Recent uciem_jetem items

Case Report: Acute Dyspnea in a Young Female

Wed, 6 May 2026 00:00:00 +0000

Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas, primarily affecting the lungs but also involving other organs such as the skin, eyes, and heart.¹ Due to its variable presentation, diagnosing sarcoidosis in the emergency department (ED) can be challenging. We report a case of a 28-year-old African American female presenting with acute dyspnea on exertion, significant weight loss, and multiple cutaneous nodules. Her diagnostic workup revealed hypercalcemia, diffuse pulmonary nodules, and extensive lymphadenopathy on imaging. Biopsy of her eyelid lesions confirmed non-caseating granulomas, leading to a diagnosis of sarcoidosis. She was initiated on high-dose steroids and evaluated for further immunologic therapy. Sarcoidosis presents a diagnostic challenge due to its nonspecific symptoms, often mimicking more common conditions.² Early...

Midline Catheters: A Novel Curriculum for Emergency Medicine Residents

Wed, 6 May 2026 00:00:00 +0000

Audience and Type of Curriculum: This curriculum is designed for all levels of emergency medicine (EM) Residents. The curriculum covers the appropriate anatomy, indications, contraindications, and specific steps for placement of midline catheters.

Length of Curriculum: Three one-hour sessions over a period of three months or a single three-hour session.

Introduction: Midline catheters have become more mainstream in the emergency department as a replacement for central lines. They are readily insertable into a peripheral vein and useful for access, blood draws, and medication administration, which are well...

Enhancing Relationship-Centered Communication and Feedback in Emergency Medicine Through Applied Improvisation (EM-PROV)

Wed, 6 May 2026 00:00:00 +0000

Audience: This small group session is intended for emergency medicine residents, medical students, and faculty.

Introduction: Improvisational techniques offer a novel and effective approach to teaching relationship-centered communication (RCC) and enhancing learner feedback in emergency medicine (EM).¹ Improvisational theater (improv) is a form of spontaneous performance where all things or most things are made up on the spot. The “yes, and” principle—accepting a partner’s idea ("yes") and building upon it ("and")—reflects core improv values such as affirmation, spontaneity, active listening, and empathy, all of which contribute to psychologically safe learning environments.¹ It is an engaging practice that can foster creativity,...

Escape Intern Orientation! — A Capstone and Team Building Activity for New EM Interns

Wed, 6 May 2026 00:00:00 +0000

Audience: This activity is designed as a team building capstone exercise for new interns to review important content from intern orientation at an emergency medicine residency program.

Introduction: Medical students matriculate into residency with various backgrounds, medical knowledge base, and personalities. As they orient themselves into their respective specialties, interns are commonly taught using lectures and slide decks with varied and unclear effectiveness.^1,2 It has been recommended that intern orientation should incorporate active learning, such as simulation as well as a collaborative environment to bolster retention and encourage teamwork.^1,3Escape rooms are becoming increasingly popular in medical education as...

A Case Report on an Open Fracture Dislocation Injury of the Proximal Phalanx of the Thumb Resulting from Playing Cricket

Wed, 6 May 2026 00:00:00 +0000

Open fractures represent high acuity injuries requiring rapid evaluation and management for optimal outcomes. In this report, we discuss a patient presenting with an open fracture of the proximal phalanx of the right thumb with interphalangeal (IP) joint dislocation. The patient reported that the injury occurred in the setting of trauma from catching a cricket ball, experiencing immediate severe pain and bleeding. Key interventions in the emergency department included rapid x-ray evaluation of the injury, administration of cefazolin and tetanus vaccine, pain control, covering the exposed bone in moist gauze, and involvement of the hand surgery team for bedside irrigation and reduction. He underwent open reduction and internal fixation of the fracture the next day. He was followed in the hand clinic and was doing well at the 12-week appointment. In summary, we report on an open fracture and dislocation of the proximal phalanx of...

Postpartum Complications TBL

Wed, 6 May 2026 00:00:00 +0000

Audience: The intended audience for this modified TBL are resident physicians of all years, PGY1-4.

Introduction: Biological females represent 50% of the population we encounter in the emergency department (ED), and following delivery, the ED is often the main resource for postpartum patients to seek urgent/emergent care. The US is one of the most dangerous developed nations for pregnant women, with about 1/3 of pregnancy related deaths occurring in the postpartum period.^1,2 It is presumed that many of these deaths are related to lack of support or insurance for close follow up after delivery.² The three most common reasons for postpartum hospital readmission and mortality are cardiovascular related disorders (such as hypertension,...

Overlooked and Undernourished: A Case Report of Scurvy Linked to Food Insecurity

Wed, 6 May 2026 00:00:00 +0000

Food insecurity is a commonly underrecognized social determinant of health and is a risk factor for severe, though uncommon, nutritional deficiencies. This report describes a 60-year-old male with a history of asthma and housing instability who presented to the emergency department (ED) for shortness of breath and was found to have classic findings of vitamin C deficiency, colloquially known as scurvy. Examination revealed diffuse wheezing, poor dentition with palatal ecchymosis, and a perifollicular rash with scattered bruising on his bilateral lower extremities. Due to financial struggles, he was experiencing food and housing insecurity, with a diet primarily composed of processed carbohydrates. Laboratory studies revealed anemia, hypoalbuminemia, and severely low levels of vitamins C and B6. He was admitted for management of his asthma exacerbation and treatment of his nutritional deficiencies with vitamin supplementation, electrolyte...

Trapped In Transit – A Case Report of a Pediatric Gastric Bezoar Causing Intermittent Small Bowel Obstruction

Wed, 6 May 2026 00:00:00 +0000

A 14-year-old female patient presented to the pediatric emergency department (ED) with chief complaints of abdominal pain, vomiting, and unintentional weight loss. A palpable abdominal mass was noted on exam, prompting a computed tomography (CT) scan which revealed a gastric bezoar that had fragmented, leading to intermittent and spontaneously resolving small bowel obstruction. The patient underwent surgical removal of the bezoar for definitive management.

This report highlights a novel case of spontaneous bezoar fragmentation and its associated imaging findings. Because this phenomenon represents the description of a rare occurrence, the goal is to enhance the emergency medicine providers’ understanding of an uncommon cause of abdominal masses and small bowel obstruction (SBO).

A Novel Low-Cost Phantom for Ultrasound-Guided Fascia Iliaca Nerve Blocks

Wed, 6 May 2026 00:00:00 +0000

Audience: This phantom is designed to instruct emergency medicine residents in ultrasound-guided fascia iliaca (FI) nerve blocks but could also be used for medical students and attending physicians.

Introduction: Ultrasound-guided regional nerve blocks are increasingly used in the emergency department for pain management. The FI block, used for pain management in patients with hip fractures, have been shown to provide pain relief for up to eight hours with rare complications and to decrease need for parenteral pain medication.^1,2 It is considered best practice to train physicians in ultrasound-guided procedures such as FI blocks by using phantoms, which are objects designed to mimic human tissue and anatomy relevant to the specific...

OptimEYEzing Emergency Skills: A Novel Model for Ocular Procedural Education for Emergency Medicine Residents

Wed, 6 May 2026 00:00:00 +0000

Audience: This model for ocular procedural education is designed to instruct emergency medicine residents of all levels of training.

Introduction: Ocular complaints are a common presentation to the emergency department (ED) with some studies quoting as many as two to three million ocular-related visits annually.^1,2 These complaints can range from minor issues, such as corneal abrasions, to more serious conditions that require prompt evaluation and management, such as retrobulbar hematomas. Emergency medicine physicians are often the first-line providers assessing these complaints, so it is imperative that they feel adept in recognizing and managing these complaints.²

Low-Cost, Reusable Fracture Reduction Task Trainer for Distal Radius Fractures

Wed, 6 May 2026 00:00:00 +0000

Audience: This task trainer is designed to instruct emergency medicine (EM) resident physicians, senior medical students, and advanced practice providers.

Introduction: While orthopedic emergencies are common, exposure to fracture management may vary depending on one’s training environment. Given that extremity bony trauma and fracture reduction techniques are listed as core content topics in the American Board of Emergency Medicine’s (ABEM) 2022 Model of the Clinical Practice of Emergency Medicine,¹ it is beneficial to practice their management in a simulated environment. Fracture reduction is particularly difficult to practice without any task trainers. Commercial fracture models are available and cost thousands of dollars which limits universal...

Diagnosis of Sinonasal Carcinoma in the Emergency Department: A Case Report Highlighting Red Flag Symptoms

Wed, 6 May 2026 00:00:00 +0000

Sinonasal carcinoma is a rare malignancy that often presents with nonspecific symptoms, making early diagnosis challenging. Delayed recognition can lead to disease progression and worse outcomes. This case report emphasizes the importance of early identification, prompt imaging, and multidisciplinary management. A 73-year-old male with a history of anemia and hypertension presented with progressive facial swelling, 20-pound weight loss, and vision loss in the left eye over two months. Initially misdiagnosed with bacterial sinusitis, his symptoms persisted. Examination revealed a proptotic left eye and a large obstructive nasal mass. Computed tomography (CT) and MRI (magnetic resonance imaging) demonstrated a destructive sinonasal mass with skull base and intracranial extension. A biopsy confirmed sinonasal carcinoma, and the patient was started on chemoradiation therapy due to the inoperability of the tumor.

Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of assisted reproductive technology (ART). Here, we present the case report of a 30-year-old female undergoing infertility treatment who presented to the emergency department (ED) with nausea and vomiting, abdominal distention, and shortness of breath. On physical exam, she had notable ascites. Computed tomography (CT) of the abdomen and pelvis and pelvic ultrasound (US) revealed significant ascites and enlarged ovaries with multiple cysts. She was diagnosed with severe OHSS and admitted to obstetrics and gynecology (OBGYN) service for five days where she underwent intravenous (IV) hydration and paracentesis. This case report reviews the clinical presentation, categorization, management, and prevention of OHSS and provides examples of imaging findings consistent with the condition.

The Rash That Didn’t Blanch: A Case Report of Adult-Onset IgA Vasculitis with Underlying Cirrhosis and IgA Nephropathy

Wed, 6 May 2026 00:00:00 +0000

Rashes are a common presentation in the emergency department (ED) and can signify a wide variety of underlying conditions. Early recognition of serious dermatologic rashes in the acute care setting is essential in improving patient outcomes. Here we describe the case of a 69-year-old female with a medical history of cirrhosis with ascites, chronic kidney disease (CKD) secondary to immunoglobulin A (IgA) nephropathy, and hypertension who presented to the ED with a chief complaint of foot pain with an associated rash. On examination, she had tender purpura with bilateral symmetric pedal edema. Initial work up in the ED was significant for mildly elevated inflammatory markers. Given the concern for vasculitis, dermatology was consulted; punch biopsy confirmed IgA vasculitis. The patient was subsequently admitted for acute renal injury and started on corticosteroids. After a week-long inpatient stay, she was discharged home in stable...

Woman with a Blackened Tongue: A Case Report

Wed, 6 May 2026 00:00:00 +0000

Primary adrenal insufficiency is a rare disease characterized by deficient production of glucocorticoids with or without a deficiency of mineralocorticoids and adrenal androgens.¹ This disease can present as a range of symptoms provoking a visit to the emergency department (ED). In this case, we present a 40-year-old female who reported tongue and gingival discoloration, unintentional weight loss, and skin hyperpigmentation. The patient was evaluated by an endocrinologist in the ED, received a dose of steroids in the ED, and discharged home with a prescription for steroids. This case report illustrates the distinctive tongue discoloration seen in primary adrenal insufficiency, highlighting the need for early recognition in the emergency setting to enable prompt and appropriate management.

A Case Report of Acute Appendicitis Complicated by Appendicoliths

Wed, 6 May 2026 00:00:00 +0000

This case report highlights the clinical complexities of diagnosing and managing appendicitis complicated by appendicoliths in a 44-year-old female patient. Appendicitis is a common cause of acute abdominal pain, with imaging playing a crucial role in diagnosis. The patient presented with symptoms of right lower quadrant pain, nausea, vomiting, and chills that were initially misattributed to menstrual cramps. Diagnostic evaluation revealed multiple appendicoliths via computed tomography (CT), and the decision for laparoscopic appendectomy was based on the imaging results and clinical presentation. Intraoperative findings showed gangrenous but non-perforated appendicitis. The patient's postoperative recovery was uneventful, with successful symptom resolution. This case highlights the importance of considering appendicitis in the differential diagnoses for acute abdominal pain in females, particularly with overlapping gynecological...

A Case Report of Corneoscleral Laceration with Open Globe Injury and Iris Prolapse

Wed, 6 May 2026 00:00:00 +0000

Open globe injury is defined as a full-thickness injury through all anatomical layers of the eye. Prolapse or herniation of the iris may be observed at presentation of an open globe injury, and iris prolapse is not well represented in the literature. This case report details the case of a 48-year-old male presenting with three hours of right eye pain after sustaining a traumatic injury due to a foreign body. Examination of the right eye revealed a 2 mm x 1 mm laceration to the 4-5 o'clock position with iris prolapse and plugging. The affected eye also revealed a teardrop-pupil with associated corectopia in the inferonasal direction and a 2 mm hyphema. The patient was diagnosed with a globe rupture and underwent same-day surgical intervention. This report emphasizes the use of fluorescein eye exams and explains the rationale against the measurement of intraocular pressures or removal of an obvious foreign body. The care provided...

Stopping Fistula Hemorrhage without Bleeding Time and Money - A Low Cost, Low Resource Hemodialysis Fistula Model for Emergency Medicine Residents

Wed, 6 May 2026 00:00:00 +0000

Audience: This bleeding fistula model is designed to instruct emergency medicine residents and third- and fourth-year medical students on their emergency medicine rotation.

Introduction: The prevalence of end-stage renal disease (ESRD) has increased since 2001 (808,536 people in 2021 versus 409,226 in 2001).¹ About 14% of the United States population has a decreased glomerular filtration rate (GFR), and the overall presence of ESRD in the population as of 2021 was 2,219 per million population.¹ As of 2021, 87.7% of patients receiving dialysis were on hemodialysis.² Around 60% of dialysis patients use a fistula for access.³ Patients with ESRD have a high emergency department utilization...

A Multimodal Approach to Lateral Canthotomy and Cantholysis Training for Emergency Medicine Trainees: A Simulation Training Package

Tue, 3 Feb 2026 00:00:00 +0000

Audience: This simulation is intended for emergency medicine residents.

Background: Lateral canthotomy and cantholysis (LCC) is a sight-saving procedure for orbital compartment syndrome (OCS).¹ Due to the rarity of OCS, emergency-medicine trainees often have limited exposure and low procedural confidence. In a questionnaire we found that trainees have low confidence levels in performing the procedure attributed to the low incidence of OCS and the scarcity of training opportunities. Existing literature describes LCC task trainers with creation of simulation models, but few provide a reproducible multimodal package adaptable for multiple training centres.^2,3 Our innovation combines presentation, instructional video, gamified quiz, and hands-on practicer with low fidelity models. Unlike previous studies...

A Case Report of Carotid Cavernous Fistula: A Commonly Missed Diagnosis

Tue, 3 Feb 2026 00:00:00 +0000

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)...

A Case Report of an Atypical Presentation of Fournier’s Gangrene

Tue, 3 Feb 2026 00:00:00 +0000

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...

Development and Design of a Pediatric Case-Based Virtual Escape Room on Acute Iron Toxicity

Tue, 3 Feb 2026 00:00:00 +0000

Audience: This virtual escape room (VER) serves as a didactic activity tailored for learners specializing in emergency medicine, pediatrics, and family medicine across all postgraduate years. The VER can be undertaken collaboratively in teams or individually, leveraging virtual platforms and adaptable to various educational settings.

Introduction: Iron tablets appeal to children due to their vibrant color and sugar coating, resembling candy. Nearly 11,000 cases of iron exposure in children under six are reported annually in the US.¹ More severe incidents involve prenatal vitamins and iron preparations containing ferrous sulfate, which has a significantly higher concentration of elemental iron per tablet than other formulations.² Virtual...

Pre-Clinical Case Competition to Assess Confidence in Responding to Select Out-Of-Hospital Medical Emergencies

Tue, 3 Feb 2026 00:00:00 +0000

Audience: This session is intended for first- and second-year medical students, or any pre-clinical medical students.

Introduction: Preclinical learners build skills and confidence when they practice first responder tasks early in training, and simulation helps them to perform basic procedures better.^1,2 A small group case competition uses a game format to reinforce rapid assessment, clear team roles, and closed-loop communication.^3,4

Out-of-hospital cardiac arrest affects hundreds of thousands of people in the United States each year, and survival to discharge is low. Bystander cardiopulmonary resuscitation (CPR) and early use of an...

Pediatric Difficult Airway Simulation Day

Tue, 3 Feb 2026 00:00:00 +0000

Audience: This small-group simulation workshop is designed for pediatric emergency medicine fellows but can also be offered to emergency medicine residents or faculty.

Introduction: Pediatric intubation is a high-acuity, low-frequency event. Specific patient scenarios that may lead to a difficult pediatric airway, such as airway edema, airway contamination (hemorrhage, emesis), prematurity, obesity, shock, and inhalational injuries, compound an already challenging and emergent situation. Previous studies have investigated simulation-based airway education for emergency medicine (EM), anesthesia, and critical care trainees. To our knowledge, there has been no study reporting the development and outcomes of a difficult airway course for pediatric emergency medicine (PEM) fellows...

A Case Report of a 36-year-old Male Diagnosed with a Spontaneous Coronary Artery Dissection

Tue, 3 Feb 2026 00:00:00 +0000

This case report discusses a 36-year-old male who presented to the emergency department with an atypical story for acute coronary syndrome (ACS). Initially, the patient was felt to have a non-diagnostic electrocardiogram (ECG). Once the laboratory test results were obtained and the initial high-sensitivity troponin was noted to be elevated, the initial ECG was again reviewed. The patient was felt this time to have an abnormal ECG, demonstrating borderline ST elevation in leads I, aVL, and V2-V5. The interventional cardiologist on call was contacted, and the cardiac catheterization lab was activated. Upon left heart catheterization, the patient was found to have a spontaneous coronary artery dissection (SCAD) of the distal left anterior descending (LAD) artery. Post-catheterization, the patient was observed on cardiac telemetry and started on dual antiplatelet therapy. Echocardiogram revealed a preserved ejection fraction (EF), but hypokinesis of the apical anterior, anterolateral,...

Enhancing Emergency Medicine Resident Education: A Weekly Education Series to Augment Electrocardiogram Education

Tue, 3 Feb 2026 00:00:00 +0000

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...

Cards Against Pulmonology

Tue, 3 Feb 2026 00:00:00 +0000

Audience: This card game is designed to cultivate educational discussion among emergency medicine resident physicians about the assessment, treatment, and disposition of key pediatric and adult thoracic-respiratory diagnoses in a fun, casual environment. It could also be played by emergency medicine-bound medical students.

Introduction: Emergency department visits related to the thoracic-respiratory system are common complaints in both the pediatric and adult populations. In the United States, for several years prior to the Covid-19 pandemic, respiratory system diseases accounted for about 10.6% of ED visits.¹ In children, respiratory complaints make up the largest percentage of their ED visits, particularly in the fall and winter seasons.² This...

Open Chest Wound with Sternal Fracture in the Emergency Department, a Case Report

Tue, 3 Feb 2026 00:00:00 +0000

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...

Clinical Decision-Making Case: Febrile Infant

Tue, 3 Feb 2026 00:00:00 +0000

Audience: This clinical decision-making (CDM) case is intended for emergency medicine residents of all levels, medical students, and fellows preparing for standardized oral board exams.

Introduction: Fever in a neonate (infant <28 days old) is a medical emergency due to the high risk of serious bacterial infections (SBIs) like meningitis, sepsis, or urinary tract infections (UTIs).^1-3 Compared with older infants and children, neonates have immature immune responses, reduced ability to localize infection, and limited physiologic reserve, which contribute to rapid clinical deterioration and increased morbidity and mortality when invasive infection is present.^1,3

Importantly, clinical presentation in this age group is often subtle and nonspecific. Neonates...

Effects of Volume Overload: A Case Report of an Edema Bulla

Tue, 3 Feb 2026 00:00:00 +0000

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...

Prioritization: Run This Board: Septic Shock, Acute Coronary Syndrome, Small Bowel Obstruction, and Penetrating Chest Trauma

Wed, 31 Dec 2025 00:00:00 +0000

Audience: This case was specifically designed for senior emergency medicine (EM) resident physicians as a preparatory tool for the American Board of Emergency Medicine (ABEM) Certifying Exam. However, it is applicable for EM residents at all levels of training.

Introduction: “A hallmark of emergency medicine is the ability to triage or prioritize care. This case will require the physician to evaluate and treat multiple patients while ensuring those who require immediate care receive it quickly. The physician may face the arrival of additional patients, the deterioration of existing patients, and realistic workflow interruptions during the case. A successful candidate will identify and stabilize high acuity patients.”1 With the introduction of the new Certifying Exam by ABEM and the current lack of resources to practice prioritization in an assessment setting, resident physicians will need practice material in order to adequately prepare for their board examination.

Educational...

Clinical Decision-Making Case: A Giant Headache

Wed, 31 Dec 2025 00:00:00 +0000

Audience: This certifying exam practice case is intended for emergency medicine residents and medical students rotating through emergency medicine.

Introduction: Giant cell arteritis (also known as GCA, temporal arteritis, cranial arteritis, or Horton’s disease) is the most common systemic vasculitis.¹ Patients commonly present with a new and unique headache, often with tenderness in the temporal region. Patients may present with associated jaw claudication and transient visual loss. Constitutional symptoms such as fever and fatigue are common and proximal muscle weakness may be present with concurrent polymyalgia rheumatica.¹ These symptoms are thought to be a result of an exaggerated immune response to vascular injury with lymphocyte proliferation and giant cell formation which can lead to luminal narrowing and even ischemia.²

The incidence varies among various demographics. It...

Clinical Decision-Making Case: Intussusception

Wed, 31 Dec 2025 00:00:00 +0000

Audience: This clinical decision making case is intended for emergency medicine residents of all levels.

Introduction/Background:

To become board certified in emergency medicine, graduates must pass both a qualifying exam and an oral exam. In 2026, the American Board of Emergency Medicine (ABEM) is transitioning to a Certifying Exam. Historically, the oral exam included two structured interview (now retitled clinical decision making [CDM]) cases and one pediatric case. Vomiting and abdominal pain are two of the top five reasons pediatric patients present to the emergency department. Being able to take a complete history and exam, regardless of age, and form an appropriate differential diagnosis is a critical skill for emergency physicians. There are many resources available to prepare for standardized single patient encounters, but there are very few resources available for candidates to prepare for the CDM cases. Here we present a CDM case of irritability and...

Clinical Decision-Making Case: Seizing the Diagnosis: Eclampsia

Wed, 31 Dec 2025 00:00:00 +0000

Audience: This practice certifying exam case is intended for emergency medicine residents.

Introduction: The American Board of Emergency Medicine (ABEM) certification process is currently undergoing a significant transformation, with the new ABEM Certifying Exam replacing the long-standing ABEM Oral Exam, which has been in place since 1980. The Certifying Exam will utilize a new exam format to evaluate different competencies compared to the Oral Exam, including high-stakes communication, managing difficult conversations, patient-centered communication, clinical decision-making, team management, leadership, procedural skills, ultrasound skills, reassessment, troubleshooting, task switching, and prioritization. This shift has understandably generated a degree of apprehension among Emergency Medicine (EM) residents preparing for their board exams. The new exam emphasizes several new cases and scenarios, including Clinical Decision-Making (CDM) cases. These structured...

Prioritization: Intracranial Hemorrhage, Testicular Torsion, and Tricyclic Antidepressant Department

Wed, 31 Dec 2025 00:00:00 +0000

Audience: This case is designed for emergency medicine residents preparing for the American Board of Emergency Medicine Certifying Exam (ABEM). While we tested the case with third year emergency medicine residents, it could also be used with first- and second-year residents to develop complex decision-making and prioritization skills in a simulated environment.

Introduction: Emergency medicine requires physicians to rapidly prioritize care, stabilize critically ill patients, adapt to changing clinical circumstances, and delegate tasks and resources. Traditional oral board cases emphasize single-patient encounters rather than multitasking or task-switching. This prioritization case better aligns with the clinical workflow of a shift in the emergency department, including triage, teamwork, and flexibility. This case forces learners to make timely decisions with incomplete information, giving examiners insight into how the examinee performs in the clinical environment.

Educational...

Clinical Decision-Making Case: Pediatric Sexually Transmitted Infections and Consent

Wed, 31 Dec 2025 00:00:00 +0000

Audience: This clinical decision-making case for the Certifying Board Exam is designed for emergency medicine residents at all training levels (PGY1 through PGY4).

Introduction: Navigating consent for pediatric patients in the emergency department (ED) presents unique ethical and legal challenges. Physicians must understand parental consent requirements and the relevant exceptions that apply in the ED. Studies indicate that residents may lack confidence or knowledge in handling complex or nuanced consent scenarios, particularly regarding adolescents. We aimed to develop a structured educational intervention to address this gap. This clinical decision-making case aims to improve resident competency and comfort in managing these situations.

Educational Objectives: By the end of this case the learner will be able to: 1) demonstrate competency with the new ABEM Certifying Exam Clinical Decision-Making Case format, 2) manage a simulated pediatric care encounter that...

Clinical Decision-Making Case: Non-Accidental Trauma

Wed, 31 Dec 2025 00:00:00 +0000

Audience: This clinical decision-making (CDM) case is intended for emergency medicine (EM) residents of all levels.

Introduction: Non-accidental trauma (NAT) is a leading cause of morbidity and mortality in pediatrics. Every year in the United States, more than 656,000 children are found to be victims of NAT, causing over 1,800 deaths annually.¹ Subtle abusive injuries are frequently missed in medical settings,^1-3 and children may subsequently experience escalating or life-threatening abuse if interventions do not occur.² Timely identification of abusive injuries in acute care settings is crucial to provide appropriate and potentially life-saving care.

Educational Objectives: By the end of this clinical decision-making case, learners will be able to: 1) demonstrate familiarity with the CDM case format and case play, 2) describe important historical information to obtain when suspecting non-accidental trauma, 3) recognize...

Clinical Decision-Making Case: Pulmonary Embolism

Wed, 31 Dec 2025 00:00:00 +0000

Audience: Emergency medicine residents and medical students on emergency medicine rotations.

Introduction: Pulmonary embolism (PE) is a common diagnosis with an annual incidence of approximately one in 1000 persons.1,2,3 There is a wide variety of clinical presentations, ranging from the asymptomatic patient to shock and cardiac arrest. Most patients have chest pain and shortness of breath (SOB), but PE may also present with mild or nonspecific symptoms, such as dizziness, cough, wheezing, syncope and hemoptysis. These patients have risk for clinical decompensation.4,5 It is therefore critical to maintain a high level of suspicion because misdiagnosis is common. There are risks attributable to the diagnostic evaluation and treatment, including radiation exposure, contrast reactions and complications related to anticoagulant therapy. Work up requires an understanding of clinical pretest probability, diagnostic algorithms such as the modified Wells scoring system and the...

Clinical Decision-Making Case: Thyroid Storm

Wed, 31 Dec 2025 00:00:00 +0000

Audience: This clinical decision-making case is intended for all emergency physicians (EP) in training.

Introduction: Thyroid storm (TS) is a rare but life-threatening endocrine emergency that represents the most severe form of thyrotoxicosis. If not promptly recognized and appropriately managed, TS carries a mortality rate of up to 25%.¹ However, with timely and aggressive treatment, mortality can be significantly reduced to 1.2–3.6% in the United States.² Due to its rarity and often nonspecific presentation, early diagnosis and intervention in the emergency department are essential to improving patient outcomes. Recognizing its critical nature, the American Board of Emergency Medicine (ABEM) identifies thyroid storm as a core emergency condition that emergency physicians (EPs) must be trained to manage.³ Additionally, recent updates to the ABEM certifying examination emphasize the importance of clinical decision-making and the ability to verbalize diagnostic reasoning...

A Low-Cost Task Trainer Constructed from Silicone Nipple Covers

Fri, 31 Oct 2025 00:00:00 +0000

ABSTRACT:

Audience: This low-cost task trainer is intended for the education of medical students, advanced practice providers and surgical subspecialties interns, including emergency medicine.

Introduction: Superficial soft-tissue abscesses are a frequent chief complaint in any emergency department, with up to 3.2 % of patients presenting with this issue. The preferred method for treatment is incision and drainage (I&D) because antibiotics alone are often insufficient. There are two common methods for draining abscesses. The first is a single linear incision over the length of the abscess that is either left open or packed with gauze which is removed 24-48 hours later. The second is the loop technique, which uses two smaller parallel incisions with a sterile rubber or plastic tube threaded through them and tied into a circle.

While abscess drainage is a common procedure for surgical and sub-surgical specialties, it is not often taught in medical schools...

Case Report of a Patient Presenting with Nonketotic Hyperglycemia Hemichorea

Fri, 31 Oct 2025 00:00:00 +0000

ABSTRACT:
Nonketotic hyperglycemia hemichorea is a rare neurological manifestation associated with uncontrolled diabetes mellitus. This case report presents the clinical features, diagnostic workup, and management of a 74-year-old female with hemichorea secondary to nonketotic hyperglycemia. Patient presented to the emergency department with acute onset of right leg movement that was non-purposeful and random without any associated neurological symptoms such as paresthesias weakness, pain, or systemic symptoms. Patient’s medical history included untreated diabetes mellitus with glucose of 198 measured in the ED. Computed tomography of the and neck were unremarkable for any signs of ischemia, occlusion, hemorrhage or masses. Brain MRI without contrast showed T1 shortening within the left basal ganglia involving both the caudate nucleus and the lentiform nucleus, a radiologic finding common in nonketotic hyperglycemia hemichorea. Patient was admitted to the hospital...

In Too Deep: A Point-of-Care Ultrasound (POCUS) Escape Room

Fri, 31 Oct 2025 00:00:00 +0000

ABSTRACT:

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. 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: 1) evaluate and identify the nature of metallic foreign bodies using POCUS; 2) identify common emergency department fractures on X-Ray and identify relevant sonoanatomy for ultrasound-guided regional anesthesia applications relevant...

Trauma and Hyperthermia

Fri, 31 Oct 2025 00:00:00 +0000

ABSTRACT:

Audience: Emergency medicine residents and medical students on emergency medicine rotation

Introduction: Participating in strenuous activities during hot, humid weather places a person at risk for heat emergencies such as heat exhaustion and heat stroke. When the environmental temperature is greater than 35 degrees Celsius (95 degrees F), the body can no longer radiate heat to the environment. When the humidity is greater than 75%, the body can no longer use evaporation for cooling. The hot, humid environment has effectively eliminated both mechanisms to decrease body heat, and the individual is at risk for exertional heat injury. Altered mental status that occurs during heat stroke interferes with the ability to obtain an adequate history as to the etiology of hyperthermia and altered mental status. It is imperative that the patient receive cooling measures immediately and that supportive measures be instituted while evaluating...

Myopericarditis and Pulmonary Edema

Fri, 31 Oct 2025 00:00:00 +0000

ABSTRACT:

Audience: This oral board case is intended to be used with senior emergency medicine residents.

Introduction: Pericarditis and myocarditis are two disease entities that refer to inflammation of the pericardium and the myocardium. In clinical practice, when they occur together the term myopericarditis is used. Myopericarditis is a disease etiology that is uncommonly encountered in the emergency department (ED). Pericarditis accounts for 0.2% of all cardiovascular admissions and myopericarditis is even more rare with an unknown exact incidence. These pathologies can present with a wide spectrum of complaints varying from a simple case of chest pain to more severe hypotensive pulmonary edema, cardiogenic shock, and cardiac arrest. Since these pathologies primarily affect the younger patient population, they require careful consideration by the Emergency Physician (EP) as well as a systematic comprehensive approach to managing these critically ill...

Code Social: Integrating SDoH into Emergency Resident Education

Fri, 31 Oct 2025 00:00:00 +0000

ABSTRACT:

Audience: This small group curriculum is geared toward medical students and residents of all levels of training in emergency medicine programs.

Introduction: Emergency departments serve as critical first points of contact for patients with acute health needs, often exacerbated by social determinants of health (SDoH). Incorporating SDoH awareness into emergency medicine practice is essential for addressing immediate health concerns, preventing future crises, and reducing the burden on healthcare systems. By identifying and addressing social factors, emergency providers can break cycles of recurrent emergencies, connect patients with community resources, and foster trust-based, patient-centered relationships. Training emergency medicine residents in SDoH is crucial for preparing them to provide comprehensive, equitable care to diverse populations, enhancing their ability to advocate for vulnerable groups and reduce health disparities. This simulation curriculum...

Ultrasound Guided Peripheral Nerve Block Workshop: How to Take Your Residents from Zero to Hero

Fri, 31 Oct 2025 00:00:00 +0000

ABSTRACT:

Audience: Emergency medicine residents of all years of training

Introduction: Ultrasound guided peripheral nerve blocks (USGPNBs) provide adequate analgesic management by targeting specific nerves while limiting systemic effects. Utilizing this form of analgesia can decrease the use of procedural sedation and/or systemic pain management, which can pose inherent risks such as need for continuous monitoring and airway compromise. Nerve blocks require both training and specialized equipment to perform. This workshop aimed to evaluate resident comfort and familiarity with these blocks before and after completing specialized training sessions focusing on serratus anterior, posterior tibial, median, ulnar, and radial USGPNB. Ultrasound training for most residents is a longitudinal experience that often includes dedicated ultrasound scanning shifts and encouragement to include ultrasound into daily practice, however, the utility of ultrasound workshops in teaching...

Case Report of a Dermatologic Reaction to Wound Closure Strips and Liquid Adhesive

Fri, 31 Oct 2025 00:00:00 +0000

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.

A Comprehensive and Modality Diverse Cervical Spine and Back Musculoskeletal Physical Exam Curriculum for Medical Students

Mon, 4 Aug 2025 00:00:00 +0000

A Comprehensive and Modality Diverse Cervical Spine and Back Musculoskeletal Physical Exam Curriculum for Medical Students

Metastatic Calcinosis Cutis in the Emergency Department: A Case Report

Mon, 4 Aug 2025 00:00:00 +0000

Metastatic Calcinosis Cutis in the Emergency Department: A Case Report

A Longitudinal, Practical Curriculum for Faculty Development as New Coaches in Graduate Medical Education

Mon, 4 Aug 2025 00:00:00 +0000

A Longitudinal, Practical Curriculum for Faculty Development as New Coaches in Graduate Medical Education

Beta-Blocker Toxicity

Mon, 4 Aug 2025 00:00:00 +0000

Beta-Blocker Toxicity

A Case Report of Facial Swelling and Crepitus Following a Dental Procedure

Mon, 4 Aug 2025 00:00:00 +0000

A Case Report of Facial Swelling and Crepitus Following a Dental Procedure

A Recipe for Disaster – Sodium Bicarbonate Overdose

Mon, 4 Aug 2025 00:00:00 +0000

A Recipe for Disaster – Sodium Bicarbonate Overdose

Cognitive Errors and Debiasing

Mon, 4 Aug 2025 00:00:00 +0000

Cognitive Errors and Debiasing

A Case Report of Calciphylaxis

Mon, 4 Aug 2025 00:00:00 +0000

A Case Report of Calciphylaxis

Beware of the Pediatric Limp: A Case of Mycoplasma Associated Acute Transverse Myelitis

Mon, 4 Aug 2025 00:00:00 +0000

Beware of the Pediatric Limp: A Case of Mycoplasma Associated Acute Transverse Myelitis

Case Report of Post-Operative Uvular Necrosis Following Emergent Intubation

Mon, 4 Aug 2025 00:00:00 +0000

Case Report of Post-Operative Uvular Necrosis Following Emergent Intubation

Critical Care Transport: Blunt Polytrauma in Pregnancy

Mon, 4 Aug 2025 00:00:00 +0000

Critical Care Transport: Blunt Polytrauma in Pregnancy

Posterior Reversible Encephalopathy Syndrome and Eclampsia

Mon, 4 Aug 2025 00:00:00 +0000

Posterior Reversible Encephalopathy Syndrome and Eclampsia

Iatrogenic bowel perforation following dental procedure

Mon, 4 Aug 2025 00:00:00 +0000

Iatrogenic bowel perforation following dental procedure

Incarcerated Gastric Volvulus and Splenic Herniation in Undiagnosed Congenital Diaphragmatic Hernia in an Infant

Mon, 4 Aug 2025 00:00:00 +0000

Incarcerated Gastric Volvulus and Splenic Herniation in Undiagnosed Congenital Diaphragmatic Hernia in an Infant

A Case Report of an Unstable C-spine Fracture After Wrestling in the Emergency Department

Wed, 30 Apr 2025 00:00:00 +0000

A Case Report of an Unstable C-spine Fracture After Wrestling in the Emergency Department

A Case Report of Hydropic Gallbladder Presenting as Right Lower Quadrant Abdominal Pain

Wed, 30 Apr 2025 00:00:00 +0000

A Case Report of Hydropic Gallbladder Presenting as Right Lower Quadrant Abdominal Pain

My Broken Heart LVAD Simulation Case

Wed, 30 Apr 2025 00:00:00 +0000

My Broken Heart LVAD Simulation Case

Critical Care Transport Cardiogenic Shock Intubation Simulation

Wed, 30 Apr 2025 00:00:00 +0000

Critical Care Transport Cardiogenic Shock Intubation Simulation

The Silent Saboteur- Teaching the Clinical Implications of Occult Hypoxemia & Social

Wed, 30 Apr 2025 00:00:00 +0000

The Silent Saboteur- Teaching the Clinical Implications of Occult Hypoxemia & Social

Orthopaedic Surgery Didactic Session Improves Confidence in Distal Radius Fracture Management by Emergency Department Residents

Wed, 30 Apr 2025 00:00:00 +0000

Orthopaedic Surgery Didactic Session Improves Confidence in Distal Radius Fracture Management by Emergency Department Residents

A Case Report of Inferior Rectus Abscess

Wed, 30 Apr 2025 00:00:00 +0000

A Case Report of Inferior Rectus Abscess

Diabetic ketoacidosis and Necrotizing Soft Tissue Infection

Wed, 30 Apr 2025 00:00:00 +0000

Diabetic ketoacidosis and Necrotizing Soft Tissue Infection

Orthopaedic Surgery Didactic Session Improves Confidence in Distal Radius Fracture Management by Emergency Department Residents

Wed, 30 Apr 2025 00:00:00 +0000

Orthopaedic Surgery Didactic Session Improves Confidence in Distal Radius Fracture Management by Emergency Department Residents

Eye-Opener- A case report of eyelid taping as presenting symptom of Myasthenia Gravis

Wed, 30 Apr 2025 00:00:00 +0000

Eye-Opener- A case report of eyelid taping as presenting symptom of Myasthenia Gravis

Innovative Ultrasound-Guided Erector Spinae Plane Nerve Block Model for Training Emergency Medicine Physicians

Wed, 30 Apr 2025 00:00:00 +0000

Innovative Ultrasound-Guided Erector Spinae Plane Nerve Block Model for Training Emergency Medicine Physicians

Medical Simulation Anywhere and Anytime: Simulation in a Backpack

Mon, 31 Mar 2025 00:00:00 +0000

Medical Simulation Anywhere and Anytime: Simulation in a Backpack

Acetaminophen Toxicity

Mon, 31 Mar 2025 00:00:00 +0000

Acetaminophen Toxicity

Retropharyngeal Abscess in an Adult Patient Presenting with Neck Fullness and Dysphagia: A Case Report

Mon, 31 Mar 2025 00:00:00 +0000

Retropharyngeal Abscess in an Adult Patient Presenting with Neck Fullness and Dysphagia: A Case Report

Do’s and Don’ts of Taking Care of Deaf Patients

Mon, 31 Mar 2025 00:00:00 +0000

Do’s and Don’ts of Taking Care of Deaf Patients

A Cold Case: Myxedema Coma

Mon, 31 Mar 2025 00:00:00 +0000

A Cold Case: Myxedema Coma

A Case Report of Right Atrial Thrombosis Complicated by Multiple Pulmonary Emboli: POCUS For the Win!

Mon, 31 Mar 2025 00:00:00 +0000

A Case Report of Right Atrial Thrombosis Complicated by Multiple Pulmonary Emboli: POCUS For the Win!

Alcohol Withdrawl

Mon, 31 Mar 2025 00:00:00 +0000

Alcohol Withdrawl

A Case Report on an Elusive Incident of Erythema Multiforme

Mon, 31 Mar 2025 00:00:00 +0000

A Case Report on an Elusive Incident of Erythema Multiforme

Journal Court: A Novel Approach to Incorporate Medicolegal Education into an Emergency Medicine Journal Club

Mon, 31 Mar 2025 00:00:00 +0000

Journal Court: A Novel Approach to Incorporate Medicolegal Education into an Emergency Medicine Journal Club

Drowning Complicated by Hypothermia

Mon, 31 Mar 2025 00:00:00 +0000

Drowning Complicated by Hypothermia

The Advantage of Using Video Laryngoscope in Puncture and Incisional Drainage of Peritonsillar Abscess: A Case Report

Mon, 31 Mar 2025 00:00:00 +0000

The Advantage of Using Video Laryngoscope in Puncture and Incisional Drainage of Peritonsillar Abscess: A Case Report

A Case of Painful Visual Loss - Managing Orbital Compartment Syndrome in the Emergency Department

Fri, 1 Nov 2024 00:00:00 +0000

Audience: Emergency medicine (EM) residents. This simulation curriculum may also be utilized for senior medical students conducting EM rotations.

Background: Ophthalmologic education represents only a small portion of medical school curriculums and continues to decrease over time, leaving physicians poorly equipped to diagnose and manage eye complaints.1 Of emergency physicians (EPs) surveyed, 72.5% felt that they could diagnose orbital compartment syndrome (OCS), yet only 40.3% felt comfortable performing a necessary lateral canthotomy and cantholysis (LCC).2 These survey results demonstrate the urgent need for improved ophthalmology education in EM residency to help us diagnose and manage potentially vision-threatening pathology.

Educational Objectives: By the end of this simulation, learners will be able to: 1) demonstrate the major components and a systematic approach to the emergency ophthalmologic examination, 2) develop a differential diagnosis of sight-threatening...

A Simulation and Small-Group Pediatric Emergency Medicine Course for Generalist Healthcare Providers: Gastrointestinal and Nutrition Emergencies

Fri, 1 Nov 2024 00:00:00 +0000

Audience and Type of Curriculum: This is a review curriculum utilizing multiple methods of education to enhance the skills of generalist healthcare providers in low- and middle-income countries (LMICs) in the identification and stabilization of pediatric respiratory emergencies. Our audience of implementation was Belizean generalist providers (nurses and physicians).

Length of Curriculum: 8-10 hours

Introduction: Early recognition and stabilization of critical pediatric patients can improve outcomes. Compared with resource-rich systems, many low-resource settings (i.e., LMICs) rely on generalists to provide most pediatric acute care. We created a curriculum for general practitioners comprising multiple educational modules focused on identifying and stabilizing pediatric emergencies. Our aim was to develop an educational framework to update and teach generalists on the recommendations and techniques of optimally evaluating and managing pediatric nutritional and gastrointestinal...

A Whodunit Gamified Flipped Classroom For High Yield Bite Injuries And Envenomation

Fri, 1 Nov 2024 00:00:00 +0000

Audience: Clerkship-level medical students, sub-interns, junior and senior residents, attending physicians

Introduction: Bite injuries and envenomation are core content found in the model of the clinical practice of emergency medicine.1 However, depending on the geographic location of training or clinical practice, physicians may or may not be exposed to these pathologies. For example, a qualitative analysis conducted in 2022 discovered a significant range in emergency medicine (EM) physician perception of snake antivenom use and level of comfort, noting that experiences with its use ranged from hundreds of cases treated to purely didactic understanding.2 Such discrepancies necessitate supplemental education and activities to bridge the knowledge gap. Ideally, these activities would utilize tenets of experiential learning to allow learner processing comparable to that of clinical experience.3 Flipped classroom and audience participation promote engagement and active learning...

Going in Blind: A Common Scenario in an Uncommon Situation

Fri, 1 Nov 2024 00:00:00 +0000

Audience: Medical students, interns, junior resident physicians, senior resident physicians

Background: Power outages have been increasing in frequency in the past few years, therefore becoming an increased threat to healthcare delivery.1 While most studies related to the effects of power outages are focused on outpatient care, such as acute exacerbations of chronic lung conditions and the lack of chargeable equipment, with the increasing number of power outages, hospitals must be prepared for this situation as well.2,3 Although agencies such as the Federal Emergency Management Agency (FEMA) and the US Department of Health and Human Services (HHS) have provided guidelines for the response of hospitals to temporary loss of power,12,13 hospitals generally rely on institutional policies in response to the event of a power outage. Given the relative rarity but increasing frequency of power outages in hospital settings, this medical simulation was created to present a common...

A Case Report on Dermatomyositis in a Female Patient with Facial Rash and Swelling

Fri, 1 Nov 2024 00:00:00 +0000

ABSTRACT:Early diagnosis of rheumatologic diseases can improve patient outcomes. While clinical presentations of rheumatologic diseases can be vague, dermatomyositis (DM) has distinctive cutaneous findings that can clue in providers towards the diagnosis. This is a case report of a 49-year-old female who presented with progressive facial swelling, rash, and generalized myalgias for a month. She had seen several outpatient providers and had one other emergency department (ED) visit for these symptoms prior to her diagnosis. She had already trialed steroid creams, antibiotics, and oral steroids with no significant improvement in her symptoms. A physical exam revealed peri-orbital edema, rash on her face, chest, and arms, and proximal muscle weakness. Lab work was significant for an elevated creatine kinase (CK). Rheumatology was consulted and recommended admission for expedited work-up for DM. The DM diagnosis was confirmed, and the patient was given intravenous immunoglobulin...

Actively Teaching Active Teaching Techniques

Fri, 1 Nov 2024 00:00:00 +0000

Audience: The target audience for this small group workshop are interns and residents of any specialty.

Introduction: All residents are expected to become proficient teachers in a variety of settings as they progress in training, and many residency programs offer advanced training or credentialing in medical education.1,2 Recently, some emergency medicine programs have also begun to offer a formal medical education fellowship. Traditional resident education has been in the form of didactic lectures such as morning report, noon conference, and Grand Rounds as well as small group bedside teaching by attendings. Due to the COVID-19 pandemic, in many cases these learning structures have been reengineered into a hybrid or virtual model.3 This new educational paradigm has spurred the search for best practice teaching methods across a variety of situations. 4 Active teaching, characterized by audience engagement and self-directed learning, has been shown to promote deeper understanding...

Computed Tomography Findings in Non-Obstetric Vulvar Hematoma: A Case Report

Fri, 1 Nov 2024 00:00:00 +0000

Non-obstetric vulvar hematoma is a rare but clinically important diagnosis in the emergency department for which there is no consensus on optimal diagnosis or management. We present a case of non-obstetric vulvar hematoma that occurred after minimal trauma in a young, otherwise healthy woman who presented with labial swelling after consensual digital penetration, initially managed conservatively but ultimately requiring surgical drainage. Although a rare presentation in the emergency department, prompt identification, diagnosis, and management of vulvar hematoma is crucial to appropriately treat complications including pain, hemodynamically significant hemorrhage, urinary obstruction, and soft tissue necrosis.

Bridging Hospital Resource Variability: Adapting the Escape Room to Integrate Procedure Teaching for Emergency Medicine Trainees in India

Fri, 1 Nov 2024 00:00:00 +0000

Audience: This is an in-person escape room and procedure simulation activity based on complications of human immunodeficiency virus (HIV) in India, which was created by using local HIV management guidelines. Emergency Medicine (EM) trainees of all post-graduate levels are the target audience. This may also be used by trainees in other specialties, such as infectious disease or internal medicine, who require an understanding of HIV and its complications. This escape room can be completed in teams of varying sizes and is designed to be adaptable to local resource availability.

Background: Patients with HIV present to the Emergency Department (ED) for a variety of reasons such as initial viral syndrome, medication side effects, and opportunistic infections. While the widespread use of antiretroviral therapy (ART) has significantly increased the life expectancy of patients living with HIV and decreased the incidence of classical opportunistic infections, EM providers should...

First Aid Curriculum for Second Year Medical Students

Fri, 2 Aug 2024 00:00:00 +0000

Audience: This small-group workshop is designed for pre-clinical medical students. The workshop can also be offered to other medical students looking to review first aid in the community setting.

Introduction: First aid training in medical students varies based on each student’s previous experience. Because of this, medical students in their pre-clinical years have expressed a desire for further training in first aid.1 While most bystanders in an emergency situation do not have a medical background, medical students have received additional training that can provide the skillset to process and respond to emergency situations in a different capacity. Most medical schools have not adopted a universal curriculum in teaching medical students first aid.2 Incorporating first aid into a medical school curriculum can enhance medical students’ confidence in emergent situations and lead to better outcomes for patients requiring immediate on-site care.

Educational Objectives:...

High-Fidelity Simulation with Transvaginal Ultrasound in the Emergency Department

Fri, 2 Aug 2024 00:00:00 +0000

Audience: Intern and junior emergency medicine residents.

Introduction: Abdominal pain and vaginal bleeding in the first trimester of pregnancy are common presentations to the emergency department (ED).1 Formal transvaginal ultrasound (TVUS) is considered the test of choice for evaluation of first trimester pregnancy due to its high sensitivity and specificity for identifying intrauterine and ectopic pregnancies.1 Additionally, TVUS can evaluate for various uterine and ovarian pathology as well as identify other non-gynecologic conditions and is within the scope of practice for the emergency physician.2 Given the emergent and time sensitive nature of certain obstetric and gynecologic conditions, formal transvaginal ultrasound imaging may not be feasible. A rapid assessment with transvaginal point-of-care ultrasound (TVPOCUS) can be utilized by emergency medicine physicians (EMP) to confirm intrauterine pregnancies (IUP) and identify any associated complications. There...

A Man With Chest Pain After An Assault – A Case Report

Fri, 2 Aug 2024 00:00:00 +0000

This case report highlights an uncommon sequelae of chest wall trauma that should be evaluated for patients presenting with similar history and symptoms. A 60-year-old man presented to the emergency department (ED) with swelling, fever, and chest wall pain two days after an assault with blunt chest wall trauma. On exam, there was a suspected chest wall abscess, verified on computed tomography (CT) with associated displaced midsternal fracture. This patient was admitted for abscess incision and drainage. While uncommon, chest wall abscess formation is an important condition that should be considered as a differential diagnosis in any patient presenting with chest wall pain post blunt trauma. With few reported similar presentations in the literature, this case is an important addition in a likely underreported phenomenon that requires prompt evaluation and treatment.

Subarachnoid Hemorrhage Causing a Seizure: An Assessment Simulation for Medical Students

Fri, 2 Aug 2024 00:00:00 +0000

Audience: This simulation is intended for 4th year medical students.

Introduction: Headache is the fifth most common chief complaint in the emergency room, and the vast majority are ultimately diagnosed as benign primary headaches.1,2 However, subarachnoid hemorrhage (SAH) is one of several critical diagnoses which can present as a headache. With a case fatality rate of up to 66.7% in some instances, SAH is considered a “can’t miss” diagnosis.3

Subarachnoid hemorrhage is classically associated with a thunderclap headache, one definition of which is a headache that reaches maximal intensity within one minute or less and reaches a seven out of ten in severity.1 Unfortunately, a thunderclap headache is not as sensitive nor specific for SAH as is often taught. In one study, only 50% of patients with an aneurysmal subarachnoid hemorrhage presented with a thunderclap headache and an additional 19% of SAH headache came on more gradually over the course of five minutes.4...

Utilization of an Asynchronous Online Learning Module Followed by Simulated Scenario to Train Emergency Medicine Residents in Mass-Casualty Triage

Fri, 2 Aug 2024 00:00:00 +0000

Audience: This is a combined independent study and simulation session designed to teach and drill Mass Casualty Incident (MCI) Triage and is intended for emergency medicine residents at all levels.

Introduction: The training of emergency medicine residents to assume leadership roles in disaster response is important. However, lack of accepted specific educational goals on the national level leads to significant variability between residencies.

Educational Objectives: The purpose of this session is to train EM residents in the use of the Simple Triage and Rapid Treatment (START) and pediatric JumpSTART algorithms for triage in mass casualty incidents (MCIs) using an asynchronous model. By the end of this small group session, learners will be able to: 1) describe START triage for adult MCI victims; 2) describe JumpSTART triage for pediatric MCI victims; 3) demonstrate the ability to apply the START and JumpSTART triage algorithms in a self-directed learning environment;...

Development and Design of a Pediatric Case-Based Virtual Escape Room on Organophosphate Toxicity

Fri, 2 Aug 2024 00:00:00 +0000

Audience: This case-based virtual escape room (VER) serves as a didactic activity suitable for learners who require an understanding of organophosphate toxicity. Educators may use this VER for distance-based learning in settings with adequate internet access.

Introduction:

India faces a concerning escalation in suicide rates, particularly among teenagers and young adults, often involving intentional pesticide ingestion, notably organophosphates.1-3 Our project addresses organophosphate ingestion by using a VER, a virtual learning platform adapted from in-person escape rooms to engage participants for educational purposes.4,5 Demonstrating success in medical, pharmacy, and nursing education, VERs increased satisfaction and competency among healthcare trainees compared to traditional learning platforms while fostering teamwork and communication in a virtual learning environment.6,7

Educational Objectives:By the end of the activity, learners should be able to:...

Identification of a Human Trafficking Victim: A Simulation

Fri, 2 Aug 2024 00:00:00 +0000

Audience: This case was designed for emergency medicine interns and residents.

Introduction: Human trafficking is unfortunately an ever-growing and wide-reaching problem in the United States as well as the rest of the world. The International Labor Organization estimates 49.6 million people were affected by this modern-day slavery worldwide in 2021.1,2 The emergency department represents an opportunity to identify and provide aid to victims of human trafficking. Studies have shown that 63.3% of survivors interacted with the emergency department during their time of exploitation; however, most of these patients are not identified as human trafficking victims and opportunities for intervention are missed.3,4

Educational Objectives: By the end of this simulation, participants will be able to: (1) Identify signs of human trafficking. (2) Demonstrate the ability to perform a primary and secondary assessment of a patient when there is concern for human trafficking. (3)...

A Case Report of Dermatographia

Fri, 2 Aug 2024 00:00:00 +0000

The authors present a case of symptomatic dermatographia. Dermatographia is an inducible urticaria where the light pressure of scratching leaves a raised wheal in the pattern of the scratching. The presentation can be striking and is often very stressful for the patient; however, the etiology is benign and the key takeaway is to provide reassurance to the patient.

A Case Report of Lateral Subtalar Dislocation: Emergency Medicine Assessment, Management and Disposition

Fri, 2 Aug 2024 00:00:00 +0000

Subtalar dislocations of the talonavicular and talocalcaneal joints are rare, accounting for approximately one percent of all dislocations.1 These dislocations are typically the result of a high energy mechanism and present a challenge during reduction attempts. We present the case of a male in his early 20’s who presented to the emergency department after a motorcycle accident with right foot and ankle pain and obvious deformity. Emergent X-ray and immediate attempt at reduction are of utmost importance with these dislocations. After multiple failed attempts at reduction in the ED, this patient was taken to the operating room for an open reduction with podiatry. This case report reviews the pathophysiology and management of this rare injury including nerve blocks and reduction techniques.