Procedures

A Man with Sore Throat—A Case Report

Nathan Mercado, BS^*, Sawyer Schuljak, MD^{^}, Daniel Ng, MD^{*^}, Curtis Knight, MD^{*^}, Allison Woodall, MD^{*^}and John Costumbrado, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J8MH0B Issue 8:2 No ratings yet.

Video laryngoscopy of the upper airway was performed two days after initial burn injury. The images obtained demonstrated laryngeal edema and inflammation near the epiglottis. The dot identifies the epiglottis and the asterix identifies the area of moderate thermal burns. Imaging also demonstrated adequate patency of airway and ruled out the need for intubation at that time.

Visual EM ENT Procedures

High-Efficiency Ultrasound-Guided Regional Nerve Block Workshop for Emergency Medicine Residents

Brandon Yonel, BS^*, Eunice Kwak, BS^* and Mohamad Moussa, MD, RDMS^*

DOI: https://doi.org/10.21980/J84P8R Issue 7:3 No ratings yet.

The objective of this workshop is to provide emergency medicine residents the confidence and skill sets needed to effectively perform five commonly used UGRNBs for conditions encountered in the emergency department. Through this one-day, accelerated workshop, residents will be given an opportunity to sharpen their UGRNB technique prior to applying them in the clinical environment. By the end of this workshop, learners will be able to: 1) recognize the clinical situations in which UGRNBs can be utilized and understand the associated risks, 2) list the commonly used local anesthetic medications and their proper dosing in respect to regional nerve blocks, 3) demonstrate proper ultrasound probe positioning and identify relevant anatomical landmarks for each nerve block on both standardized patients and cadavers, 4) describe the common steps involved to perform each nerve block, 5) perform the five UGRNB techniques outlined in this workshop.

Procedures Small Group Learning Ultrasound

Evaluation of ACE-inhibitor Induced Laryngeal Edema Using Fiberoptic Scope: A Case Report

Joya Singh, DO^* and Colin Danko, MD^*

DOI: https://doi.org/10.21980/J83P9T Issue 7:3 No ratings yet.

Physical exam was initially significant for swelling isolated to the right sided cheek and upper lip. There was no edema to lower lip, uvular swelling, or swelling to the submandibular space. She was speaking full sentences and did not endorse any voice changes. Initial vital signs were as follows: BP 125/77, HR 74, RR 16, and oxygen saturation of 100% on room air. Approximately 40 minutes later, after 125 mg solumedrol intravenous (IV) and 50mg diphenhydramine by mouth, swelling had spread to the entire upper lip and the patient reported spreading to her jaw (Photo 1). Although no jaw or submandibular edema was appreciated on physical exam, a flexible fiberoptic laryngoscope was used to evaluate the patient’s airways given worsening symptoms. Viscous lidocaine was applied intranasally five minutes prior to the procedure. The patient was positioned in a seated position on the stretcher. A flexible fiberoptic laryngoscope was then inserted through the nares and advanced slowly. Laryngoscopy showed diffuse edema of the epiglottis, arytenoids, and ventricular folds (see photos 2-4). Vital signs and respiratory status remained stable both during and after the procedure.

ENT Procedures Visual EM

Peritonsillar Abscess Simulator: A Low-Cost, High-Fidelity Trainer

Chad R Keller, DO^*, Ivanna Nebor, MD^*, David Choi, MD, FRCSC^*, Kattia Moreno, MD^* and Yash J Patil, MD, MPH^*

DOI: https://doi.org/10.21980/J85M0B Issue 7:2 No ratings yet.

By the end of this training session, learners will be able to: 1) locate the abscess, 2) perform needle aspiration, and 3) develop dexterity in maneuvering instruments in the small three-dimensional confines of the oral cavity without causing injury to local structures.

Procedures ENT Innovations

The Zipperator! A Novel Model to Simulate Penile Zipper Entrapment

Dale Till, MD^*, Simran Ghuman, BS^{^}, Luke Kim, MS^{^}, Ryan Roleson, MD^‡, Jessica Morrison, MD^** and Sage Wexner, MD^‡^{^^}

DOI: https://doi.org/10.21980/J8NS8F Issue 6:4 No ratings yet.

After training on the Zipperator, learners will be able to: 1) demonstrate at least two techniques for zipper release and describe how methods would extrapolate to a real patient; 2) verbalize increased comfort with the diagnosis of zipper entrapment; and 3) present a plan of care for this low-volume, high-anxiety presentation.

Procedures Innovations Urology

Modified Manikin for Tracheoinnominate Artery Fistula

Emily M Tarver, MD^*, Gina D Jefferson, MD, MPH^{^}, Patrick Parker^‡, Kristina Readman^‡, Susana M Salazar Marocho, BDS, PhD^** and Anna A Lerant, MD, CHSE^‡^{^^}

DOI: https://doi.org/10.21980/J8Z93H Issue 6:3 No ratings yet.

By the end of this educational session, learners will be able to: 1) perform a focused history and physical exam on any patient who presents with bleeding from the tracheostomy site; 2) describe the differential diagnosis of bleeding from a tracheostomy site, including a TIAF; 3) demonstrate the stepwise management of bleeding from a suspected TIAF, including cuff hyperinflation and the Utley Maneuver; 4) verify that definitive airway control via endotracheal intubation is only feasible in the tracheostomy patient when it is clear, upon history and exam, that the patient can be intubated from above; and 5) demonstrate additional critical actions in the management of a patient with a TIAF, including early consultation with otolaryngology and cardiothoracic surgery as well as emergent blood transfusion and activation of a massive transfusion protocol.

Innovations Procedures Respiratory

Tracheoinnominate Artery Fistula

Emily M Tarver, MD^*, Anna A Lerant, MD, CHSE^{^}, Jeffrey D Orledge, MD^*, Benjamin P Stevens, MD^‡, and Gina D Jefferson, MD, MPH, FACS^‡

DOI: https://doi.org/10.21980/J8K05R Issue 6:3 No ratings yet.

By the end of this simulation, learners will be able to: 1) perform a focused history and physical exam on any patient who presents with bleeding from the tracheostomy site, 2) describe the differential diagnosis of bleeding from a tracheostomy site, including a TIAF, 3) demonstrate the stepwise management of bleeding from a suspected TIAF, including cuff hyperinflation and the Utley Maneuver, 4) verify that definitive airway control via endotracheal intubation is only feasible in the tracheostomy patient when it is clear, upon history and exam, that the patient can be intubated from above, 5) demonstrate additional critical actions in the management of a patient with a TIAF, including early consultation with otolaryngology and cardiothoracic surgery as well as emergent blood transfusion and activation of a massive transfusion protocol.

Procedures Respiratory Simulation

A Low-Cost Facial and Dental Nerve Regional Anesthesia Task Trainer

Andrew Eyre, MD, MSHPed^{*^} and Valerie Dobiesz, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J8RP9Q Issue 6:2 No ratings yet.

By the end of this educational session, learners should be able to: 1) describe and identify relevant anatomy for supra-orbital, infra-orbital, mental, and inferior alveolar nerves and 2) successfully demonstrate supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks using a partial task trainer.

Procedures ENT Innovations

An Ultrasound-Guided Regional Anesthesia Elective for Emergency Medicine Residents

Ryan V Tucker, MD^*, Robert Huang, MD^*, William J Peterson, MD^*, Brendan W Munzer, MD^* and Molly Thiessen, MD^{^}

DOI: https://doi.org/10.21980/J8TP9B Issue 6:1 No ratings yet.

ABSTRACT: Audience: This ultrasound-guided regional anesthesia elective is designed for emergency medicine residents. Length of Curriculum: The proposed length of this curriculum is over one week. Introduction: Ultrasound-guided regional anesthesia (UGRA) is a useful tool in the emergency department (ED) for managing painful conditions, and many programs have identified that these are useful skills for emergency providers; however, only about

Procedures Curricula Ultrasound

Design and Implementation of a Low-Cost Priapism Reduction Task Trainer

Andrew Eyre, MD, MSHPed^{*^} and Valerie Dobiesz, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J8K64F Issue 6:1 No ratings yet.

By the end of this educational session, learners should be able to 1) Verbalize the difference between low-flow and high-flow priapism 2) Describe the landmarks for a penile ring block and cavernosal aspiration/injection 3) Demonstrate the appropriate technique for performing a penile ring block, cavernosal aspiration, and cavernosal injection.

Innovations Procedures Urology