis efficiently when they present. This makes pediatric sepsis education particularly amenable to simulation scenarios.
Acute Necrotizing Ulcerative Gingivitis (ANUG)
DOI: https://doi.org/10.21980/J8S88HPhysical examination revealed inflamed gingiva, ulceration, and soft tissue necrosis (Image 1) along with mandibular lymphadenopathy (not shown). Given her symptoms, poor oral care, and her immunocompromised state, she was given a diagnosis of Acute Necrotizing Ulcerative Gingivitis (ANUG) or Vincent’s Angina.
Infectious Mononucleosis: Pharyngitis and Morbilliform Rash
DOI: https://doi.org/10.21980/J88C7HHer physical exam was significant for bilateral tonsillar exudates, cervical lymphadenopathy, and a morbilliform rash that included the palms (Figure 1-4). Laboratory testing was significant for white blood cell (WBC) count of 16.5 thous/mcl with an elevation in absolute lymphocytes of > 10 thous/mcl. The monospot and EBV (Epstein-Barr virus) panel were positive.