Issue 7:2

Management of Poisoned Patients: Implementing a Blended Toxicology Curriculum for Emergency Medicine Residents

Madeline Dwyer, MD^*, Megan Stobart-Gallagher, DO^*, Jared Kilpatrick, MD^* and Alanna O’Connell, DO^{^}

DOI: https://doi.org/10.21980/J8C937 Issue 7:2 No ratings yet.

The goal of this curriculum is to introduce EM residents to core toxicology concepts and to reinforce toxicology principles through a multimodal approach that leads to increased confidence in the management of poisoned patients on shift.

Toxicology Curriculum

Peritonsillar Abscess Simulator: A Low-Cost, High-Fidelity Trainer

Chad R Keller, DO^*, Ivanna Nebor, MD^*, David Choi, MD, FRCSC^*, Kattia Moreno, MD^* and Yash J Patil, MD, MPH^*

DOI: https://doi.org/10.21980/J85M0B Issue 7:2 No ratings yet.

By the end of this training session, learners will be able to: 1) locate the abscess, 2) perform needle aspiration, and 3) develop dexterity in maneuvering instruments in the small three-dimensional confines of the oral cavity without causing injury to local structures.

Procedures ENT Innovations

Breaking Bad News in the Emergency Department

Susan Siraco, BA^*, Cindy Bitter, MD, MPH, MA^{^} and Tina Chen, MD^{^}

DOI: https://doi.org/10.21980/J81W7H Issue 7:2 No ratings yet.

At the conclusion of these two simulation cases, learners will be able to 1) recognize signs of poor prognosis requiring emergent family notification, 2) take practical steps to contact family using available resources and personnel, 3) establish goals of care through effective family discussion, 4) use a structured approach, such as GRIEV_ING, to deliver bad news to patients’ families, and 5) name the advantages of family-witnessed resuscitation.

Miscellaneous (stats, etc)Simulation

Infant Botulism

Victoria Morris, MD^*, Robert Wians, MD, MPH^*, Jessica Wilson, MD^* and Gowri Stevens, MD^*

DOI: https://doi.org/10.21980/J8X35W Issue 7:2 No ratings yet.

After this simulation learners should be able to: 1) develop a differential diagnosis for the hypotonic infant, 2) recognize signs and symptoms of infant botulism, 3) recognize respiratory failure and secure the airway with appropriate rapid sequence intubation (RSI) medications, 4) initiate definitive treatment of infant botulism by mobilizing resources to obtain antitoxin, 5) continue supportive management and admit the patient to the pediatric intensive care unit (PICU), 6) understand the pathophysiology and epidemiology of infant botulism, 7) develop communication and leadership skills when evaluating and managing critically ill infants.

Pediatrics Simulation Toxicology

Lightning Strike

Thomas Powell, MD^*, Aubri Charnigo, MD^* and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J8SD2M Issue 7:2 No ratings yet.

At the conclusion of the simulation session, learners will be able to: 1) Describe how to evaluate for scene safety in an outdoor space during a thunderstorm, 2) Obtain a relevant focused physical examination of the lightning strike patient, 3) Describe the various manifestations of thermo-electric injury, 4) Discuss the management of the lightning strike patient, including treatment and disposition, 5) Outline the principles of reverse triage for lightning strike patients, and 6) Describe long-term complications of lightning strike injuries.

Wilderness Simulation

3rd-Degree Atrioventricular Block

Patrick Meloy, MD^*, Dan Rutz, MD^{^} and Amit Bhambri, MD^†

DOI: https://doi.org/10.21980/J8NP9S Issue 7:2 No ratings yet.

At the end of this oral board session, examinees will: 1) demonstrate ability to obtain a complete medical history including detailed cardiac history, 2) demonstrate the ability to perform a detailed physical examination in a patient with cardiac complaints, 3) investigate the broad differential diagnoses which include acute coronary syndrome (ACS), electrolyte imbalances, pulmonary embolism, cerebrovascular accident, aortic dissection and arrhythmias, 4) obtain and interpret the cardiac monitor rhythm strip to identify complete heart block, 5) list the appropriate laboratory and imaging studies to differentiate arrhythmia from other diagnoses (complete blood count, comprehensive metabolic panel, magnesium level, EKG, troponin level, chest radiograph), 6) identify a patient with complete heart block and manage appropriately (administer IV atropine, attempt transcutaneous pacing, place a transvenous pacemaker, emergent consultation with interventional cardiology), 7) provide appropriate disposition to intensive care after consultation with interventional cardiologist.

Cardiology/Vascular Oral Boards

Point-of-Care Ultrasound to Diagnose Molar Pregnancy: A Case Report

Katherine Wietecha, MD^*, Caitlin A Williams, MS^{^}and Valori Slane, MD^*

DOI: https://doi.org/10.21980/J82W7T Issue 7:2 No ratings yet.

A transabdominal point-of-care ultrasound (POCUS) was initiated to determine whether an abnormality to the pregnancy could be identified. Curvilinear probe was used. Our transabdominal POCUS, in the transverse plane, showed a heterogenous mass with multiple anechoic areas in the uterus. The white arrow on the ultrasound identifies these findings. The classic “snowstorm” appearance was concerning for molar pregnancy.

Ob/Gyn Visual EM

A Case Report of Fournier’s Gangrene

Huy Alex Duong, BS^*, Mark Slader, BS^*, Jana Florian, MD^* and Jonathan Smart, MD^*

DOI: https://doi.org/10.21980/J8Z356 Issue 7:2 No ratings yet.

Physical exam revealed a comfortable-appearing male patient with tachycardia and a regular cardiac rhythm. The genitourinary exam indicated significant erythema and fluctuance of the bilateral lower buttocks with extension to the perineum. Black eschar and ecchymosis were also noted at the perineum. There was significant tenderness to palpation that extended beyond the borders of erythema. There was no palpable crepitus on initial examination. Physical exam was otherwise unremarkable.

Infectious Disease Urology Visual EM

A Case Report of the Rapid Evaluation of a High-Pressure Injection Injury of a Finger Leading to Positive Outcomes

Nathaniel Hansen, MD^*and Colin Danko, MD^*

DOI: https://doi.org/10.21980/J8TD2X Issue 7:2 No ratings yet.

On exam the patient was noted to have a punctate wound to the ulnar aspect of his right index finger, just proximal to the distal interphalangeal joint. The finger appeared pale and taut, with absent capillary refill. The patient displayed diminished range of motion with both extension and flexion of the joints of the finger. Sensation was absent and no doppler flow was appreciated to the distal aspects of the finger. X-ray of the hand was obtained and showed many small foreign bodies in the soft tissue and extensive radiolucent material consistent with gas or oil-based material to the palmar aspect of the index finger tracking up to the level of the metacarpal heads.

Orthopedics Visual EM

Unravelling the Mystery of a Continuous Coil: A Case Report

Ryan Brown, MD^*, Sharon Kim, PhD^{^}and Robert Tennill, MD^*

DOI: https://doi.org/10.21980/J8PM00 Issue 7:2 No ratings yet.

A CT scan of the abdomen and pelvis with intravenous contrast for evaluation of new onset abdominal pain and distension was obtained in the emergency department. The axial view (CT Image A) shows the coil pack from the prior coil-assisted retrograde transvenous obliteration procedure, seen in the left renal vein and gastric varix (red arrow). The path of the coil (yellow arrow) is continuous into the inferior vena cava (CT Image B). It is then seen (CT Image C) situated in the right ventricle (green arrow). Finally, the coil pack is seen in a coronal section, demonstrating its upward path (blue arrow) in the inferior vena cava. (CT Image D). Additional findings included ascites with advanced cirrhosis. As noted in the CT images, a vascular embolization coil was seen within a varix near the junction of the left renal vein. This appeared to have unraveled and extended superiorly into the inferior vena cava and ultimately into the right atrium and right ventricle.

Cardiology/Vascular Visual EM