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A Cold Case: Myxedema Coma

Andrew M Namespetra, MD^*, Matthew J Petruso, DO^* and Andrew M Bazakis, MD^*

DOI: https://doi.org/10.21980/J8VM0J Issue 10:1 No ratings yet.

At the conclusion of the simulation, the learner is expected to: 1) Recognize the key features on history and examination of a patient presenting in myxedema coma and initiate the appropriate workup and treatment, 2) Describe clinical features and management for a patient with myxedema coma, 3) Develop a differential diagnosis for a critically ill patient with altered mental status, 4) Discuss the management of myxedema coma in the ED, including treatments, appropriate consultation, and disposition.

Adolescent with Diabetic Ketoacidosis, Hypothermia and Pneumomediastinum

Steven Millner, MD^* and Courtney Devlin, MD^*

DOI: https://doi.org/10.21980/J8FP8J Issue 8:4 No ratings yet.

By the end of the simulation, learners will be able to: 1) develop a differential diagnosis for an adolescent who presents obtunded with shortness of breath; 2) discuss the management of diabetic ketoacidosis; 3) discuss management of hypothermia in a pediatric patient; 4) discuss appropriate ventilator settings in a patient with diabetic ketoacidosis; and 5) demonstrate interpersonal communication with family, nursing, and consultants during high stress situations.

Endocrine Pediatrics Procedures Respiratory Simulation

A Case Report of Glycogenic Hepatopathy

Dane Brown, MD^* and Theresa Mead, DO, RDMS^*

DOI: https://doi.org/10.21980/J8SQ0Z Issue 6:3 No ratings yet.

The ultrasound images reveal hepatomegaly and an increased echogenicity of the liver parenchyma that is diffuse. The increased echogenicity can be best appreciated by a comparison to surrounding structures. It is important to note that the increased echogenicity is non-focal and consistent throughout the entire liver in multiple views. These findings can be consistent with nonalcoholic steatohepatitis as well as glycogenic hepatopathy.

Endocrine Visual EM

A Case Report of a Large Goiter Resulting in Tracheal Deviation

Thomas Powell, MD^* and Geremiha Emerson, MD^*

DOI: https://doi.org/10.21980/J80645 Issue 6:3 No ratings yet.

In the image, one can see significant tracheal deviation around the right side of the mass (black arrows). This degree of deviation would make ventilation in a paralyzed patient extremely difficult, if not impossible.

Endocrine Visual EM

A Case Report of Neonatal Vomiting due to Adrenal Hemorrhage, Abscess and Pseudohypoaldosteronism

Raymen Rammy Assaf, MD, MPH^* and Mary Jane Piroutek, MD^{^}

DOI: https://doi.org/10.21980/J8QQ0B Issue 6:3 No ratings yet.

An ultrasound (US) of the abdomen was obtained to evaluate for possible pyloric stenosis (see US transverse/dopper imaging). While imaging showed a normal pyloric channel, it revealed an unexpected finding: a complex cystic mass arising from the right adrenal gland (yellow outline), measuring 5.8 by 4.0 by 6.4 cm with calcifications peripherally and mass effect on the kidney without evidence of vascular flow (blue arrow). Computed tomography (CT) of the abdomen/pelvis with IV contrast was subsequently obtained and measured the lesion as 2.8 by 4.6 by 4 cm without evidence of additional masses, lymphadenopathy or left adrenal gland abnormality (see CT axial, coronal, and sagittal imaging).

Endocrine Visual EM

Thyroid Storm

Kathryn Ritter, MD^* and Carmen Wolfe, MD^*

DOI: https://doi.org/10.21980/J8RW71 Issue 5:4 No ratings yet.

At the end of this practice oral boards case, the learner will: 1) assess a patient with altered mental status in an oral boards format; 2) review appropriate laboratory testing and diagnostic imaging; 3) identify signs and symptoms of thyroid storm and 4) review appropriate pharmacologic therapies with the proper sequence and timing.

Endocrine Oral Boards

Case Report of Spontaneous Thyroid Hemorrhage Following LMA Insertion

Gregory Podolej, MD^* and Gary Bhagat, MD^*

DOI: https://doi.org/10.21980/J8XP8W Issue 5:3 No ratings yet.

Two photographs of patients neck, both showcasing no obvious erythema, bruising, or swelling which is noteworthy because there is potential for airway compromise but there was nothing visible to indicate that on exam. CTA of neck showing thyroid nodule and potential thyroid hemorrhage (outlined in orange) on the left without evidence of airway compromise at the time of CT scan. Official read by attending radiologist states there is a “heterogeneous left thyroid nodule measuring 3 cm. Findings are suggestive of multinodular goiter with possible acute hemorrhage. Adjacent tract of soft tissue stranding in the anterior left neck with mild adjacent fascial thickening. This could represent small amount of hemorrhage or could be inflammatory.”

Endocrine Visual EM

The Elusive Pheo: A Case Report of Pheochromocytoma in the Emergency Department

Jason Cody Pickett, MD^* and Jonah Gunalda, MD^*

DOI: https://doi.org/10.21980/J8KW63 Issue 4:4 No ratings yet.

ED work-up: BMP within normal limits (WNL), white blood cell (WBC) 27.4, ECG showed sinus tachycardia, nonspecific ST segment abnormalities, BNP and troponin were within normal limits, HR 146 beats/minute, CT abdomen/pelvis showed a 10-cm-heterogenous enhancing left adrenal mass (anterior-posterior view [shown in red], lateral view [shown in blue]).

Endocrine Visual EM

Thyroid Storm

Natalie Ferretti, MD^* and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J8XD03Issue 4:3 No ratings yet.

By the end of this simulation session, the learner will be able to: 1) understand the essential physical exam components necessary to evaluate for etiologies of acute encephalopathy, 2) review laboratory and imaging studies to obtain for evaluation of acute encephalopathy and/or suspected thyroid storm, as well as the rationale behind ordering each study, 3) identify underlying etiologies or pathologies for developing thyroid storm, 4) discuss treatment for thyroid storm.

Endocrine Simulation

Thyroid Storm in the Emergency Department

Christopher Eric McCoy, MD, MPH^* and Reid Honda, MD^*

DOI: https://doi.org/10.21980/J8234RIssue 4:3 No ratings yet.

By the end of this simulation-based session, the learner will be able to: 1) Recognize the signs and symptoms of thyroid storm and appropriately diagnose a patient with thyroid storm. 2) Choose appropriate medications for the treatment of thyroid storm. 3) Determine the appropriate disposition for a patient presenting in thyroid storm. 4) Discuss the rationale behind each drug used to treat thyroid storm. 5) List at least three precipitants of thyroid storm.

Endocrine Simulation

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