Issue 9:2
Modification of an Airway Training Mannequin to Teach Engagement of the Hyoepiglottic Ligament
DOI: https://doi.org/10.21980/J8R06PBy the end of this education session, participants should be able to: 1) identify relevant airway anatomy during intubation, including base of the tongue, epiglottis, midline vallecular fold, anterior arytenoids; 2) appreciate the value of a stepwise anatomically guided approach to intubation; 3) become familiar with the midline vallecular fold and underlying anatomy, including the hyoepiglottic ligament, and how proper placement of the laryngoscope can result in improved glottic visualization.
A Realistic, Low-Cost Simulated Automated Chest Compression Device
DOI: https://doi.org/10.21980/J8M63CBy the end of this educational session using a resuscitation trainer or high-fidelity manikin, learners should be able to: 1) recognize appropriate application of simulated ACCD to an ongoing resuscitation case; 2) demonstrate proper positioning of simulated ACCD in manikin model and 3) integrate simulated ACCD to provide compressions appropriately throughout cardiac arrest scenario.
Septic Abortion Complicated by Disseminated Intravascular Coagulation
DOI: https://doi.org/10.21980/J8GH1GAt the conclusion of the simulation session, learners will be able to: 1) Obtain a relevant focused history including pregnancy history, medication use, and past medical history. 2) Develop a differential for fever and vaginal bleeding in a pregnant patient. 3) Discuss management of septic abortion, including empiric broad-spectrum antibiotics and obstetric consultation for source control with dilation and curettage (D&C). 4) Discuss expected laboratory findings of disseminated intravascular coagulation (DIC). 5) Discuss management of DIC, including identification of underlying etiology and supportive resuscitation with blood products. 6) Review the components of blood products. 7) Identify appropriate disposition of the patient to the intensive care unit (ICU).
Electrical Storm/Refractory Ventricular Tachycardia
DOI: https://doi.org/10.21980/J8TS80By the end of this simulation, learners should be able to: 1) recognize unstable ventricular tachycardia and initiate ACLS protocol, 2) practice dynamic decision making by switching between various ACLS algorithms, 3) create a thoughtful approach for further management of refractory ventricular tachycardia, 4) interpret electrocardiogram (ECG) with ST-segment elevation (STE) and left bundle branch block (LBBB), 5) appropriately disposition the patient and provide care after return of spontaneous circulation (ROSC), 6) navigate a difficult conversation with the patient’s husband when she reveals that the patient’s wishes were to not be resuscitated.
Managing STEMIs without a Catheterization Lab: A Simulated Scenario to Improve Emergency Clinician Recognition and Execution of Thrombolysis in the Setting of Rural STEMI Management
DOI: https://doi.org/10.21980/J8K933By the end of this simulation, learners will be able to: 1) diagnose ST elevation myocardial infarction accurately and initiate thrombolysis in the rural setting without timely access to cardiac catheterization; 2) engage the simulated patient in a shared decision-making conversation, clearly outlying the benefits and risks of thrombolysis; 3) identify the indications and contraindications for thrombolysis in ST elevation myocardial infarction; 4) arrange for transfer to a tertiary care center following completion of thrombolysis.
Hypertensive Emergency Team-Based Learning
DOI: https://doi.org/10.21980/J8BP90By the end of this TBL session, learners should be able to: 1) define features of asymptomatic hypertension versus hypertensive emergency, 2) discuss which patients with elevated blood pressure may require further diagnostic workup and intervention, 3) identify a differential diagnosis for patients presenting with elevated blood pressures, 4) recognize the features of different types of end-organ damage, 5) review an algorithm for the pharmacologic management of hypertensive emergencies, 6) indicate dosing and routes of various anti-hypertensive medications, 7) choose the appropriate treatment for a patient who is hypertensive and presenting with flash pulmonary edema, 8) identify an aortic dissection on computed tomography (CT), 9) choose the appropriate treatment for a patient who is hypertensive and presenting with an aortic dissection, 10) identify intracranial hemorrhage on CT, 11) choose the appropriate treatment for a patient who is hypertensive and presenting with an intracranial hemorrhage, and 12) describe the intervention for warfarin reversal.
A Case Report of Acute Compartment Syndrome
DOI: https://doi.org/10.21980/J87061Inspection of the extremity revealed significant swelling with dark discoloration and multiple bullae (pre-operative photograph). Furthermore, notable swelling of the right foot was noted, which felt cold to palpation. Radiographs of pelvis, bilateral knees, tibia, fibula, and feet demonstrated no fractures or dislocations. The bilateral tibia and fibula X-ray revealed soft tissue swelling in the proximal legs, particularly evident in the right leg's AP view, which also showed numerous ovoid radiodensities in the anterior compartment, likely related to soft tissue injury. Post operative images are also provided demonstrating the patients’ four compartment fasciotomies which were loosely closed using staples.
Vaginal Bleeding Due to Iatrogenic Uterine Perforation – A Case Report
DOI: https://doi.org/10.21980/J83643The bedside transabdominal US of the pelvis showed a heterogeneous mixture of hypoechoic and hyperechoic endometrial thickening extending to the lower uterine segment (blue arrow), which was thought to represent active hemorrhage. Computed tomography of the abdomen and pelvis showed evidence of a large amount of endometrial hyperdensity (red arrow) suggestive of hemorrhagic contents within a grossly enlarged uterus. There was relative decreased enhancement of the uterine body and fundus, concerning for devascularization. There was also active extravasation along the left lateral uterus (yellow arrow).
A Case Report Evaluating Gastric Emphysema versus Emphysematous Gastritis
DOI: https://doi.org/10.21980/J8ZH26A CT scan of the abdomen and pelvis was obtained and revealed gas within the gastric wall at the fundus (blue arrows), concerning for gastric emphysema versus emphysematous gastritis. There was no gastric wall thickening, free air, bowel obstruction, drainable fluid collection, or evidence of portal venous gas. Incidentally, hepatomegaly and likely hepatic steatosis were also noted.
Telescoping into Adulthood: A Case Report of Intussusception in an Adult Patient
DOI: https://doi.org/10.21980/J8Q06CComputed tomography imaging of the abdomen and pelvis with intravenous and oral contrasts was obtained. In the axial view, one will see a concentric ring formed by layers of bowel, mesenteric vessels, and fat (red arrow and circle); this is the equivalent of the ultrasonographic “target sign.” The inner ring (blue arrow) represents the lead point causing telescoping of the bowel. One can see that the proximal bowel is dilated (yellow arrow). In the coronal view, one can see an obstructive mass, also known as the lead point (red arrow), located in the lumen of the descending colon. Located proximal to the lead point are dilated loops of bowel with edematous changes and fat stranding (pink circle). The proximal portion of the bowel will take on a concentric appearance with the telescoping loop of bowel.