Journal of education & teaching in emergency medicine最新文献

{"title":"Do's and Don'ts of Taking Care of Deaf Patients.","authors":"Luke Johnson, Sarah Smetana, Wyatte Hall, Aaron D Weaver, Jason Rotoli","doi":"10.21980/J8336T","DOIUrl":"10.21980/J8336T","url":null,"abstract":"<p><strong>Audience: </strong>Emergency medicine residents, fellows, and attending physicians, any practicing provider in a medical setting that may serve Deaf patients.</p><p><strong>Introduction: </strong>Emergency medicine providers often interact with Deaf and Hard of Hearing (DHH, or just HOH, for only hard of hearing) patients. Various limitations, however, affect their ability to effectively engage with DHH patients such as acuity, lack of time, and/or readily available communication tools (eg. virtual or in-person interpreters), among other challenges. These barriers contribute to numerous DHH healthcare disparities. Estimating the number of DHH people and ASL users in the US is challenging because the US Census Bureau inquires about hearing loss as it (1) pertains to interactions between a person speaking and the person (who may be experiencing hearing loss or deafness) being spoken to and (2) does not inquire if ASL is used in the home as a primary language.1,2 In reviewing data from the 2002 Survey of Income and Program Participation (SIPP), there were approximately 11 million people (4.1%) in the US with hearing loss and 1 million (0.38%) who are functionally deaf (unable to hear \"normal\" conversation at all).2 Best estimates of the number of <i>total people</i> using sign language in the US come from survey data from the National Census of the Deaf Population in 1974.3 In this survey, it was noted that approximately 410,522 people have been signing in homes irrespective of hearing status (i.e. may include signing to hearing household members of DHH family). In considering prevocational deaf individuals (i.e. born deaf or lost the ability to hear before 19 years old), there are approximately 277,000 deaf people who are considered \"good signers.\"4 Understanding that the DHH community makes up an important portion of our patient population, we sought to design an educational intervention and infographic to demonstrate common pitfalls while caring for this marginalized group in the Emergency Department (ED). Not only does this community face difficulties navigating the health care system due to communication barriers and poor health literacy, but DHH and American Sign Language (ASL) users also appear to have higher rates of ED utilization than the general population of non-DHH individuals.5,6 Despite increased ED utilization, disparities persist such as extended door-to-disposition time, limited diagnostic studies, lack of IV placement, and lower likelihood of hospital admission.7,8 Our project sought to help mitigate these disparities by engaging a group of highly dedicated individuals seeking to improve the quality of care for DHH patients in our community. Collectively, we developed an instructional video and quick reference infographic to help educate providers in preferred communication strategies and in pitfalls to avoid while communicating with DHH patients.</p><p><strong>Educational objectives: </strong>By the end of this didacti","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"10 1","pages":"L1-L8"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129137","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 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":"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":"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":"Journal Court: A Novel Approach to Incorporate Medicolegal Education into an Emergency Medicine Journal Club.","authors":"Kevin McGurk, Mary Jordan, Bradley Davis","doi":"10.21980/J8093T","DOIUrl":"10.21980/J8093T","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Audience: &lt;/strong&gt;The target audience includes health professions students, residents, and fellows who participate in journal clubs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Journal club plays an important role in teaching emergency medicine residents how to critically evaluate medical literature and apply it to their clinical practice. While there is some consensus on the general goals and objectives of journal club, significant variability exists between how different residency programs design and conduct them.1 Papers selected may address similar or disparate topics, highlight specific research applications, or demonstrate diverging evidence on a specific issue.2-5 While numerous approaches have been implemented and described, they do not traditionally entail a trial-based format.More than 7% of practicing physicians have a malpractice claim annually and more than one third will be sued in their lifetime.6,7 Some estimates indicate 75% of emergency medicine physicians will be named in a medical malpractice suit during their career.8 Despite this, the American College of Graduate Medical Education (ACGME) has no specific requirement for medicolegal instruction during emergency medicine training.9 By structuring journal club to encompass a hypothetical medical malpractice lawsuit, our program sought to provide instruction on this topic while also fostering improved resident enthusiasm and participation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational objectives: &lt;/strong&gt;By the end of this exercise, participants should: 1) identify the four necessary elements for a malpractice claim, 2) understand the basic structure of medical malpractice litigation, and 3) critically analyze medical literature representing diverging viewpoints or conclusions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Educational methods: &lt;/strong&gt;Residents read two papers regarding fluid resuscitation in sepsis and a fictional case narrative and associated medical malpractice complaint. The case described a septic patient with a history of congestive heart failure who clinically decompensates after large volume IV fluid administration.10,11 After a brief faculty-led discussion on medical malpractice, a mock trial was conducted. Rather than a more conventional journal club format, the two presenting residents discussed the papers by citing them as evidence in their role as expert witnesses providing testimony on behalf of the plaintiff or defense. Each expert witness explained the strengths of their respective paper and highlighted the weaknesses of the opposing paper. A jury made up of resident attendees then deliberated and rendered a verdict followed by an open discussion among the entire group regarding both papers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research methods: &lt;/strong&gt;At the conclusion of the journal club, residents in attendance were asked to complete a brief and anonymous survey evaluating the activity. Questions utilized a 5-point Likert scale to assess the journal club's utility for teaching about research appraisal and th","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"10 1","pages":"SG1-SG11"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129217","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":"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":"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":"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}