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Pediatric Sedation for Forearm Fracture
DOI: https://doi.org/10.21980/J8CS7KAt the end of this simulation, participants will: 1) review options for pain control in pediatric patients, 2) perform a pre-sedation history and physical exam, 3) review the indications and contraindications for pediatric moderate sedation, 4) understand components of consent, and get consent from the patient’s parent, 5) list medication options for moderate sedation in a pediatric patient and review their appropriate doses, indications, contraindications, and side effects, 6) discuss management of moderate sedation complications, and 7) review criteria for discharging a patient after sedation.
Out-of-Hospital Delivery of a Live Newborn Requiring Resuscitation
DOI: https://doi.org/10.21980/J8834MBy the end of this simulation session, the learner will be able to: 1) perform a neonatal assessment, 2) identify which neonates require resuscitation, 3) understand the principles of neonatal resuscitation, 4) describe proper airway management in neonatal resuscitation, 5) discuss underlying etiologies or pathologies that may lead to a neonate to require resuscitation, and 6) communicate effectively with team members and nursing staff during the resuscitation of a critically ill neonate.
Wellens’ Syndrome
DOI: https://doi.org/10.21980/J8FS8KInitial electrocardiogram (ECG) revealed the classic biphasic T waves in V2 and V3 of Wellen’s syndrome (see red outlines). A second EKG demonstrated an evolving deeply inverted T wave (see blue outlines).
Arteriovenous Graft Pseudoaneurysm
DOI: https://doi.org/10.21980/J8B06ZA bedside ultrasound of the mass demonstrated a large compressible hypoechoic structure (see purple outline) above the arteriovenous graft (see red outline). The contents demonstrated movement of fluid within the structure. This was confirmed with Doppler mode, which allowed for visualization of flow communicating between the structure and the underlying vessel, which is diagnostic for a pseudoaneurysm.
Bilateral Shoulder Dislocation after Ski Injury
DOI: https://doi.org/10.21980/J86929An anteroposterior chest X-ray demonstrates bilateral shoulder dislocations. Both the right and left humeral heads (blue lines) are displaced medially, anteriorly, and inferiorly from their normal positions in the glenoid fossae (red lines), thus signifying bilateral anterior dislocations. There is also a fracture of the left humeral head at the greater tubercle (green arrow).
Abdominal Pain with Black Tongue
DOI: https://doi.org/10.21980/J8XS7JPatient’s tongue had a black discoloration, without elongated filiform papillae. We could not appreciate lymphadenopathy. His abdomen was tender to palpation.
Beware the Devastating Outcome of a Common Procedure
DOI: https://doi.org/10.21980/J8T336Non-contrast head computed tomography (CT) demonstrates multifocal bilateral hypodense lesions (white arrows) representing air emboli. Note the lesions are located in the intra-axial distribution which indicates an underlying vascular origin.
Suspicious Skin Lesion in an 11-Year-Old Male
DOI: https://doi.org/10.21980/J8JK9TThe patient had a 5 cm ulcerative lesion with raised borders and a yellow, “fatty” center. There was no active drainage, site tenderness, or lymphadenopathy.
Guilty as Charged: Jailed Coronary Vessel Presenting as Wellens’ Syndrome Type B
DOI: https://doi.org/10.21980/J8DS6HEvolving changes to electrocardiograph (ECG) were noted during serial ECG monitoring involving leads V2 and V3, along with some T-wave inversion in V4 and V5 that were concerning for a Wellens’ syndrome type B on second ECG. She was admitted and subsequently taken to cardiac catheterization suite where it was revealed that the previously placed stent in the left anterior descending (LAD) artery was patent. Unfortunately, the stent blocked off an adjacent side branch vessel off the LAD in proximal two-third region of the stent (as seen in the cartoon).
Ovarian Teratoma
DOI: https://doi.org/10.21980/J8934XThe CT scan with oral contrast in the emergency department revealed a large heterogeneous abdominopelvic mass measuring 13.2 x 18.8 x 23.1 cm (see white lines), suggestive of an ovarian teratoma from the right ovary. This mass included fat, fluid, calcifications (see yellow arrows), and enhancing soft tissue components. The teratoma resulted in mass effect upon large and small bowel loops (see blue highlighted areas), inferior vena cava (IVC), distal aorta (see red highlighted area) and right common iliac artery. A small volume of ascites was also observed. There was no evidence of bowel obstruction, vascular occlusion or other significant emergent finding. Additionally, transabdominal and transvaginal ultrasound images were obtained. The transabdominal image visualized the abdominopelvic mass (see four yellow stars). The transvaginal image visualized a cross section of the teratoma (see four red stars) in relation to the bladder (see four blue stars).