Issue 7:1

Syncope Due to a Ruptured Ectopic Pregnancy

Derek JC Hunt, DO^*, Kevin McLendon, DO^* and Jodi Conrad, DO^*

DOI: https://doi.org/10.21980/J86M0N Issue 7:1 No ratings yet.

At the conclusion of this simulation, the learner will be able to: 1) review the initial management of syncope; 2) utilize laboratory and imaging techniques to diagnose a ruptured ectopic pregnancy; and 3) demonstrate the ability to resuscitate and disposition an unstable ruptured ectopic pregnancy.

Ob/Gyn Simulation

Massive Upper Gastrointestinal Bleeding

Eytan Shtull-Leber, MD, MSCR^*, Amrita Vempati, MD^{^}, Geoff Comp, DO^{^} and Aneesh T Narang, MD^*

DOI: https://doi.org/10.21980/J8W93W Issue 7:1 No ratings yet.

By the end of this simulation, learners will be able to: 1) manage a hypotensive patient with syncope and hematemesis, 2) pharmacologically manage an acute UGIB addressing the various causes, 3) recognize worsening clinical status and intervene by performing difficult airway management, 4) place a gastroesophageal balloon tamponade device.

Abdominal/Gastroenterology Lectures

Principles of Hypotensive Shock: A Video Introduction to Pathophysiology and Treatment Strategies

Brittany MacDonald, BA^*, Nicholas MacDonald, BA^*, Jacob Garcia, BS^*, Xiao Chi Zhang, MD, MS^{^} and Dimitrios Papanagnou, MD, MPH^{^}

DOI: https://doi.org/10.21980/J8MS84 Issue 7:1 No ratings yet.

By the end of this module, participants should be able to: 1) review basic principles of cardiovascular physiology; 2) describe the 4 general pathophysiologic mechanisms of hypotensive shock; 3) recognize various etiologies for each mechanism of hypotensive shock; 4) recognize differences in the clinical presentation of each mechanism of hypotensive shock; 5) cite the basic approach to treatment for each mechanism of hypotensive shock.

Cardiology/Vascular Lectures

A Lecture to Teach an Approach and Improve Resident Comfort in Leading Resuscitation of Young Infants in the Emergency Department

Anne Whitehead, MD^*

DOI: https://doi.org/10.21980/J8H36J Issue 7:1 No ratings yet.

By the end of this lecture, participants should be able to: 1) apply a consistent approach to the initial resuscitation of a critically ill young infant in the emergency department; 2) select appropriate medications and equipment for use in resuscitation of critically ill young infants; 3) describe the components of the Pediatric Assessment Triangle,6 which can be used to identify critically ill infants and children; 4) improve comfort in resuscitating young infants in the emergency department.

Pediatrics Cardiology/Vascular Lectures

Initial Management and Recognition of Aortoiliac Occlusive Disease, A Case Report

Ashley Hope, BA^*, Alisa Wray, MD, MAEd^* and Graham Stephenson, MD^*

DOI: https://doi.org/10.21980/J87M0Z Issue 7:1 No ratings yet.

Computerized tomography with angiography (CTA) of the entire aorta demonstrated an occluded distal infrarenal aorta with extension into the bilateral common femoral arteries (red outline), lack of flow through femoral arteries (yellow outline) and trickle flow reconstituted distally consistent with aortoiliac occlusive disease (blue outline). Some small segments of the proximal celiac axis showed signs of occlusion (purple outline). A short segment of non-specific bowel wall thickening, which may have been related to ischemic changes, was also seen (not seen on images). The included coronal slice shows the extent of the bilateral occlusive burden, with three-dimensional reconstruction emphasizing the same findings.

Cardiology/Vascular Visual EM

Case Report: It’s a Small Whirl Afterall

Lisa M Schwartz, MD^*, Ryan M Perdomo, MD^* and Jason An, MD^*

DOI: https://doi.org/10.21980/J83S8G Issue 7:1 No ratings yet.

The CT imaging of the abdomen and pelvis demonstrated multiple loops of dilated small bowel with a whirl sign (red arrow) within the mid abdomen and a transition point (green arrow), suspicious for closed loop bowel obstruction and internal hernia.

Abdominal/Gastroenterology Visual EM

Ovarian Juvenile Granulosa Cell Tumor Case Report

Jasmine Lemmons, MD^*, Kim Little-Wienert, MD, MEd^* and Alia Hamad, MD^*

DOI: https://doi.org/10.21980/J8035H Issue 7:1 No ratings yet.

A focused assessment with sonography in trauma (FAST) exam was performed initially to evaluate for intra-abdominal injury given the clinical picture. A phased-array ultrasound transducer was placed in sagittal orientation along the patient’s right and left flank, demonstrating extensive heterogenous fluid collections in Morrison’s pouch (red arrow), subphrenic space (solid green arrow), and splenorenal recess (dashed green arrow). To further evaluate, a phased-array transducer was placed over her pelvic area in transverse orientation, demonstrating, a large, heterogeneous mass (outlined in yellow arrows). The surgical team was promptly consulted and blood products were ordered. Although there was concern for impending hemorrhagic shock due to patient’s presenting tachycardia, the patient was hemodynamically stable enough for a CT scan of her chest, abdomen, and pelvis. The CT scan showed large-volume ascites, which exerted mass effect on all abdominal organs with centralization of bowel loops. Additionally, there was a large, 6.4 x 6.8 x 10.9-centimeter, midline pelvic mass (outlined in blue arrows).

Ob/Gyn Visual EM

A Case Report of Aortic Dissection Involving the Aortic Root, Left Common Carotid Artery, and Iliac Arteries

Miguel Angel Martinez-Romo MD^* and Christopher Eric McCoy MD^*

DOI: https://doi.org/10.21980/J8V93K Issue 7:1 No ratings yet.

Computed tomography angiography (CTA) of the thoracic and abdominal aorta revealed an aortic dissection of the ascending aorta, with a dissection flap starting from the aortic root/aortic annulus (yellow arrows), extending into the aortic arch (light blue arrowhead) and involving the left common carotid artery (purple arrow), left subclavian artery (pink arrow), extending to the descending aorta (red arrows), and into the bilateral iliacs (green arrows). The true lumen (red star) and false lumen (blue star) created by the dissection flap can best be seen in the axial views.

Cardiology/Vascular Visual EM

A Case Report of Epiglottitis in an Adult Patient

Savannah Tan, BS^*, Kyle Dornhofer, MD^*, Allen Yang, MD^*, Shadi Lahham, MD, MS^* and Lindsey C Spiegelman, MD^*

DOI: https://doi.org/10.21980/J8QM09 Issue 7:1 No ratings yet.

At the time of presentation to the ED, laboratory results were significant for leukocytosis to 11.8 x 109 white blood cells/L and a partial pressure of carbon dioxide of 52 mmHg on venous blood gas. Computed tomography (CT) of the soft tissue of the neck with contrast showed edematous swelling of the epiglottis and aryepiglottic fold with internal foci of gas (blue arrow) and partial effacement of the laryngopharyngeal airway and scattered cervical lymph nodes bilaterally (Figure 1). Findings were consistent with epiglottitis containing nonspecific air. Additionally, the pathognomonic “thumbprint sign” (yellow arrow) was found on lateral x-ray of the neck (Figure 2). The CT findings as shown in figure 3 illustrate lateral view of the swelling of the epiglottis, gas, and blockage of the airway.

ENT Visual EM

An Unusual Case Report of a Toddler with Metastatic Neuroblastoma Mimicking Myasthenia Gravis

Raymen Rammy Assaf, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J8G35V Issue 7:1 No ratings yet.

While still in the ED, MRI with and without gadolinium contrast of the brain, orbits, and cervical, thoracic and lumbar spine were obtained to evaluate for possible CNS lesions including encephalitis, myelitis, or demyelination. Imaging, however, demonstrated multiple unexpected findings: a T1 hypointense, T2 hyperintense and heterogeneously enhancing right adrenal mass measuring 2.7 x 2.1 x 3 cm (yellow asterisk) along with heterogenous enhancement at the clivus, C6, C7, T7, T8, T12, and L3 vertebral bodies (red asterisks). There were otherwise no significant intracranial signal or structural abnormalities and normal orbits.

Pediatrics Hematology/Oncology Neurology Visual EM