Journal of education & teaching in emergency medicine最新文献

{"title":"A Case Report on an Elusive Incident of Erythema Multiforme.","authors":"Cynthia Tsang, Savannah Tan, Lindsey Spiegelman","doi":"10.21980/J8BM0W","DOIUrl":"10.21980/J8BM0W","url":null,"abstract":"<p><p>The presentation of erythema multiforme in the emergency department is relatively rare, thus recognition and rapid intervention requires a high index of suspicion. This study presents a case of a 55-year-old female with past medical history of hypertension and active endometrial cancer with recent chemotherapy treatment complaining of four days of progressive erythematous rash with associated pruritis and blistering. An exam found multiple tense, scattered vesicles with an erythematous base. The patient also demonstrated leukopenia, elevated alkaline phosphatase level, and elevated C-reactive protein level. A shave biopsy was performed and intravenous acyclovir was started for concern of varicella-zoster virus. Biopsy results favored an erythema multiforme diagnosis, and she was discharged with topical clobetasol. In addition to reviewing the presentation and intervention of erythema multiforme, this case report adds to growing literature of erythema multiforme as a delayed reaction to malignancy therapy.</p><p><strong>Topics: </strong>Erythema multiforme, dermatology, radiotherapy.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"10 1","pages":"V17-V21"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retropharyngeal Abscess in an Adult Patient Presenting with Neck Fullness and Dysphagia: A Case Report.","authors":"Justin Rederer, Tanner Folster, Sara Dimeo","doi":"10.21980/J8M36G","DOIUrl":"10.21980/J8M36G","url":null,"abstract":"<p><p>Retropharyngeal abscess (RPA) is an uncommon yet potentially life-threatening condition that is more often seen in young children and may be misdiagnosed in adults presenting with atypical features.1 Retropharyngeal abscess results from spread of antecedent upper respiratory tract infection or traumatic inoculation via foreign body ingestion or medical instrumentation. Clinically, RPA may present with fever, pharyngitis, neck pain, and dysphagia. Diagnosis is often confirmed with imaging studies. We present a case of a 66-year-old female with asthma, hypertension, and gastroesophageal reflux disease (GERD) who presented to the emergency department (ED) for evaluation of neck fullness, shoulder pain, dysphagia, and abdominal pain starting less than 24 hours prior to presentation. Computed tomography (CT) revealed a prevertebral/retropharyngeal fluid collection from the odontoid tip to the C4 vertebral body measuring 5.4 × 1.0 × 3.3 centimeters (cm) in size with associated edema at the left neck base extending into the upper chest, suggestive of retropharyngeal abscess. The patient received intravenous (IV) vancomycin and piperacillin/tazobactam and was transferred to a higher level of care for otolaryngologist evaluation. The patient remained stable without airway compromise while in our department. This case underscores challenges in diagnosing atypical presentations of RPA in adults, emphasizing timely recognition to prevent complications.</p><p><strong>Topics: </strong>Dysphagia, retropharyngeal abscess, prevertebral abscess, otolaryngology.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"10 1","pages":"V12-V16"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Right Atrial Thrombosis Complicated by Multiple Pulmonary Emboli: POCUS For the Win!","authors":"Andrea Wolff, Evan Leibner, Jill Gualdoni","doi":"10.21980/J8TM07","DOIUrl":"10.21980/J8TM07","url":null,"abstract":"<p><p>A 78-year-old gentleman presented to the emergency department (ED) for palpitations and dizziness. He had a complicated medical history including atrial fibrillation (AF), recently status post a Watchman procedure, oxygen-dependent chronic obstructive pulmonary disease (COPD), and heart failure with preserved ejection fraction (HFpEF). Point-of-care ultrasound (POCUS) revealed the presence of an intracardiac right atrial thrombus. Computed tomography (CT) angiography confirmed the presence of multiple pulmonary emboli (PE), and extension of the thrombus into the inferior vena cava. Pulmonary emboli are a common complication of thrombus in the right atrium. Management may include anticoagulation, thrombolysis, or thrombectomy. This case highlights that emergency physicians can expedite the diagnosis of intracardiac thrombus by using POCUS. The case presented describes a medically complex patient presenting with symptomatic right intracardiac and inferior vena caval thrombosis complicated by multiple PE. Point-of care ultrasound of the heart and lungs were included in his initial assessment, revealing findings of an intracardiac thrombus, and ruling out multiple other differential diagnoses including pericardial tamponade, pleural effusion, pulmonary edema, and pneumothorax. This finding changed the trajectory of this patient's evaluation and management, and demonstrates the important role of POCUS in the care of ED patients with undifferentiated cardiopulmonary symptoms.</p><p><strong>Topics: </strong>Point-of care ultrasound (POCUS), focused cardiac ultrasound (FOCUS), inferior vena cava thrombosis, right atrial thrombosis, pulmonary embolism, computed tomography, echocardiography.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"10 1","pages":"V1-V11"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol Withdrawal.","authors":"Patrick Meloy, Dan Rutz, Amit Bhambri","doi":"10.21980/J87S8Q","DOIUrl":"10.21980/J87S8Q","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Audience: &lt;/strong&gt;Emergency medicine residents and medical students on emergency medicine rotations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Alcohol use disorder (AUD) is common in the United States, with an estimated lifetime prevalence of 30%.1 The rate of use is higher among white males, Native Americans, and individuals of low socioeconomic status.1 Alcohol withdrawal symptoms manifest in 50% of individuals who misuse alcohol.1 While life-threatening sequelae of alcohol withdrawal are rare, the syndrome is a common reason for emergency department (ED) presentations. Alcohol withdrawal symptoms range from benign, cravings, nausea, anxiety and tremulousness, to life-threatening autonomic dysfunction, seizures, coma, and death.2 The pathophysiology of this clinical syndrome involves dysregulation of central nervous system (CNS) receptor function. Alcohol acts as a CNS depressant through activation of the CNS Gamma-aminobutyric acid (GABA) receptors. Chronic or heavy alcohol use results in downregulation of CNS inhibitory GABA receptors and upregulation of CNS excitatory &lt;i&gt;N&lt;/i&gt;-methyl-D-aspartate (NMDA) receptors.2 Upon discontinuation of alcohol use, this imbalance results in CNS hyperexcitability, creating the clinical symptoms of alcohol withdrawal.2 Symptoms typically manifest within eight hours after alcohol cessation, reach their peak in one to three days, and can extend for up to two weeks.3 Mild symptoms include anxiety, tremors, diaphoresis, nausea and/or vomiting. Severe symptoms include hallucinations (typically 12-24 hours after last alcohol intake) in 2-8% of patients, seizures (12-48 hours after last intake) in up to 15% of patients, and delirium tremens.3 Delirium tremens is a potentially fatal encephalopathy in patients experiencing alcohol withdrawal and occurs in 3-5% of patients approximately 72 hours after last alcohol intake.3 Without recognition or prompt treatment, mortality from delirium tremens can be as high as 50%.4 Management of alcohol withdrawal requires prompt recognition and control of symptoms. Most often this is accomplished by administering benzodiazepines, though alternative medications such as barbiturates, ketamine, or propofol are also used. Severe withdrawal may progress to intubation and mechanical ventilation.5 Given the high prevalence of AUD in the United States and the potential for life-threatening withdrawal symptoms, ED practitioners must recognize the spectrum of this disease and be comfortable with managing an array of presentations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational objectives: &lt;/strong&gt;At the end of this oral boards session, learners will: 1) demonstrate the ability to perform a detailed history and physical examination in a patient presenting with signs and symptoms of alcohol withdrawal, 2) investigate the broad differential diagnoses, including electrolyte abnormalities, trauma in the intoxicated patient, mild alcohol withdrawal, and delirium tremens, 3) list appropriate laboratory and ima","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"10 1","pages":"O1-O30"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Advantage of Using Video Laryngoscope in Puncture and Incisional Drainage of Peritonsillar Abscess: A Case Report.","authors":"Daisuke Goto, Jin Takahashi, Hiraku Funakoshi","doi":"10.21980/J8G935","DOIUrl":"10.21980/J8G935","url":null,"abstract":"<p><p>This case report demonstrates the use of a video laryngoscope to aid in the incision and drainage of a peritonsillar abscess in a 30-year-old male. This technique, which has not been widely discussed in the literature, provided enhanced visualization, overcoming challenges like poor access due to trismus and poor lighting. The video laryngoscope improved safety, offered clearer guidance, and provided valuable teaching opportunities, particularly for less experienced physicians and residents. This case contributes to the literature by illustrating how the video laryngoscope can function as both a therapeutic tool and an educational resource, improving the management of peritonsillar abscesses and potentially reducing complications.</p><p><strong>Topics: </strong>Peritonsillar abscess, peritonsillar aspiration, peritonsillar incision, video laryngoscope.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"10 1","pages":"V22-V24"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cold Case: Myxedema Coma.","authors":"Andrew M Namespetra, Matthew J Petruso, Andrew M Bazakis","doi":"10.21980/J8VM0J","DOIUrl":"10.21980/J8VM0J","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Audience: &lt;/strong&gt;This case was designed and developed to train emergency medicine residents through high-fidelity simulation and experiential learning in the management of a hemodynamically unstable patient presenting with myxedema coma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Myxedema coma refers to decompensated hypothyroidism manifesting as altered mental status and multisystem organ dysfunction. Myxedema coma is a life-threatening endocrine emergency that requires prompt recognition and treatment. Mortality associated with this condition is high, approaching 30% with optimized treatment, and nearly 100% if untreated.1 Whilst myxedema coma is a cannot-miss diagnosis, it is a relatively uncommon presentation to the emergency department (ED); incidence of myxedema coma is as low as 1.08 per million people per year.2 The clinical triad of myxedema coma is altered mental status, hypothermia and the presence of a precipitating factor.3 Typically, the patient will be over age 60 years, female, and with clinical features associated with hypothyroidism including dry skin, coarse hair, non-pitting edema.4 Myxedema coma has a temporal association with most cases occurring in the winter months.5 Despite knowledge of the disease process, recognition can be challenging, thus delaying treatment. Therefore, clinicians must have a high degree of suspicion to make the diagnosis in the ED. These characteristics of infrequency and lethality suggest medical simulation as an ideal medium to educate learners on recognition, diagnosis and management of myxedema coma in the ED in a realistic and safe setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational objectives: &lt;/strong&gt;The primary educational goals are to elicit the differential diagnoses for a patient with altered mental status, order an appropriate workup, and initiate life-saving interventions for a patient with decompensated hypothyroidism. At the conclusion of the simulation, the learner is expected to: 1) Recognize the key features on history and examination of a patient presenting in myxedema coma and initiate the appropriate workup and treatment, 2) Describe clinical features and management for a patient with myxedema coma, 3) Develop a differential diagnosis for a critically ill patient with altered mental status, 4) Discuss the management of myxedema coma in the ED, including treatments, appropriate consultation, and disposition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational methods: &lt;/strong&gt;This case was delivered as a high-fidelity simulation employing a computerized manikin as the patient, and a confederate actor in the role of the registered nurse (RN). A post-scenario debriefing session was facilitated by the instructor as a four-step formative process described by Rudolph, &lt;i&gt;et al.&lt;/i&gt;6 Other aspects of the debriefing included discussion about the pathophysiology, presentation, management, and disposition of patients with myxedema coma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research methods: &lt;/strong&gt;Learners were asked to submit anonymous feedba","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"10 1","pages":"S1-S42"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drowning Complicated by Hypothermia.","authors":"Alexander Close, Jennifer Yee","doi":"10.21980/J8QS7P","DOIUrl":"10.21980/J8QS7P","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Audience: &lt;/strong&gt;This scenario was developed to educate emergency medicine residents on the diagnosis and management of two concurrent conditions: drowning and hypothermia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Patients who present after drowning may have delayed respiratory compromise without immediate radiographic pathological findings, highlighting the need for continued observation. The presentation and management of patients with hypothermia depends on multiple factors, including core temperature. Emergency physicians should be aware of hypothermia's underlying pathophysiology, associated dysrhythmias, and different warming methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational objectives: &lt;/strong&gt;At the conclusion of the simulation session, learners will be able to:Obtain a relevant focused history, including circumstances of drowning and/or cold exposure.Outline different clinical presentations of hypothermia, loosely correlated with core temperature readings.Discuss management of hypothermia, including passive external rewarming, active external rewarming, active internal rewarming, and extracorporeal blood rewarming.Discuss pathophysiology of drowning.Identify appropriate disposition of patients who present after drowning.Identify appropriate disposition of hypothermic patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational methods: &lt;/strong&gt;This session was conducted using high-fidelity simulation, followed by a debriefing session and discussion about the diagnosis, differential, and management of both drowning and hypothermia. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. In this technique, the facilitators describe something they observed in the case, outline their reasoning as a facilitator why this observation was important or why they had questions, and then ask the learners to share their frame of reference at the time. An example: \"I heard someone say that both chest tubes should be placed on the left, but then another resident said 'I disagree.' No one paused to come to a consensus. I'm wondering why this wasn't explored further in real time. Tell me more.\" This scenario may also be run as a structured interview case.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research methods: &lt;/strong&gt;Our residents were provided a survey at the completion of the debriefing session so they might rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. The local institution's simulation center's electronic feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form1 with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventeen learners filled out a feedback form. This session received a majority of 6 and 7 scores (consistently effective/very good, and extremely effective/outstanding, respectively) other than four 5 scores","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"10 1","pages":"S43-S74"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acetaminophen Toxicity.","authors":"Rachel Whittaker, Navneet Cheema","doi":"10.21980/J8435R","DOIUrl":"10.21980/J8435R","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Audience: &lt;/strong&gt;This is a practice structured interview case which is appropriate for emergency medicine residents at all levels of training.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Acetaminophen (APAP) is an over-the-counter medication commonly used by adult and pediatric populations. While acetaminophen has demonstrated to be reasonably safe and well-tolerated at therapeutic doses, it can cause severe hepatic toxicity if taken in excess. Acetaminophen toxicity is the most common cause of acute hepatic failure in the United States, accounting for approximately 50 percent of all reported cases and 20 percent of liver transplants.1 In 2021, poison control received more than 80,000 cases involving acetaminophen-containing products, and acetaminophen toxicity is responsible for 56,000 - 75,000 emergency department visits annually.2,3 Acetaminophen toxicity is compounded by introduction of acetaminophen combination products, with unintentional and chronic overdose accounting for over 50 percent of cases of acetaminophen-related acute hepatic failure in the United States and United Kingdom.4 Given the prevalence of acetaminophen toxicity and oftentimes vague presentation of symptoms, it is imperative that emergency medicine physicians promptly identify and manage acetaminophen toxicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational objectives: &lt;/strong&gt;At the end of this practice oral board session, examinees will be able to: 1) demonstrate an ability to obtain a complete medical history in an oral boards structured interview format, 2) review appropriate laboratory tests and imaging to evaluate abdominal pain, 3) investigate a broad differential diagnosis for right upper quadrant abdominal pain, 4) recognize chronic acetaminophen toxicity, 5) initiate the appropriate treatment for chronic acetaminophen toxicity, 6) demonstrate effective communication with the patient, consultants, and the admitting team.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational methods: &lt;/strong&gt;This is a structured interview case intended to evaluate learner thought processes throughout the evaluation, workup, and diagnosis of a patient with acetaminophen toxicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research methods: &lt;/strong&gt;The practice structured interview case was developed and then tested in a small group environment with emergency medicine residents at different levels of training. After the case was completed, learners and instructors were given the opportunity to assess its strengths and weaknesses by providing electronic feedback during a residency conference. The format of oral boards' assessing the strengths and weaknesses of a case was mimicked through having one instructor to one to two residents per case administration. Subsequent modifications were made to remove ambiguity based on the feedback provided.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This case was administered as part of our residency oral boards didactics series. Thirty-one EM residents PGY1-PGY3 were administered in the case. Ten learners completed an evalua","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"10 1","pages":"SI1-SI19"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed Tomography Findings in Non-Obstetric Vulvar Hematoma: A Case Report.","authors":"Eleanor M Birch, Theodore McClean, Scott Szymanski","doi":"10.21980/J8194H","DOIUrl":"10.21980/J8194H","url":null,"abstract":"<p><p>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.</p><p><strong>Topics: </strong>Vulvar hematoma, pelvic trauma, women's health, CT (computed tomography) angiography.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"9 4","pages":"V6-V9"},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Whodunit Gamified Flipped Classroom For High Yield Bite Injuries And Envenomation.","authors":"Mary G McGoldrick, Laryssa Patti, Meigra Chin, Tiffany Murano","doi":"10.21980/J88S81","DOIUrl":"10.21980/J88S81","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Audience: &lt;/strong&gt;Clerkship-level medical students, sub-interns, junior and senior residents, attending physicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;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 when compared to the passive learning of lectures.4 In that vein, there is a growing body of gamified resources in medical education which utilize pattern recognition and problem solving skills that can be analogous to clinical practice.5,6.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational objectives: &lt;/strong&gt;By the end of this activity, learners will be able to: 1) identify and name species responsible for bite/sting/envenomation injuries, 2) recognize associated signs, symptoms, physical exam findings and complications associated with bites/stings/envenomations by certain species, 3) discuss management such as antibiotics, antivenom, and supportive care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational methods: &lt;/strong&gt;We designed a small group activity asking residents to identify, research, and present the \"culprits\" implicated in environmental exposures to animals and insects, and match them to corresponding clinical scenarios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research methods: &lt;/strong&gt;Participants anonymously answered electronic multiple-choice quizzes before and after completing the activity to gauge its effectiveness in conveying the material. They also completed an additional anonymous, electronic survey regarding their attitudes towards this activity and the possibility of other gamified didactics within the curriculum.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Each resident class showed an upward trend in their average multiple-choice score, the greatest of which was seen in the post-graduate year (PGY) 1 class. The residency demonstrated a statistically significant improvement in their ability to answer multiple choice questions (MCQs), with an average pre-activity score of 67.14%, and post-activity score of 87.14%. Participants showed determination and enthusiasm to engage with the material when presented in a gamified format, and 100% of post-activity survey respondents wanted to participate in further gamified activities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Gamified small group activities ","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"9 4","pages":"SG13-SG23"},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}