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Little Patients, Big Tasks – A Pediatric Emergency Medicine Escape Room

Jessica Pelletier, DO*, Ernesto Romo, MD*, Bryan Feinstein, MD*, Charles Smith, MD*, Gina Pellerito, CCNRP^ and Alexander Croft, MD*

DOI: https://doi.org/10.21980/J89W70 Issue 8:4[mrp_rating_result]
By the end of this small group exercise, learners will be able to: 1) demonstrate appropriate dosing of pediatric code and resuscitation medications; 2) recognize normal pediatric vital signs by age; 3) demonstrate appropriate use of formulas to calculate pediatric equipment sizes and insertion depths; 4) recognize classic pediatric murmurs; 5) appropriately diagnose congenital cardiac conditions; 6) recognize abnormal pediatric electrocardiograms (ECGs); 7) identify life-threatening pediatric conditions; 8) demonstrate intraosseous line (IO) insertion on a pediatric model; and 9) demonstrate appropriate use of the Neonatal Resuscitation Protocol (NRP®) algorithms.
PediatricsSmall Group Learning
Point Of Care Ultrasound Use for Detection of Multiple Metallic Foreign Body Ingestion. US. JETem 2023
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Point-Of-Care Ultrasound Use for Detection of Multiple Metallic Foreign Body Ingestion in the Pediatric Emergency Department: A Case Report

Sarah Bella, DO*, Joseph Heiney, MD* and Amy Patwa, DO^ 

DOI: https://doi.org/10.21980/J83D2D Issue 8:4[mrp_rating_result]
Bedside POCUS was performed on the patient’s abdomen using the curvilinear probe. The left upper quadrant POCUS image demonstrates multiple hyperechoic spherical objects with shadowing and reverberation artifacts concerning multiple foreign body ingestions. Though the patient and mother initially denied knowledge of foreign body ingestion, on repeated questioning after POCUS findings, the patient admitted to his mother that he ate the spherical magnets he received for his birthday about one week ago. The patient swallowed these over the course of two days. The presence of multiple radiopaque foreign bodies was confirmed with an abdominal X-ray.
UltrasoundAbdominal/GastroenterologyPediatricsVisual EM
CRAO Exam. JETem 2023
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Sonographic Retrobulbar Spot Sign in Diagnosis of Central Retinal Artery Occlusion: A Case Report

Emiliya Usheva, MD*, Dustin Williams, MD^, Haley Musgrave, MD† and Scott Zhou, MD**

DOI: https://doi.org/10.21980/J8735P Issue 8:4[mrp_rating_result]
The bedside ocular ultrasound (B-scan) was significant for small, hyperechoic signal (white arrow) in the distal aspect of the optic nerve, concerning for embolus in the central retinal artery. Subsequent direct fundoscopic exam was significant for a pale macula with cherry red spot (black arrow), consistent with central retinal artery occlusion (CRAO).
OphthalmologyUltrasoundVisual EM
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Everyday Water-Related Emergencies: A Didactic Course Expanding Wilderness Medicine Education

Geoffrey B Comp, DO*, Erica Burmood, DO*, Molly Enenbach, DO* and Savannah Seigneur, DO*

DOI: https://doi.org/10.5072/FK2HX1GX76Issue 8:3[mrp_rating_result]
By the end of the session, the learner will be able to: 1) describe the pathophysiology of drowning and shallow water drowning, 2) prevent water emergencies by listing water preparations and precautions to take prior to engaging in activities in and around water, 3) recognize a person at risk of drowning and determine the next best course of action, 4) demonstrate three different methods for in-water c-spine stabilization in the case of a possible cervical injury, 5) evaluate and treat a patient after submersion injury, 6) appropriately place a tourniquet for hemorrhage control, and 7) apply a splint to immobilize skeletal injury.
WildernessSmall Group Learning
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Alcohol Withdrawal with Delirium Tremens

Courtney Schwebach, MD* and Amrita Vempati, MD*

DOI: https://doi.org/10.21980/J8S35N Issue 8:3[mrp_rating_result]
By the end of the session, learner will be able to  1) discuss the causes of altered mental status,  2) utilize CIWA scoring system to quantify AW severity, 3) formulate appropriate treatment plan for AW by treating with benzodiazepine and escalating treatment appropriately, 4) treat electrolyte abnormalities by giving appropriate medications for hypokalemia and hypomagnesemia, and 5) discuss clinical progression and timing to AW.
SimulationToxicology
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Headache Over Heels: CT Negative Subarachnoid Hemorrhage

Sarah Hogan, MD*, Sara Dimeo, MD, MEHP^ and Caroline Astemborski, MD, MEHP* 

DOI: https://doi.org/10.21980/J8ND2C Issue 8:3[mrp_rating_result]
By the end of this case, the participant will be able to: 1) construct a broad differential diagnosis for a patient presenting with syncope, 2) name the history and physical exam findings consistent with SAH, 3) identify SAH on computer tomography (CT) imaging, 4) identify the need for lumbar puncture (LP) to diagnose SAH when CT head is non-diagnostic > 6 hours after symptom onset, 5) correctly interpret cerebral fluid studies (CSF) to aid in the diagnosis of SAH, and 6) specify blood pressure goals in SAH and suggest appropriate medication management.
NeurologySimulation
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A Homemade, Cost-Effective, Realistic Pelvic Exam Model

Jessie Godsey, MD*, Ilya Kott, MD*, Adrienne Payden* and Patricia Ward*

DOI: https://doi.org/10.21980/J8HM0F Issue 8:3[mrp_rating_result]
After utilizing this pelvic examination model, the learner will be able to: 1) demonstrate ability to perform a pelvic examination comfortably and safely, 2) demonstrate ability to obtain a cervical swab on female patients, and 3) show proficient understanding of female anatomy.
ProceduresInnovationsOb/Gyn

Acute Pulmonary Edema and NSTEMI

Ashley Pilgrim, MD*

DOI: https://doi.org/10.21980/J8CW67 Issue 8:3[mrp_rating_result]
At the end of this practice oral boards case, the learner will: 1) recognize unstable vital signs (VS) and intervene to stabilize ventilation and oxygenation, 2) demonstrate the ability to obtain a complete medical history including the important characteristics of chest pain, 3) demonstrate an appropriate exam on a patient, 4) order the appropriate evaluation studies for a patient with complaints of dyspnea, 5) interpret the results of diagnostic evaluation and diagnose Non- ST elevation myocardial infarction (NSTEMI) and pulmonary edema, 6) order appropriate management of pulmonary edema and NSTEMI, and 6) demonstrate effective communication with patient and family members.
Cardiology/VascularCertifying Exam Cases

Infant Botulism

Ashley Garispe, DO* and Steven Cherry, MD^

DOI: https://doi.org/10.21980/J88350 Issue 8:3[mrp_rating_result]
At the end of this oral board session, examinees will: 1) demonstrate an ability to obtain a complete pediatric medical history, 2) perform an appropriate physical exam on a pediatric patient, 3) investigate a broad differential diagnosis for neuromuscular weakness in a pediatric patient, 4) recognize the classic presentation of infant botulism and implement treatment with botulinum specific antitoxin before confirmatory testing, 5) recognize impending airway failure and intubate the pediatric patient with appropriately dosed medications and ET tube size, and 6) demonstrate effective communication with healthcare team members and parents. 
ToxicologyCertifying Exam Cases
R Retroperitoneal Hematoma US 1 Unannotated. JETem 2023
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Trauma by Couch: A Case Report of a Massive Traumatic Retroperitoneal Hematoma

Cassandra Smith, BSN *, Graham Stephenson, MD*, Alisa Wray, MD, MAEd* and Matthew Hatter, BS*

DOI: https://doi.org/10.21980/J84D2QIssue 8:3[mrp_rating_result]
Upon arrival at the trauma center, a FAST revealed a large, well-circumscribed abnormality (red outline) deep to the liver (blue outline and star) and gallbladder (green outline and star). The right kidney and hepatorenal space were not clearly visualized. The remainder of the FAST showed no free fluid in the splenorenal space, pelvis, and no pericardial effusion. He had lung sliding bilaterally.
TraumaVisual EM