Journal of education & teaching in emergency medicine最新文献

Audience: This simulation is intended to be used for emergency medicine (EM) residents (all levels) and 4th year medical students.

Introduction: Beta-blocker (BB) toxicity ranks seventh among the top 25 substances associated with fatalities, with a cardiovascular mortality rate of up to 1.4%.1,2 Patients with BB overdose may present with bradydysrhythmias, hypotension, hypoglycemia, altered mental status, and cardiogenic shock.3 Given that EM physicians are often the first to encounter such patients, EM learners need to be proficient in managing all aspects of BB toxicity.

Educational objectives: By the end of the session, learners will be able to: 1) manage a patient with hypotension, and bradycardia while maintaining a broad differential, 2) evaluate the causes of hypotension by utilizing ultrasound, 3) review when to initiate vasopressors and first-line agents for beta-blocker toxicity, 4) discuss treatment algorithm for BB toxicity including high-dose insulin and, 5) discuss the risk factors for suicide.

Educational methods: This session employed high-fidelity simulation followed by an in-depth debriefing. It was conducted during the orientation for first-year EM residents, with 16 residents participating. The group was divided into two cohorts: eight residents actively managed the simulated patient, while the other eight observed.

Research methods: Following the simulation and debriefing, participants were surveyed online using Google Form. The survey included the following questions: 1) the case was believable, 2) the case had right amount of complexity, 3) the case helped in improving medical knowledge and patient care, 4) I feel more confident in managing undifferentiated hypotension, 5) I feel more confident in managing BB overdose, 6) the simulation environment gave me a real-life experience and, 7) the debriefing session after simulation helped improve my knowledge. Responses were collected using a Likert scale.

Results: Ten participants completed the post-session survey. All respondents either agreed or strongly agreed that the case was effective in enhancing learning, medical knowledge, and patient care skills. Every participant found the debriefing session valuable and reported increased confidence in managing undifferentiated hypotension and BB toxicity.

Discussion: The simulation session effectively educated participants on the management of BB toxicity, reinforcing key concepts such as the treatment of hypoglycemia, bradycardia, and hypotension. As the case unfolded, learners were required to assess refractory hypotension and initiate vasopressor therapy and specific treatments for BB toxicity. Overall, participants found the simulation beneficial for learning the management of BB overdose.

Topics: Beta-blocker toxicity, refractory hypotension, bradyca

Audience: This simulation is designed for critical care transport nurses and attending physicians. It can also be adapted for critical care transport paramedics and respiratory therapists as well as emergency medicine nurses, residents, and attending physicians.

Introduction: Emergency and trauma surgery practitioners routinely perform primary and secondary surveys as a systematic approach to trauma care. While this approach has broad applications, clinicians must also be versed in the nuances of caring for special populations in trauma. One such example is the obstetric patient. The incidence of trauma in pregnancy is increasing and is now the leading cause of non-obstetrical maternal death in the United States.1 Optimal maternal resuscitation depends on an understanding of the significant anatomic and physiologic changes of pregnancy and their influence on airway, breathing, and circulation.2,3,4This case presents a blunt polytrauma with unstable pelvic and lower extremity fractures precipitating hemorrhagic shock and the need for blood product transfusion. Learners must quickly adapt their clinical acumen and consider the influence of an obviously gravid patient on their resuscitation. Implementing and practicing the required skills allows for delivery of high-quality care. This session ensures that learners have a well-rounded understanding of scenarios that could occur in the resuscitation of a pregnant trauma patient.

Educational objectives: At the completion of this simulation participants will be able to 1) perform primary and secondary trauma surveys, 2) assess the neurovascular status of a tibia/fibula fracture, 3) appreciate anatomic and physiologic differences in pregnancy, 4) appropriately order analgesia and imaging, 5) recognize and treat hemorrhagic shock, 6) perform an extended focused assessment with sonography in trauma exam (eFAST) in undifferentiated hemorrhage, 7) identify a displaced pelvic fracture and properly apply a pelvic binder, and 8) obtain and interpret fetal heart rate using ultrasound.

Educational methods: This is a high-fidelity simulation portraying a 24-year-old pregnant female who requires hemodynamic resuscitation, pelvic and extremity fracture stabilization, and assessment of fetal heart rate. After completion of the simulation, learners will participate in a debrief and small group discussion that focuses on didactic knowledge and its application to patient care, crew resource management, and interprofessional communication.

Research methods: Learners were required to complete a pre- and post-simulation test evaluating their knowledge of pregnant trauma patient care. The results were then compared to evaluate whether the simulation improved participants' knowledge base. Learners also completed an evaluation of the simulation case itself using a 5-point Likert scale and free response. Feedback fro

Abdominal pain is a common complaint in emergency medicine, with a vast differential diagnosis. We report a case of a 42-year-old male presenting with two days of progressively worsening left lower quadrant (LLQ) pain. A CT scan of the abdomen demonstrated a small metallic foreign body. The patient had not ingested any grilled food, since this was the speculated etiology, given the concern for potentially ingesting a wire grill brush piece. Considering the significant pain and associated computer tomography (CT) findings, the patient was taken to the operating room. A 2 cm piece of metal wire was found perforating his small intestines. The patient remembered a recent visit to his orthodontist which was uneventful. Complications from orthodontic procedures are rare and typically benign. We report an unusual case of an iatrogenic small bowel perforation from an archwire. The patient had a full recovery.

Topics: Orthodontist, bowel perforation, iatrogenic, archwire.

Calciphylaxis is a rare condition that is not well understood but is known to carry significant morbidity and mortality. We present a 44-year-old male with a history of end-stage renal disease on dialysis complaining of increasingly painful chronic wounds. The patient's physical exam was remarkable for ulcerated, bilateral anterior leg wounds with large areas of eschar along with purulent drainage. He was admitted to the hospital for intravenous antibiotics, wound care, and specialist consultation for treatment of calciphylaxis. This case report provides an overview of the key clinical features of calciphylaxis and reviews potential treatment strategies for this life-threatening condition.

Topics: Calciphylaxis, chronic kidney disease, end-stage renal disease, wound infection, wound care.

Subcutaneous emphysema (SE) is a rare but significant complication following dental procedures characterized by the presence of air in the subcutaneous tissue. This case report presents a 67-year-old male who developed right-sided facial swelling after tooth extraction, a procedure executed with high-power dental tools. Clinical findings included facial swelling and crepitus with no lip involvement, differentiating SE from an allergic reaction and hematoma. Diagnostic imaging through computed tomography (CT) and chest X-ray confirmed SE, showing diffuse subcutaneous air in facial and neck soft tissues. Initial management in the emergency department (ED) involved administration of antihistamines, corticosteroids, antibiotics, and otolaryngology (ENT) consultation with close monitoring for airway compromise. This case underscores the importance of including SE in differential diagnoses for post-dental procedure swelling, the effectiveness of CT imaging in SE identification, and the importance of early detection and treatment to prevent severe complications like respiratory and cardiac issues.

Topics: Subcutaneous emphysema; facial swelling; computed tomography (CT); dental procedure; emergency medicine.

Congenital diaphragmatic hernia is usually diagnosed prenatally and surgically repaired within the first few days of life. It is very rarely associated with acute gastric volvulus, an uncommon surgical emergency in children. A male infant with atypical presentation of acute gastric volvulus was diagnosed and treated by a swift-acting team across two medical centers. The patient presented with generalized abdominal distention and non-productive retching. Upper gastrointestinal series diagnosed acute gastric volvulus. During laparoscopic intervention, the volvulized stomach and the spleen were identified within an undiagnosed congenital diaphragmatic hernia. Corrective surgery was performed, and the patient tolerated a regular diet within days and continues to do well. Given the emergent nature of acute gastric volvulus in children, a high index of suspicion is warranted to quickly initiate potentially life-saving diagnostics and treatment.

Topics: Acute gastric volvulus, diaphragmatic hernia, pediatric.