Journal of education & teaching in emergency medicine最新文献

Fournier's gangrene is a well-established surgical emergency as patients can decompensate rapidly, resulting in significant morbidity and mortality. We describe a case in which a 54-year-old medically complex male presented to the emergency department (ED) with a primary complaint of abdominal pain after a therapeutic paracentesis was performed by interventional radiology just prior to arrival. Upon further questioning, the patient reported scrotal pain that had developed over three to four days. On exam, the patient was well-appearing although he did have scattered scrotal masses with chalky white purulence. Given the relatively quick development, an atypical presentation of Fournier's gangrene was suspected, and the patient was started on antibiotics with urology immediately consulted. Imaging was concerning for subcutaneous gas. The patient was subsequently taken to the operating room (OR) for debridement, where Fournier's gangrene was confirmed by surgical investigation and culture. Significant lessons from the case include the importance of early identification of Fournier's gangrene and having a low threshold to start treatment in coordination with a surgical service for atypical presentations.

Topics: Fournier's gangrene, bilateral epididymitis, scrotal pain, urologic emergency, renal transplant.

We present a case of a 75-year-old female with a history of congestive heart failure who developed a large edema bulla on her right shin after running out of her home medications. The patient presented with swelling and a rapidly enlarging bulla that reached the size of a grapefruit. Physical examination revealed bilateral pitting edema and a 10 x 10 cm bulla filled with serous fluid. Dermatology was consulted, confirming the diagnosis of edema bulla secondary to acute volume overload. The bulla was drained in the emergency department, and the patient was discharged with wound care instructions, including the application of petroleum jelly and vinegar compresses. Follow-up three months later showed significant healing. This case highlights the importance of recognizing edema bullae in patients and managing the underlying fluid overload. This case report specifically demonstrates that edema bullae can present at sizes larger than the 1-5 cm range described in existing literature.

Topics: Bulla, vesicle, dermatology, blister.

This case highlights a rare and complex occurrence of an open chest wound with a pathologic sternal fracture. This resulted from a combination of remote chest trauma, chronic chest wall infection, malignancy, and ultimately, sternal osteomyelitis. A 69-year-old male presented with a large, open anterior chest wound, chronic ulceration, and weight loss. Thirty years earlier, the patient had sustained trauma from a firecracker, which led to a chronic wound for which he did not seek medical attention. Physical exam revealed a large open chest wound with an open sternal fracture and exposed pericardium. The patient underwent surgical resection, followed by chest wall reconstruction using a rectus myocutaneous flap. Tissue pathology confirmed squamous cell carcinoma and osteomyelitis of the sternum. The case demonstrates the complexity of managing a large chronic chest wound and pathologic sternal fracture secondary to malignancy and osteomyelitis. The key lesson is the importance of early medical evaluation and a multidisciplinary approach to improve outcomes in similar scenarios. The rarity of this case emphasizes the need for heightened awareness among clinicians who may encounter earlier presentations of this disease process in order to prevent complications, such as osteomyelitis, pathological fractures and structural instability of the chest wall.

Topics: Open sternal fracture, open chest wound, chest wall malignancy, squamous cell carcinoma, sternal osteomyelitis, chronic chest wall infection.

Audience and type of curriculum: This electrocardiogram (ECG) curriculum was designed for residents of all levels.

Length of curriculum: The curriculum runs over 1.5 years and is repeated, so that there will be repetition during a resident's training.

Introduction: Electrocardiogram interpretation is a vital skill for emergency physicians. Formal ECG education in emergency medicine (EM) often consists of a few conference lectures, with the majority of education relegated to the clinical environment. However, this often leaves significant gaps in education, as a full curriculum cannot be implemented within limited conference time.

Educational goals: The goals of the curriculum were to establish an asynchronous ECG curriculum to help improve standardization of EM resident education, expose EM residents to a more comprehensive ECG curriculum, increase active learning in this arena, and decrease the administrative burden while not dedicating further conference time towards ECG education.

Educational methods: The educational strategies used in this curriculum include weekly case emails with instructional content located on a Google Site. These were added to conference lectures that were standard ECG education prior to this initiative. The first year of the augmented curriculum added only the weekly ECG emails with a follow-up answer email, and the website was created for the second year of curriculum implementation.

Research methods: The educational content was assessed by the learners via a survey to gauge resident satisfaction as well as level of engagement and barriers to use. Additionally, the content was assessed via resident testing at the end of their second year so that they had completed a complete cycle of the curriculum.

Results: The asynchronous curriculum improved resident test scores with the addition of the weekly emails from an average of 70% and pass rate of 58% to 82% and 92%, respectively (p=0.012). The addition of the informational website did not further improve scores, though it decreased variation in scores. The residents found the curriculum useful for their education.

Discussion: Curriculum implementation was successful to improve on resident ECG education, both in terms of objective testing as well as resident feedback. It is a sustainable curriculum with methodology that requires little faculty time after setup; the maintenance required for the curriculum mostly consists of updating resident contacts as classes graduate. However, the setup time was significant; despite this, the authors believe this is a time-effective method of educational programming given the little ongoing time requirements.

Topics: Electrocardiogram, curriculum development.