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Pediatric Pulmonary Abscess

Kyle Barbour* and Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J83S6QIssue 3:2[mrp_rating_result]
Upright posterior-anterior plain chest films show a left lower lobe consolidation with an air-fluid level and a single septation consistent with a pulmonary abscess (white arrows). A small left pleural effusion was also present, seen as blunting of the left costophrenic angle and obscuration of the left hemidiaphragm (black arrows).
RespiratoryInfectious DiseaseVisual EM
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Scaphoid Fracture

Esther Kim, BS* and Justin Yanuck, MD*

DOI: https://doi.org/10.21980/J80344Issue 3:2[mrp_rating_result]
The anteroposterior (AP) plain film of this patient demonstrates a full thickness fracture through the middle third of the scaphoid (red arrow), with some apparent displacement (yellow lines) and subtle angulation of the fracture fragments (blue line).
OrthopedicsVisual EM
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Type 1 Brugada Syndrome

Sha Yan, DO*, Grant Wei, MD* and Chirag Shah, MD*

DOI: https://doi.org/10.21980/J8V91T Issue 3:2[mrp_rating_result]
ECG shows an incomplete right bundle branch block (blue arrow) with coved ST segment elevation and an inverted T wave in V1 (red arrow) and ST segment elevation in V2 (black arrow).
Cardiology/VascularVisual EM
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Acute comminuted intertrochanteric hip fracture

Samuel Kaplan, BS* and Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J8QK9C Issue 3:2[mrp_rating_result]
History of present illness: A 69-year-old male presented to the emergency department (ED) with left hip pain after he was rear-ended on his bicycle by a vehicle traveling 10-15 miles per hour. He had normal vital signs. On exam, his left lower extremity was externally rotated and shortened with trochanteric point tenderness. His pelvis was stable. His lower extremity compartments
OrthopedicsVisual EM
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Radial Nerve Palsy

Richard Barnett, DO* and Amy Church, MD*

DOI: https://doi.org/10.21980/J8KS7F Issue 3:2[mrp_rating_result]
On physical exam, the patient was unable to extend his right wrist, thumb, and fingers, and had no sensation of his 1stdorsal interosseous muscles up to the proximal dorsal radial aspect of his forearm. The patient also had slight weakness in thumb abduction. Triceps strength was preserved.
NeurologyVisual EM
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Osborn Waves

James Elliot Karz, DO*, Grant Wei, MD* and Chirag Shah, MD*

DOI: https://doi.org/10.21980/J8G34G Issue 3:2[mrp_rating_result]
The initial ECG shows a junctional rhythm with Osborn waves (or J point elevations/J waves) in the lateral precordial leads, as well as the limb leads (Image 1). The second ECG, 49 minutes later, shows an improving ventricular rate and Osborn wave height decrease of approximately 50% (Image 2). 
Cardiology/VascularVisual EM
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Rare Rapidly Growing Thumb Lesion in a 12-Year-Old Male

Alana J Arnold, MD, MBA*

DOI: https://doi.org/10.21980/J8B92J Issue 3:2[mrp_rating_result]
History of present illness: A 12-year-old male presented to the emergency department with right thumb pain and a mass for four months (see images). He denied fevers, chills, change in appetite, or fatigue. He noted that the lesion was growing and “bleeds easily if bumped.” He denied any trauma to the thumb, except “hitting it” months ago while in football
Hematology/OncologyOrthopedicsVisual EM
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Large Ventral Hernia

Meryl Abrams, MD*, Raymond Feuga, MD*, Nicholas Governatori, MD* and Jennifer White, MD*

DOI: https://doi.org/10.21980/J86K9QIssue 3:2[mrp_rating_result]
Computed tomography (CT) scan with intravenous (IV) contrast of the abdomen and pelvis demonstrated a large pannus containing a ventral hernia with abdominal contents extending below the knees (white circle), elongation of mesenteric vessels to accommodate abdominal contents outside of the abdomen (white arrow) and air fluid levels (white arrow) indicating a small bowel obstruction.
Abdominal/GastroenterologyVisual EM
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Elderly female with acute abdominal pain presenting with Superior Mesenteric Artery Thrombus

Sassan Ghassemzadeh, MD*

DOI: https://doi.org/10.21980/J82W52 Issue 3:2[mrp_rating_result]
Computed tomography (CT) angiogram of the abdomen and pelvis revealed a superior mesenteric artery (SMA) thrombosis 5 cm from the origin off of the abdominal aorta. As seen in the sagittal view, there does not appear to be any contrast 5 cm past the origin of the SMA. On the axial views, you can trace the SMA until the point that there is no longer any contrast visible which indicates the start of the thrombus.  The SMA does not appear to be reconstituted. There was normal flow to the celiac artery. (See annotated images).
Abdominal/GastroenterologyCardiology/VascularVisual EM
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An OSCE Evaluation Tool for the Assessment of Emergency Medicine Resident Progression Performance of ACGME Patient Case and Interpersonal Communication Milestones

Miriam Kulkarni, MD*, Tiffany Murano, MD*, Harsh Sule, MD^, Jill Ripper, MD^ and Gregory Suglaski, MD^

DOI: https://doi.org/10.21980/J8J63RIssue 3:1[mrp_rating_result]
Our goal was to create a standardized OSCE based formative assessment tool that could be deployed with minimal resource utilization. The purpose of our tool is to provide data regarding Emergency Medicine Residents’ performance in ACGME patient care milestones as they progress longitudinally through their residency.
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