Type IV hypersensitivity reactions are delayed, cell-mediated reactions between T cells and antigens that normally occur usually within 48 to 72 hours after exposure to an antigen. This is a case of a 51-year-old male status post left Achilles tendon repair with findings consistent with a type IV hypersensitivity reaction on post-operative day 12. The patient's examination revealed blistered and macerated skin underneath the region of the wound closure strips and liquid skin adhesive. Wound care and debridement were initiated on post-operative day 14 by a wound care specialist. After six weeks of weekly wound care with debridement, the wound ultimately healed. Clinicians should be aware of the ability for any patient to develop a delayed type IV hypersensitivity reaction to treatment regimens, including dermatologic wound closure strips and liquid skin adhesives.
Topics: Type IV hypersensitivity reaction, wound closure strips, liquid skin adhesive.
Audience: Emergency medicine residents and emergency ultrasound fellows.
Introduction: Point-of-care ultrasound (POCUS) is an essential emergency medicine skill that requires hands-on practice and an understanding of anatomy in three-dimensional space.1 Experientially, some common POCUS challenges are identifying foreign bodies in soft tissue, recognizing nerves, and identifying lower extremity veins in relation to other anatomic landmarks. But finding novel ways to challenge and engage advanced learners who have mastered basic POCUS content can be difficult, and this was the impetus of the current gamified educational activity.
Educational objectives: By the end of this session, the participant will be able to:Evaluate and identify the nature of metallic foreign bodies using POCUS.Identify common emergency department fractures on X-Ray and identify relevant sonoanatomy for ultrasound-guided regional anesthesia applications relevant to those fractures.Identify normal lower extremity venous POCUS sonoanatomy and demonstrate understanding of proximal versus distal anatomical location within the lower extremity venous system.
Educational methods: A hands-on, gamified approach was used. This approach builds on previously published escape room models to focus on the application of the three POCUS indications described above.2,3.
Research methods: After the activity, participants filled out a standardized teaching evaluation including questions about the quality of the material presented, the degree to which they felt actively involved as learners, and free-text qualitative feedback.
Results: Our test group including emergency ultrasound fellows and senior emergency medicine residents successfully completed the escape room. Three of the four participants (75%) completed the evaluation; 3/3 (100%) rated the escape room as exceeded expectations for actively involving learners and qualitatively reported that the activity was "fun," "interactive," "engaging," and "innovative."
Discussion: We found that using an escape room format for POCUS education was effective and engaging. However, it is important to note that small details in the escape room design may have large impacts on the ability of the learners to complete the activity and meet the educational goals. Overall, we found that this activity was effective and fun for both learners and educators.
Topics: Point-of-care ultrasound (POCUS), team building, foreign body identification, ultrasound image review, lower extremity venous, ultrasound-guided regional anesthesia.
Audience and type of curriculum: This emergency medicine asynchronous curriculum is designed for emergency medicine sub-interns.
Length of curriculum: The curriculum runs monthly over a four-week sub-internship rotation.
Introduction: Emergency medicine sub-interns are at an intermediate stage of training and require exposure to material that agrees with their training level. Asynchronous learning is an effective way to supplement sub-interns' learning, and free open-access medical education (FOAM) provides valuable content for asynchronous curricula.
Educational goals: The global purpose of the curriculum is to supplement sub-interns' learning with high-yield emergency medicine topics while introducing them to various FOAM resources.
Educational methods: A gap-analysis was conducted to suggest content most appropriate for the asynchronous curriculum, and the curriculum was designed with adult learning theories in mind. The educational strategies used in the curriculum include articles, videos, podcasts, diagrams, cases, and practice questions from various high-quality FOAM resources. The content is broken up into four core modules (trauma, eye complaints, shock, obstetric and gynecologic (OBGYN) complaints) and two bonus modules (orthopedic complaints, ultrasound basics), and the modules are available on the sub-internship website for students to access throughout their rotation.
Research methods: The educational content was evaluated by the learners using pre-rotation, post-module, and post-rotation surveys.
Results: Survey results show that at least 95% of students agreed with meeting each of the modules' learning objectives. The curriculum also significantly increased learners' confidence in evaluating specific chief complaints and ultrasounds. Students reported an increased likelihood of changing their clinical practice, an increased awareness of the role of social determinants of health, and an increased preparedness for residency after engaging with the curriculum.
Discussion: Asynchronous curricula using thoughtfully-selected FOAM content and resources can effectively supplement synchronous learning methods in emergency medicine sub-internships. The curriculum is easy to implement and receives high satisfaction from students.
Topics: Sub-Internship, asynchronous curriculum, free-open access medical education, trauma, eye complaints, shock, OBGYN complaints, ultrasound, social determinants of health.
Audience: Emergency medicine residents and medical students.
Introduction: Many emergency medicine residency programs have their residents take an in-training exam (ITE) in which performance has been linked to certifying exam pass rates, so solid preparation is important.1 The typical clinical schedule of an emergency medicine resident is incredibly varied and time-consuming, which limits time to dedicate to preparation. All emergency medicine programs have synchronous and asynchronous protected time for resident education which provides an excellent opportunity to prepare learners for in-training exams and thus the certifying exam. Gamification is a promising tool some educators have turned to which has been shown to improve attitudes and behaviors towards learning.2 This may make it a useful tool for board-review, particularly for the cohort of residents who may have negative attitudes or behaviors towards preparing for it.3 This session took inspiration from "The Amazing Race" - a reality television competition where teams race around the world - to provide learners with an exciting activity during dedicated synchronous or asynchronous educational conference time, which may be helpful for board review. Residents may prefer question-based preparation for the in-training exam, so the authors devised The EMazing Race to include some components of this while also adding more clinical practice-relevant topics and activities.3.
Educational objectives: By the end of this 2-hour session, learners will demonstrate their knowledge on the following board-related emergency medicine topics: Ob/GYN - links to 13.7 Complications of Delivery in Core Model of EM 2022 1. Know the first maneuver to manage a nuchal knot in an emergency delivery2. Recognize the signs of shoulder dystocia and learn multiple maneuvers to manage this including McRoberts, suprapubic pressure, Rubin, Woods, and Menticoglou3. Identify the steps in delivering a fetus in breech positioning and learn about the Gaskin maneuver4. Understand management of trauma in pregnant patients including maneuvers to manage hypotension, recognition of uterine rupture, placental abruption, as well as rupture of membranes and its diagnostic findings Renal/GU - links to 15.0 Renal and Urogenital Disorders in Core Model of EM 2022 5. Review indications for admission in patients with nephrolithiasis such as intractable nausea and vomiting6. Recognize signs of acute tubular necrosis by urinalysis findings7. Recall that staghorn calculi are most commonly composed of magnesium, ammonium, and phosphate8. Identify appropriate medications to manage hypertension in patients with kidney disease9. Recall various managements of priapism including intracavernosal irrigation, drainage, and phenylephrine injection10. List specific indications for emergent hemodialysis including specific medications11. Identify appropriate medications to manage
Audience: The aim of this simulation case is to educate medical students, interns, junior residents, senior residents, nurses, and faculty on how to identify victims of human trafficking in the healthcare setting. This scenario is adaptable for emergency medicine, outpatient clinic settings, and prehospital settings, including EMS personnel as learners.
Introduction: Human trafficking is a profound violation of human rights and a pressing local, national, and global health problem. Victims are reduced to objects for commerce, fueling a $150 billion-dollar industry and representing the second largest source of income for organized crime.1,2,3,4 Globally, an estimated 40.3 million people are victims of modern slavery, with more than 70% being women and girls, and one in four victims being children under the age of 18.3,4 While once perceived as a mostly international problem, prevalence estimates now show 5.4 victims per 1,000 people across the world, with 1.3 victims per 1,000 in the United States for forced labor.4Healthcare providers are among the few professionals likely to encounter victims. Multiple studies show that 28-88% of victims sought medical care while being trafficked.6-9 These victims are most likely to seek medical care from emergency departments (63.3%), Planned Parenthood clinics (29.6%), private practices (22.5%), urgent care clinics (21.4%), women's health clinics (19.4%), and neighborhood clinics (19.4%).8 Despite this, only a small fraction of emergency physicians report receiving formal training on human trafficking. This highlights the critical need for enhanced education in emergency medicine, where providers are frequently the first point of contact for victims.
Educational objectives: At the conclusion of this case, learners should be able to: 1) review red flags of identifying victims of human trafficking in healthcare settings, 2) identify common indicators and injuries associated with human trafficking, 3) demonstrate a trauma-informed care approach when interviewing potential victims, 4) list and provide patients with national resources for human trafficking,5) understand federal and state mandatory reporting laws and the role of the healthcare provider, 6) determine best treatment options in patients with limited healthcare access, including counseling on empiric treatment of sexually transmitted infection (STI), 7) review management options for an undesired pregnancy according to local institutional policies and state laws for the senior case.
Educational methods: This simulation was designed to assess and improve the level of knowledge on identifying victims of human trafficking in the healthcare setting. This session was conducted using standardized patients portraying both the patient and father/trafficker, a faculty member in the nursing role, and a second faculty member in the control booth. The control booth faculty adjus
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：