Issue 6:2

A Low-Cost Facial and Dental Nerve Regional Anesthesia Task Trainer

Andrew Eyre, MD, MSHPed^{*^} and Valerie Dobiesz, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J8RP9Q Issue 6:2 No ratings yet.

By the end of this educational session, learners should be able to: 1) describe and identify relevant anatomy for supra-orbital, infra-orbital, mental, and inferior alveolar nerves and 2) successfully demonstrate supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks using a partial task trainer.

Teaching about the Wild: A Survival Course as a Novel Resident Educational Experience

Geoffrey Comp, DO^*, Rachel Munn, DO^{^}, Renee Moffitt, DO^† and Eric Cortez, MD^{^^}

DOI: https://doi.org/10.21980/J8N06RIssue 6:2 No ratings yet.

By the end of the session the learner will be able to: 1) differentiate at least three different methods for water purification 2) describe how to erect a temporary survival shelter 3) construct a survival pack for personal use emphasizing multi-use items 4) demonstrate how to make a fire without a direct flame supply.

Small Group Learning Wilderness

Escape the EM Boards: Interactive Virtual Escape Room for GI Board Review

Megan Gillespie, DO^*

DOI: https://doi.org/10.21980/J8H63FIssue 6:2 No ratings yet.

By the end of this didactic activity, learners will be able to: 1) identify causes of upper gastrointestinal bleeding; 2) recall test-taking buzzwords for infectious causes of diarrhea; 2) acknowledge the correct hepatitis B titers that correspond with various clinical scenarios; 3) describe the management for alkali caustic ingestions; 4) determine the components of Maddrey Discriminant Function Score, Charcot’s triad, Ranson’s Criteria for Pancreatitis, and Glasgow-Blatchford Score; 5) diagnose specific gastrointestinal diseases from a clinical description; 6) choose the correct gastrointestinal diagnosis based on clinical image findings; 7) demonstrate teamwork in solving problems.

Abdominal/Gastroenterology Small Group Learning

Let’s Escape Didactics: Virtual Escape Room as a Didactic Modality in Residency

Anisha Turner, MD^*, Aleksandr M Tichter, MD, MS^* and M Tyson Pillow, MD, MEd^*

DOI: https://doi.org/10.21980/J8CH2X Issue 6:2 No ratings yet.

By the end of the activity, learners should be able to: 1) identify the hazardous chemicals associated with house fires; 2) classify burn injury according to depth, extent and severity based on established standards; 3) recall the actions to take in response to fire emergencies (R.A.C.E. and P.A.S.S. acronyms); 4) recall key laboratory features of cyanide and carbon monoxide poisonings; 5) identify appropriate management strategies for smoke inhalation injuries; 6) recite the treatment for cyanide and carbon monoxide poisonings; 7) describe the management of the burn injuries; 8) communicate and collaborate as a team to arrive at solutions of problems; 9) display task-switching and leadership skills during exercise; and 10) evaluate virtual escape room experience.

Small Group Learning Toxicology

An Observation Medicine Curriculum for Emergency Medicine Education

Danie Ty, MD^*, Marney Gruber, MD^*, Noah Klein, BS^*, Jeremy Branzetti, MD^*, Matthew Brown, MD^*, Matthew McCarty, MD^*, Tracy Svetcov, MD^*, Barie Miller, MD^*, Maurice Hinson, MD^*, Raj Machhar, MD^*, Sharon Uralil, MD^*, Catherine Capo, MD^*, Yitzchak Weinberger, MD^*, Melanie Raffoul, MD^*, Robert Femia, MD^*, Christopher Caspers, MD^*

DOI: https://doi.org/10.21980/J87P92 Issue 6:2 No ratings yet.

The primary goal of this observation medicine curriculum is to train current EM residents in short-term acute care beyond the initial ED visit. This entails caring for patients from the time of their arrival to the OU to the point when a final disposition from the OU is determined, be it inpatient admission or discharge to home.

Administration Curricula

A Pediatric Emergency Medicine Refresher Course for Generalist Healthcare Providers in Belize: Respiratory Emergencies

Adeola Adekunbi Kosoko, MD^*, Alicia E Genisca, MD^{^}, Marideth Rus, MD^†, Shreya Ramayya^**, Lisa Johnson, MD^{^^} and Joy Mackey, MD^††

DOI: https://doi.org/10.21980/J84063 Issue 6:2 No ratings yet.

This curriculum presents a refresher course in recognizing and stabilizing pediatric acute respiratory complaints for generalist healthcare providers practicing in LMICs. Our goal is to implement this curriculum in the small LMIC of Belize. This module focuses on common respiratory complaints, including asthma, bronchiolitis, pneumonia and acute airway management.

Curricula Respiratory

Point of Care Ultrasound as a Diagnostic Tool to Detect Small Bowel Obstruction in the Emergency Department: A Case Report

Rebecca Nadelman, MD^* and Jesper Aurup, MD^*

DOI: https://doi.org/10.21980/J8XD1G Issue 6:2 No ratings yet.

The ultrasound findings suggestive of small bowel obstruction (SBO) are typically visualized in video; however, certain still images can also demonstrate SBO including greater than three dilated loops of small bowel (>2.5 cm), thickened-walled bowel (>3 mm), visualization of plicae circulares, and extraluminal fluid caused by inflammatory changes along the bowel wall, which are all highly suggestive of SBO.3 In this patient’s case, we were able to visualize several dilated loops of small bowel (red arrow) with oscillating intraluminal contents known as “Whirl Sign.” Additionally, we were able to visualize extraluminal fluid, demonstrated as an anechoic triangular-shaped collection. The characteristic shape of this triangular shaped collection of fluid is known as a “Tanga Sign,” given its name due to way it looks similar to the lower half of a bikini (blue arrow). Tanga sign can occur when the loops of dilated bowel appear prominent in contrast to the inflammatory extraluminal fluid in an SBO. These ultrasound findings were highly concerning for SBO which was later confirmed on CT imaging of the abdomen, which demonstrated SBO with a transition point in the left lower quadrant.

Abdominal/Gastroenterology Visual EM

Case Report: Altered with PRES

Fatima Dema, MD^* and David C Feldman, MD^*

DOI: https://doi.org/10.21980/J8NW73 Issue 6:2 No ratings yet.

On vitals, the patient was found to be consistently hypertensive to the 230s/160s. Point-of-care glucose was within normal limits. Noncontrast CT imaging of the head revealed no acute intracranial hemorrhage or evidence of ischemic stroke, but was remarkable for areas of biparietal subcortical low-attenuation (white arrows), concerning for PRES. Patient subsequently underwent CT angiogram imaging of the head with perfusion which revealed no large vessel occlusion.

Neurology Visual EM

A Case Report of Cardiac Tamponade

Derek JC Hunt, DO^*, Kevin McLendon, DO^* and Matthew Wiggins, MD^*

DOI: https://doi.org/10.21980/J8J644 Issue 6:2 No ratings yet.

The patient was in noticeable respiratory distress and had oxygen saturation of 94% on room air. Bilateral jugular venous distention with severe right supraclavicular lymphadenopathy and diffuse bilateral wheezing was present. Although muffled heart sounds and hypotension are part of Beck’s Triad, these were not present in this case. Electrocardiogram obtained on arrival showed a sinus tachycardia with low-voltage QRS complexes and electrical alternans. Low voltage QRS can be seen on the ECG provided and is demonstrated by the low amplitude of the QRS complexes seen on all the leads. Electrical alternans may have an alternating axis or amplitudes of the QRS complex. Alternating axis is best visualized in V4-V6 on this ECG while alternating amplitudes are seen throughout the rest of the ECG. Computed tomography angiogram (CTA) of the chest revealed a large pericardial effusion with bilateral pulmonary emboli and a right upper lobe mass. A bedside transthoracic echocardiogram (TTE) was then performed and confirmed the large effusion, but also showed right ventricular collapse during diastole, indicative of cardiac tamponade.

Cardiology/Vascular Visual EM

A Different Type of Tension Headache: A Case Report of Traumatic Tension Pneumocephalus

Travis P Sharkey-Toppen, MD, PhD^*, Dominique I Dabija, MD, MS^* and Christopher San Miguel, MD^*

DOI: https://doi.org/10.21980/J8DH0G Issue 6:2 No ratings yet.

CT head without contrast demonstrated a minimally displaced fracture of the frontal sinuses at the midline underlying his known laceration that involved the anterior and posterior tables of the calvarium. This is seen on the sagittal view and indicated by the blue arrow. There was a small volume of underlying subarachnoid hemorrhage along the falx. There was also extensive pneumocephalus most pronounced along the bilateral anterior frontal convexity associated with the frontal sinus fracture, seen on the axial image and indicated by the red arrow. This pattern of air is commonly referred to as the “Mount Fuji” sign.6 Other intracranial air can also be seen on the sagittal image and is indicated by the white arrow.

Trauma Neurology Visual EM