Issue 3:3

Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Cardiovascular Emergencies Small Group Module

Michael Barrie, MD^*, Erin Wenzel, MD^*, Colin Kaide, MD^*, Daniel Bachmann, MD^*, Daniel Martin, MD, MBA^*, Jennifer Mitzman MD^{*^}, Benjamin Ostro, MD^*, Beth Bubolz, MD^{^}, Kristin Stukus, MD^{^}, Farhad Aziz, MD^*, Cynthia Leung, MD^*, Howard Werman, MD^*, Alyssa Tyransky^* and Andrew King, MD^*

DOI: https://doi.org/10.21980/J8X334 Issue 3:3 No ratings yet.

We aim to teach the presentation and management of cardiovascular emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents.

Curriculum Cardiology/Vascular

The Continuous Residency Improvement Committee (CRIC) – A Novel Twist for Program Evaluation in an Academic Emergency Medicine Residency Program

Aaron S Kraut, MD^*, David S Tillman, MD^*, Ciara Barclay-Buchanan, MD^*, Jamie M Hess, MD^*, Azita G Hamedani, MD, MPH, MBA^{^}, Brian Jennett, MD^*, Saby Cordoba, MS^* and Mary Westergaard, MD^*

DOI: https://doi.org/10.21980/J8SD17Issue 3:3 No ratings yet.

The purpose of this innovation was to develop a novel approach to continuous program evaluation and improvement using a multisource feedback design to improve resident satisfaction with the program’s responsiveness to feedback while addressing the ACGME mandate for self-study.

Innovations Administration

Realistic and Inexpensive Ultrasound Guided Paracentesis Simulator Using Pork Belly with Skin

Jonathan Kei, MD, MPH^* and Donald P Mebust, MD^*

DOI: https://doi.org/10.21980/J8NK9RIssue 3:3 No ratings yet.

By the end of this instructional session learners should be able to: 1) Discuss the indications, contraindications, and complications associated with abdominal paracentesis; and 2) competently perform an ultrasound-guided abdominal paracentesis on a simulator and remove fluid.

Abdominal/Gastroenterology Innovations Procedures

Low Cost Task Trainer for Neonatal Umbilical Catheterization

Caitlin Walsh Feeks, DO^* and Linda Fan, MD^*

DOI: https://doi.org/10.21980/J8HW6GIssue 3:3 No ratings yet.

By the end of this instructional session learners should: 1) Discuss the indications, contraindications, and complications associated with umbilical catheterization. 2) Competently perform umbilical catheterization on the task trainer. 3) Demonstrate proper securement of the catheter.

Procedures Innovations Pediatrics

A Low Cost Escharotomy Simulation Model for Residency Education

Christopher Sampson, MD^*, Catherine D Parker, MD^*, Edward Burns, MD^{^}, Marty Ruyan, BSN, RN^†, Dena Higbee, EdS^† and Timothy Koboldt, MD^*

DOI: https://doi.org/10.21980/J8D34V Issue 3:3 No ratings yet.

By the end of this educational session, the learner will be able to: 1) Understand the indications for an escharotomy. 2) List equipment needed to perform an escharotomy. 3) Demonstrate how to perform an escharotomy. 4) Perform an escharotomy and experience the sensation of cutting through simulated burned tissue. 5) Understand post-escharotomy management and referral to specialist.

Procedures Innovations Trauma

Acute Hemolytic Transfusion Reaction

Michael Purcell, MD^*, Christopher E San Miguel, MD^* and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J88D2Z Issue 3:3 No ratings yet.

By the end of this simulation session, the learner will be able to: 1) Recognize the clinical signs and symptoms associated with transfusion reactions. 2) Discuss necessary systems-based management of potential transfusion reactions, such as notifying the blood bank and evaluating to see if another patienta accidentally received a wrong unit of blood. 3) Discuss the management of various transfusion reactions. 4) Appropriately disposition the patient to an intensive care unit (ICU) or stepdown unit. 5) Effectively communicate with team members and nursing staff during the resuscitation of a critically ill patient.

Hematology/Oncology Simulation

In-Flight Emergency: Altered Mental Status Secondary to Hypoglycemia

Nichole Niknafs, DO^*, Robert Katzer, MD^{^} and Alisa Wray, MD^{^}

DOI: https://doi.org/10.21980/J84M01 Issue 3:3 No ratings yet.

By the end of this simulation session, learners will be able to: 1) Discuss the challenges associated with in-flight emergencies. 2) List what is available in United States (US) commercial airline medical kits. 3) Discuss an appropriate differential diagnosis for a patient with altered mental status (AMS). 4) Demonstrate appropriate treatment of hypoglycemia. 5) Describe possible complications in diabetic patients with insulin pumps when flying. 6) Review the legal ramifications of responding to an in-flight emergency.

Endocrine Simulation

Bedside Ultrasound of Retinal Detachment in a 19-year-old

Rami San Gabriel, BS^*, Maili Alvarado, MD^* and Vy Han, MD^*

DOI: https://doi.org/10.21980/J80W6TIssue 3:3 No ratings yet.

The ocular point of care ultrasound (POCUS) utilizing a high frequency linear probe shows a retinal detachment (RD) with a thick, hyperechoic undulating membrane in the vitreous humor that is anchored at the ora serrata anteriorly and the optic disc posteriorly. Note that the retina is detached all the way to the optic disc making it "mac off." The macula, and more specifically the fovea, is located in the central retina and contains a high concentration of cone photoreceptors responsible for central, high resolution, color vision. In a "mac on" RD, the retina detaches in the periphery but remains intact centrally. This is an ophthalmologic emergency and timely diagnosis and intervention can be vision saving. This patient also has evidence of a posterior vitreous hemorrhage which has a characteristic swirling appearance with kinetic exam on real-time imaging. The detached vitreous body is not as well defined and is not anchored posteriorly to the optic disc.

Ophthalmology Visual EM

Bullous Emphysema

Valerie Lew, MD^*, John Costumbrado, MD, MPH^{^} and Steven Kim, MD^{^}

DOI: https://doi.org/10.21980/J8W62GIssue 3:3 No ratings yet.

The upright chest X-ray shows a large lucent area in the left lower lung field without lung markings, with associated curvilinear opacities (yellow arrows) consistent with a large air-filled bulla. The bulla is large enough to compress adjacent lung tissue as shown by the visible pleural line (blue line). The discontinuity of the pleural line and presence of lung markings superiorly makes these findings more consistent with bulla than pneumothorax. The chest computed tomography (CT) confirmed a large left hemithorax bulla.

Respiratory Visual EM

The Role of Chest X-Ray and Bedside Ultrasound in Diagnosing Pulmonary Bleb versus Pneumothorax

Mohamad Moussa, MD^* and Venkat Reddy Vaddamani, BS^*

DOI: https://doi.org/10.21980/J8MP7QIssue 3:3 No ratings yet.

The patient was evaluated with bedside ultrasound for concern of possible pneumothorax. Imaging of the left lung with M-mode demonstrated a “sea shore” sign showing a wavy pattern below the pleural line caused by lung sliding as well as “comet tail” artifact caused by from the deep pleura. However, there was no lung sliding on the right shown by a lack of “comet tail” artifact and a “bar code” sign where M-mode shows straight lines throughout the image, this is caused by lack of motion below the pleura. This lack of lung sliding is consistent with possible pneumothorax or bleb. A two-view chest X-ray (CXR) revealed absent lung parenchyma in the right lung similar to a large pneumothorax (see red outline). Electronic medical record chart review revealed previous CXRs with similar findings. This patient was determined to have an acute COPD exacerbation with chronic blebs, but no pneumothorax.

Respiratory Visual EM