Journal of education & teaching in emergency medicine最新文献

Orbital compartment syndrome (OCS) is an ophthalmologic emergency due to an acute rise in intra-orbital pressure and can result in permanent vision loss, oftentimes requiring emergent surgical decompression. Orbital compartment syndrome most commonly occurs due to recent trauma and is often easily diagnosed by history and physical exam. However, there are other causes of OCS where a more subacute/chronic rise in pressure can lead to an atypical presentation. This is a case report of a 48-year-old male who presented with left eye pain and swelling for the past 6 months. The patient had seen two ophthalmologists prior to his emergency department (ED) presentation who had prescribed him an antibiotic ointment, oral steroids, and steroid eye drops. The physical exam in the ED was concerning for increased intra-ocular pressure (IOP) and decreased vision. Ophthalmology was consulted and requested magnetic resonance angiography (MRA) to assess a vascular etiology given tortuous retinal vasculature. Emergent surgical decompression was deferred due to chronicity of symptoms, and patient was started on dorzolamide/timolol and brimonidine eye drops as well as intravenous (IV) acetazolamide with subsequent improvement in IOP. Imaging revealed a left carotid-cavernous sinus fistula (CCF), and the patient was admitted to neurosurgery. Patient successfully had an embolization with subsequent normalization of IOP and improvement of symptoms. This case is a good example of how non-traumatic causes of OCS can lead to misdiagnosis and how surgical decompression could potentially be deferred in subacute OCS.

Topics: Ocular compartment syndrome, carotid cavernous fistula, eye pain, eye swelling, vision loss.

Audience: The target audience for this communication case is senior residents and junior faculty preparing for the American Board of Emergency Medicine (ABEM) Certifying Exam. Secondary audiences include junior emergency medicine (EM) residents.

Introduction: Rapid identification of clinical changes, reassessment of previous diagnoses, and appropriate adjustment of interventions are critical skills in EM. This case highlights the skills needed to recognize and manage a change in condition with acute pulmonary edema, a life-threatening condition that requires prompt intervention.

Educational objectives: By the end of the case, the learner should will be able to: 1) demonstrate competency with the new ABEM Certifying Exam Reassessment case format, 2) demonstrate the ability to evaluate new information and integrate it into an existing care plan, 3) recognize signs and symptoms of pulmonary edema, 4) review possible etiologies of acute respiratory distress and the evaluation/work up to differentiate and diagnose those causes, and 5) manage pulmonary edema including implementing afterload reduction, positive pressure ventilation, and diuresis.

Educational method: This is a standardized patient scenario, in alignment with the expected reassessment case format of the ABEM Certifying Exam. This educational modality is advantageous for assessing the learner's ability to acquire history and physical examination data in a clinical environment, as well as to communicate with a patient using clear, understandable, and appropriate language.

Research methods: This case was iteratively evaluated using facilitator and learner surveys at three sites: an academic EM residency program, the 2025 Society for Academic Emergency Medicine Annual Meeting, and a second academic EM residency program. Feedback at each site informed further refinements. A total of 11 senior resident learners and four facilitators tested the case, providing feedback on its quality and usefulness.

Results: Learners and facilitators found the case well-written and effective. All 11 learners felt that the case was helpful practice for the ABEM Certifying Examination. Additionally, all facilitators felt the case materials were easy to use and would use the case again in the future.

Discussion: The case was well-received by both learners and facilitators and appears to be a good preparatory tool for the Reassessment case format of the ABEM Certifying Exam.

Topics: Pulmonary edema, sign-out, reassessment, Certifying Exam.