Renal/Electrolytes
Stopping Fistula Hemorrhage without Bleeding Time and Money – A Low Cost, Low Resource Hemodialysis Fistula Model for Emergency Medicine Residents
DOI: https://doi.org/10.5070/M5.52204After using the task trainer bleeding fistula model, learners will be able to: 1) identify vascular access hemorrhage as an emergency presentation in dialysis patients; 2) execute a stepwise approach to manage a bleeding fistula; 3) demonstrate effective hemorrhage control for a patient with uncontrolled bleeding from their fistula, including choice of appropriate suture material and suturing technique; and 4) discuss pitfalls of hemorrhage control in patients with fistulas, including risks of tourniquet use and complications related to clot formation at the fistula site.
Overlooked and Undernourished: A Case Report of Scurvy Linked to Food Insecurity
DOI: https://doi.org/10.5070/M5.52313Images A and B of the lower extremities show what initially appeared to be a petechial rash with scattered ecchymoses bilaterally, primarily on the right lower leg. On closer examination, images C and D more clearly show these spots to be flat and non-blanching, indicative of follicular hyperkeratosis with perifollicular hemorrhages. The classic coiled or corkscrew hair findings are not seen in these images. Image E shows evidence of palatal ecchymosis, without evidence of gingival bleeding, likely due to loss of dentition. This constellation of exam findings reflects the production of weakened or dysfunctional collagen in connective tissue and vascular structures and is strongly suggestive of the clinical diagnosis of scurvy. Image F shows resolution of the patient’s dermatologic findings after three weeks of treatment.
The EMazing Race: A Novel Gamified Board and Clinical Practice Review for Emergency Medicine Residents
DOI: https://doi.org/10.21980/J8.52075By the end of this 2-hour session, learners will demonstrate their knowledge on the following board-related emergency medicine topics: Ob/GYN – links to 13.7 Complications of Delivery in Core Model of EM 2022, Renal/GU – links to 15.0 Renal and Urogenital Disorders in Core Model of EM 2022 and Splinting – links to 18.1.8.2 Extremity bony trauma, fracture in Core Model of EM 2022.
Metastatic Calcinosis Cutis in the Emergency Department: A Case Report
DOI: https://doi.org/10.21980/J87Q00X-ray imaging was obtained of the left elbow and showed soft tissue calcium deposits. Radiology stated, “massive periarticular calcinosis of renal failure obscures fine osseous detail. Several of the largest calcifications have decompressed since the prior exam and may contribute to the drainage observed clinically. Superimposed infection is not excluded.” X-rays with an asterisk are the comparison images from two months previous to the visit. Areas of decompression are highlighted in blue demonstrating that some of the larger calcified nodules are no longer present.
A Case Report of Calciphylaxis
DOI: https://doi.org/10.21980/J8KW8VOn arrival for this visit, the patient was nontoxic appearing with stable vital signs. The physical exam was notable for deep, ulcerated, bilateral anterior leg wounds with purulent drainage and large areas of eschar (see photographs).
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.
Case Report of a Pelvic Kidney with Ureteral Obstruction from Inguinal Hernia Entrapment and Concurrent Cryptorchid Testis
DOI: https://doi.org/10.21980/J8F345The patient was afebrile with normal lactate and white blood cell count. Initial CT imaging showed an ectopic right pelvic kidney with entrapment of his right ureter within an indirect right inguinal hernia causing severe hydronephrosis (coronal: white arrow). Also discovered was an ovoid hypodensity in the right anterior pelvis consistent with right undescended testis (axial: orange arrow; coronal: green arrow) that was previously unknown to the patient, with a normal left scrotal testis (axial: red arrowhead; coronal: blue arrowhead). Other potential etiologies of the patient’s symptoms could include appendicitis or incarcerated inguinal hernia, though the imaging results and absence of systemic inflammatory response syndrome made these causes less likely.
Case Report of Unusual Facial Swelling in an 8-Month-Old
DOI: https://doi.org/10.21980/J8M06FFacial ultrasound revealed local inflammatory changes such as increased echogenicity and heterogeneity in the soft tissues of the right cheek, suggestive of soft tissue edema. There was evidence of a prominent right parotid gland with increased heterogeneity suggestive of a traumatic injury. Additionally, facial ultrasound demonstrated a 6mm ill-defined anechoic collection within the right cheek without increased doppler flow (green arrow), thought to represent a focal area of edema instead of an abscess.