Journal of education & teaching in emergency medicine最新文献

{"title":"Case Report of a Child with Colocolic Intussusception with a Primary Lead Point.","authors":"Ethan Lee, Jeremy Lins, Chelsea Cosand, Mary Jane Piroutek, Tommy Y Kim","doi":"10.21980/J8564Q","DOIUrl":"https://doi.org/10.21980/J8564Q","url":null,"abstract":"<p><p>Intussusception is the telescoping of bowel into an adjacent segment of bowel and has an associated risk for bowel ischemia and perforation. The classic triad of abdominal pain, blood in stool, and an abdominal mass is present in less than 40% of pediatric cases and is less common in older children.1 Ultrasound has a high sensitivity and specificity for the diagnosis of intussusception, and once diagnosed, treatment modalities include reduction by either ultrasound or fluoroscopic guided air or hydrostatic enema. The risk of recurrence after successful reduction occurs in up to 12% of pediatric patients and occurs more frequently in older children and children with a pathologic lead point.2 We present a case of a 6-year-old child with colocolic intussusception that was successfully reduced and recurred within five days due to a large colonic polyp.</p><p><strong>Topics: </strong>Intussusception, lead point, pediatrics.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725206","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 Novel Leadership Curriculum for Emergency Medicine Residents.","authors":"Michael J Zdradzinski, Stephen Sanders, Qasim Kazmi, Vanessa Fields, James O'Shea, Sar Medoff","doi":"10.21980/J81D2S","DOIUrl":"https://doi.org/10.21980/J81D2S","url":null,"abstract":"<p><strong>Audience and type of curriculum: </strong>This longitudinal leadership curriculum is designed for emergency medicine residents at all levels, with individual sessions designed for each residency year.</p><p><strong>Length of curriculum: </strong>This curriculum runs once annually over three to four years of emergency medicine residency.</p><p><strong>Introduction: </strong>Leadership is a vital skill for emergency physicians but is often passively taught during residency training. Strong leadership skills can lead to improved patient outcomes, but very few residency programs in any specialty and no emergency medicine residency programs have published comprehensive leadership training curricula.</p><p><strong>Educational goals: </strong>The goals of this curriculum are to expose Emergency Medicine residents to the basics of leadership, to provide a graduated series of interactive, psychologically safe environments to explore individual leadership styles, to review interesting relevant literature, and to discuss leadership principles and experiences with senior leaders in our Emergency Department.</p><p><strong>Educational methods: </strong>The educational strategies used in this curriculum include: brief lecture-style seminars, small group discussion and reflection, and a panel-style discussion.</p><p><strong>Research methods: </strong>The educational content of this curriculum was evaluated by learners via feedback surveys after each session.</p><p><strong>Results: </strong>Course evaluations conducted in both 2017 and 2020 showed that more than 89% of resident participants found these sessions \"useful\" or \"very useful.\" All residents surveyed agreed that leadership is an important topic for emergency medicine residency, and 76% felt that the inclusion of leadership content strengthened the residency's curriculum. Suggestions for future topics included handling personal conflict and discussing transitions in leadership during yearly residency promotions.</p><p><strong>Discussion: </strong>The curriculum has been successfully implemented for seven years. It has proven to be sustainable and requires minimal resources. The residents report high satisfaction with the curriculum and agree that formal instruction on the topic of leadership is important to their on-shift performance and careers.</p><p><strong>Topics: </strong>Leadership, communication.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725203","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":"E-FAST Ultrasound Training Curriculum for Prehospital Emergency Medical Service (EMS) Clinicians.","authors":"Clever M Nguyen, Krista Hartmann, Craig Goodmurphy, Avram Flamm","doi":"10.21980/J8S060","DOIUrl":"https://doi.org/10.21980/J8S060","url":null,"abstract":"<p><strong>Audience and type of curriculum: </strong>Audience and type of curriculum: This hybrid, asynchronous curriculum is designed for prehospital clinician colleagues, including but not limited to emergency medical technicians (EMT), advanced EMTs (AEMT), EMT-paramedics (EMT-P), critical care EMT-Ps (CCEMTP), critical care transport nurses (CCTN), and certified flight registered nurses (CFRN) to learn and practice ultrasound fundamentals in the setting of a standardized extended focused assessment with sonography in trauma (E-FAST) exam.</p><p><strong>Length of curriculum: </strong>Over a five-month curriculum, learners will perform a pre-test, review online module lectures, attend an ultrasound scanning workshop, and perform post-test examinations.</p><p><strong>Introduction: </strong>The extended-focused assessment with sonography in trauma (E-FAST) exam can identify intrathoracic and intraabdominal free fluid, as well as pneumothoraces. The E-FAST ultrasound exam has previously been taught to clinicians of various backgrounds in healthcare including emergency medical service (EMS). However, an open-access, systemized curriculum for teaching E-FAST exams to EMS clinicians has not been published.</p><p><strong>Educational goals: </strong>By the end of these training activities, prehospital EMS learners will be able to demonstrate foundational ultrasound skills in scanning, interpretation, and artifact recognition by identifying pertinent organs and anatomically relevant structures for an E-FAST examination. Learners will differentiate between normal and pathologic E-FAST ultrasound images by identifying the presence of free fluid and lung sliding. Learners will also explain the clinical significance and application of detecting free fluid during an E-FAST scan.</p><p><strong>Educational methods: </strong>The educational strategies used in this curriculum include a hybrid, asynchronous curriculum encompassing 2.5 hours of lectures derived from online learning modules and in-person review. In addition, learners will attend 2 hours of hands-on proctored ultrasound scanning practicing E-FAST examinations.</p><p><strong>Research methods: </strong>An online 13-question pre-test was administered prior to the study. An online post-test and in-person scanning OSCEs were administered at least eight weeks after their scheduled workshop consisting of an online 13-question multiple-choice post-test, a confidence survey, and a hands-on E-FAST Objectively Structured Clinical Exam (OSCE) session. A non-parametric Wilcoxon signed-rank test was performed between each pre-test and post-test metric to examine the statistical differences of paired data.</p><p><strong>Results: </strong>Post-test scores demonstrated statistically significant improvement in both image interpretation exams and ultrasound self-efficacy from the pre-test. The mean pre-test and post-test scores were 55.46% (7.21 ± 1.99) and 84.23% (10.89 ± 1.59) correct out of 13 questions, respective","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725207","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 Guide to the Medical School Curriculum Vitae.","authors":"Konnor Davis, Megan Boysen-Osborn, Alisa Wray, Lauren Stokes","doi":"10.21980/J8HH1S","DOIUrl":"https://doi.org/10.21980/J8HH1S","url":null,"abstract":"<p><strong>Audience: </strong>Although this lecture is aimed at medical students, it can also be utilized for residents, fellows, and junior faculty.</p><p><strong>Background: </strong>The topic of teaching medical students about the fundamentals of creating a curriculum vitae (CV) is important because a CV serves as a record of scholastic and professional experiences.1 Thus, their CV will undoubtedly play a vital role in residency applications.2,3 Intentional instruction about the elements to incorporate in a CV are especially important for first-generation and underrepresented students in the medical field because they may not have had as much exposure to both the requirements of a residency application nor qualities of an effective CV.</p><p><strong>Educational objectives: </strong>After this lecture, learners should be able to: 1) elaborate on the significance of a CV for medical students and discuss its purpose, 2) outline the elements that should and should not be included on a CV, 3) integrate knowledge gleaned from basic principles with provided examples to establish the foundation of their own CV.</p><p><strong>Educational methods: </strong>A PowerPoint lecture was used to explain the purpose of a CV and the elements to include in a personal CV for medical students. The lecture took place via Zoom and was provided at no cost to all UCISOM medical students.</p><p><strong>Research methods: </strong>Students were given a short survey after the session to assess their understanding of why it is important to create and maintain a CV, including an evaluation of their overall satisfaction with the lecture presentation.</p><p><strong>Results: </strong>All the respondents (n=10) found the workshop to be useful and enjoyed the ability to see student examples while 80% of the respondents (n=8) found their knowledge of CVs increased because of the session. On a Likert scale from 1-5, with a 1 indicating \"very unconfident\" and 5 indicating \"very confident,\" 90% of respondents (n=9) indicated they are now confident or very confident in building or updating their CV after this session.</p><p><strong>Discussion: </strong>Overall, the educational content was found to be effective. Although the sample size from the survey was modest at best, we feel the survey data and comments from attendees during and after the session indicate the effectiveness of the content. From its initial implementation, we learned that this lecture can be given by any level of medical education professional (student, administrator, etc) due to the comprehensiveness of the presentation. We also learned that using video conferencing such as Zoom was an effective administration method but could also be replaced by in-person learning without much difficulty. Overall, we deem this presentation to be easy to administer, thorough, full of examples, and educationally effective.</p><p><strong>Topics: </strong>Curriculum vitae, CV, medical student, residency application, electronic residen","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725202","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":"Calcium Channel Blocker Overdose.","authors":"Jessica G Andrusaitis, Alan Givertz","doi":"10.21980/J8CQ07","DOIUrl":"https://doi.org/10.21980/J8CQ07","url":null,"abstract":"<p><strong>Audience: </strong>Emergency medicine residents and medical students on emergency medicine rotation.</p><p><strong>Background: </strong>Calcium channel blocker (CCB) overdoses can be severe with potentially serious adverse outcomes. CCBs work by blocking the calcium channels on smooth and cardiac muscle tissue. At low dose ranges, dihydropyridine CCBs (such as nifedipine, amlodipine, and nicardipine) block the L-type calcium receptors in the peripheral vasculature, whereas non-dihydropyridine CCBs (such as: verapamil and diltiazem) affect the L-type calcium receptors in the myocardium.1 Because of this distinction, dihydropyridine CCB toxicity manifests as arterial vasodilation and non-dihydropyridine CCB toxicity is associated with cardiac manifestations such as bradycardia and negative inotropy.2 It is important to note that in high concentrations (such as in overdoses), CCBs lose specificity for their specific receptors and can show all the manifestations of toxicity such as bradycardia, peripheral vasodilation, and hypotension. Patients can develop both vasoplegic shock from peripheral vasodilation and cardiogenic shock. This is a high acuity low occurrence case with infrequently used but specific treatments, and thus this case provides educational value.</p><p><strong>Educational objectives: </strong>At the end of this oral board session, examinees will: (1) demonstrate ability to evaluate a patient with undifferentiated shock with bradycardia and discuss the differential diagnosis, (2) recognize the signs and symptoms of calcium channel blocker overdose, (3) demonstrate ability to manage treatment of a patient with calcium channel overdose.</p><p><strong>Educational methods: </strong>This oral board case followed the standard American Board of Emergency Medicine-style case in a tertiary care hospital with access to all specialists and resources needed. This case was tested using 12 resident volunteers ranging from PGY 1-2 in an ACGME (Accreditation Council for Graduate Medical Education) accredited emergency medicine residency program.</p><p><strong>Research methods: </strong>Immediate feedback was solicited both from the learners and from the evaluators following the debriefing session. Residents were asked to evaluate the educational value of the case using a 1-5 Likert scale (5 being excellent). Evaluators were asked to score the residents using the ACGME core competencies with a scale of 1-8, 1-4 being unacceptable and 5-8 being acceptable.</p><p><strong>Results: </strong>Seven PGY1 residents and five PGY2 residents, thus twelve residents in total, completed the case. The average score was 5.10/8. Three residents missed zero critical actions. The most common critical action missed was consulting cardiology or cardiothoracic surgery for circulatory support options. Many residents failed to recognize that the patient did not have a perfusing blood pressure at the beginning of the case and did not start CPR. Although most reside","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725205","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":"What You Didn't Learn in Residency: A Collective Curriculum for New Academic EM Faculty and Fellows.","authors":"Jessica Schmidt, Benjamin Schnapp, Sara Damewood, Mary Westergaard","doi":"10.21980/J8WP9Z","DOIUrl":"https://doi.org/10.21980/J8WP9Z","url":null,"abstract":"<p><strong>Audience and type of curriculum: </strong>This curriculum is designed for emergency medicine fellows and first-year junior faculty. The curriculum covers core topics related to academic and professional success for an early career faculty member.</p><p><strong>Length of curriculum: </strong>The curriculum is designed as quarterly sessions over the course of one academic year.</p><p><strong>Introduction: </strong>An increasing number of emergency medicine graduates are pursuing fellowship after completion of residency.1 Fellowship can be challenging as newly minted graduates begin to explore their academic niche, refine their clinical practice, and define their personal and professional spheres. We propose a structured curriculum to help guide fellows and new faculty to mitigate these challenges.</p><p><strong>Educational goals: </strong>The aim of this curriculum is to develop relevant skills to promote academic success for fellows and first-year faculty at the start of their academic career and which could be completed during a one-year training timeline. We included topics relevant to all fellow and new faculty's expected personal and professional journey during this first year, including time management, academic productivity, resilience/wellness, and developing a national reputation.</p><p><strong>Educational methods: </strong>The educational strategies used in this curriculum consist primarily of lecture seminars. There is one short individual activity associated with the lectures and one small group discussion.</p><p><strong>Research methods: </strong>The course was assessed with pre- and post-test surveys following each lecture. Surveys assessed participants' reaction, learning, and behavior for each session. Evaluations were completed based on a 5-point Likert scale (1=strongly disagree, 5=strongly agree).</p><p><strong>Results: </strong>Fifteen participants attended the seminar series encompassing fellows and first-year faculty/post-fellows from ten different fellowship subspecialities. Average pre-assessment scores were low for many of the self-reported skills and confidence throughout the seminar series. Overall, participants reported increased confidence on the post-test for each of the seminar topics. In addition, participants reported that they learned new skills and planned to use the new ideas presented. All participants reported they would recommend these seminars to someone else on their same career path.</p><p><strong>Discussion: </strong>Overall, participants reported increased confidence, new skills, and plans to use the ideas presented in the seminar series. The content appears applicable to this learner set since all reported they would recommend the series to others on their career path. In conclusion, we believe our seminar series will build skills for fellows and first-year faculty which will promote academic success.</p><p><strong>Topics: </strong>Academic success, professional development, early career devel","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725210","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":"Adolescent with Diabetic Ketoacidosis, Hypothermia and Pneumomediastinum.","authors":"Steven Millner, Courtney Devlin","doi":"10.21980/J8FP8J","DOIUrl":"https://doi.org/10.21980/J8FP8J","url":null,"abstract":"<p><strong>Audience: </strong>The target audience of this simulation is emergency medicine residents and medical students. The simulation is based on a real case of a 12-year-old male who presented obtunded with shortness of breath and hypothermia who was ultimately diagnosed with diabetic ketoacidosis (DKA) and pneumomediastinum. This case highlights the diagnosis and management of an adolescent with new onset diabetic ketoacidosis and pneumomediastinum with deterioration of status, as well as important ventilator settings if intubation is required in the setting of diabetic ketoacidosis.</p><p><strong>Background: </strong>Type 1 diabetes is a common disease in the pediatric population with the prevalence being approximately 2.15 per 1000 youths and diabetic ketoacidosis being the presenting status in 30-40% of the patients.1 Physicians who evaluate a child with altered mental status must have diabetic ketoacidosis in their differential. In the setting of mechanical ventilation in patients with diabetic ketoacidosis (DKA), special care must be taken. Mechanical ventilation in these patients comes with increased risk, morbidity, and mortality. Risk factors for pneumomediastinum include lung disease such as asthma, chronic obstructive pulmonary disease (COPD), and malignancy, but also can occur in the acute setting of vomiting or trauma.2.</p><p><strong>Educational objectives: </strong>By the end of the simulation, learners will be able to: 1) develop a differential diagnosis for an adolescent who presents obtunded with shortness of breath; 2) discuss the management of diabetic ketoacidosis; 3) discuss management of hypothermia in a pediatric patient; 4) discuss appropriate ventilator settings in a patient with diabetic ketoacidosis; and 5) demonstrate interpersonal communication with family, nursing, and consultants during high stress situations.</p><p><strong>Educational methods: </strong>This is a high-fidelity simulation that allows learners to manage the diagnosis and treatment of diabetic ketoacidosis and hypothermia in an adolescent patient. Participants participated in a debriefing after the simulation. There should be approximately 4-5 learners per case. This simulation was performed in 3 sessions. Each learner performed this simulation one time.</p><p><strong>Research methods: </strong>The effectiveness of this case was evaluated by surveys given to learners after debriefing. Learners gave quantitative and qualitative results of their feedback using a 1-5 rating scale and open-ended written questions. This case was trialed with residents in their first through third years of training as well as fourth year medical students.</p><p><strong>Results: </strong>Feedback was very positive, with 19 residents completing the post-simulation survey. They enjoyed the case and reported they would feel more comfortable in a comparable situation in the future. Four survey questions were asked of the participants. On average, learners stated they felt t","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650856","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":"Point-Of-Care Ultrasound Use for Detection of Multiple Metallic Foreign Body Ingestion in the Pediatric Emergency Department: A Case Report.","authors":"Sarah Bella, Joseph Heiney, Amy Patwa","doi":"10.21980/J83D2D","DOIUrl":"10.21980/J83D2D","url":null,"abstract":"<p><p>Foreign body ingestions are common complaints in the pediatric emergency department that can be difficult to diagnose in patients with vague symptoms. Magnetic foreign body ingestion can cause significant morbidity and mortality in children. Point-of-care ultrasound (POCUS) is an imaging modality that can be used to readily diagnose emergent abdominal pathology in a timely matter at the patient's bedside. In the case described in the report below, a 6-year-old male swallowed multiple round magnets, causing severe abdominal pain. This was detected on POCUS. An abdominal radiograph also confirmed the POCUS findings of multiple hyperechoic round foreign bodies. Key clinical features and sonographic findings are discussed that may help clinicians using POCUS to identify ingested foreign bodies in Pediatric Emergency Departments.</p><p><strong>Topics: </strong>Point-of-care ultrasound, pediatric emergency medicine, foreign body ingestion.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650641","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":"Ventricular Tachycardia.","authors":"Rohit Menon, Geremiha Emerson, Jennifer Yee","doi":"10.21980/J8KD2R","DOIUrl":"10.21980/J8KD2R","url":null,"abstract":"<p><strong>Audience: </strong>This scenario was developed to educate emergency medicine residents on the diagnosis and management of ventricular tachycardia (VT) that is refractory to single dose anti-arrhythmic management.</p><p><strong>Background: </strong>Electrical storm, defined as three or more episodes of sustained VT, ventricular fibrillation, or appropriate shocks from an implantable cardioverter defibrillator within 24 hours,1 has a mortality rate up to 14% in the first 48 hours.2 Ventricular tachycardia may present in a heterogenous fashion, not only with stable versus unstable clinical presentations, but also with different electrocardiographic morphologies and etiologies.1 Understanding how to rapidly diagnose, treat, and utilize second or third-line treatments is vital in the setting of refractory ventricular tachycardia rather than relying on the success of first-line agents. Appreciation for what medications are readily available in your crash cart and medication dispensing cabinet is critical for timely management for refractory ventricular tachycardia.</p><p><strong>Educational objectives: </strong>At the conclusion of the simulation session, learners will be able to: 1) identify the different etiologies of VT, including structural heart disease, acute ischemia, and acquired or congenital QT syndrome; 2) describe confounding factors of VT, such as electrolyte abnormalities and sympathetic surge; 3) describe how to troubleshoot an unsuccessful synchronized cardioversion, including checking equipment connections, increasing delivered energy, and changing pad placement; 4) compare and contrast treatments of VT based on suspected underlying etiology; 5) describe reasons to activate the cardiac catheterization lab other than occlusive myocardial infarction; and 6) identify appropriate disposition of the patient to the cardiac catheterization lab.</p><p><strong>Educational methods: </strong>This session was conducted using high-fidelity simulation, followed by a debriefing session and lecture on the diagnosis, differential diagnosis, and management of VT. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. This scenario may also be run as an oral board case.</p><p><strong>Research methods: </strong>Our residents are provided a survey at the completion of the debriefing session so they may rate different aspects of the simulation, as well as provide qualitative feedback on the scenario.</p><p><strong>Results: </strong>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 Form³ with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7. Twelve learners completed a feedback form. This session received 6 and 7 scores (consistently effective/very good and extremely effective/outsta","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650643","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":"Sonographic Retrobulbar Spot Sign in Diagnosis of Central Retinal Artery Occlusion: A Case Report.","authors":"Emiliya Usheva, Dustin Williams, Haley Musgrave, Scott Zhou","doi":"10.21980/J8735P","DOIUrl":"10.21980/J8735P","url":null,"abstract":"<p><p>Central retinal artery occlusion (CRAO) is a rare emergency department presentation with high morbidity and potential for long-term vision loss. Additionally, this finding requires an expeditious embolic workup for possible systemic pathology (i.e., stroke). The gold standard for diagnosis is visualization of a pale retina with a \"cherry-red spot\" on the fovea seen under dilated fundoscopic examination. However, performing a dilated fundoscopic exam is often not practical and technically challenging in the emergency room setting. Alternatively, point of care ultrasound is an inexpensive, non-invasive tool that is already highly utilized in the emergency department and can aid in diagnosis. In the case described in this report, a 66-year-old female presented to the emergency department with painless, monocular vision loss. Ultrasound showed a hyperechoic density on the distal aspect of the optic nerve (\"retrobulbar spot sign\") and dilated fundoscopic exam showed right eye pale macula with cherry red spot, all consistent with CRAO. Here we present a case that suggests an opportunity for improvement in evaluation of monocular vision loss in the emergency department by adding bedside ocular ultrasound to aid in more rapid diagnosis of CRAO.</p><p><strong>Topics: </strong>Central retinal occlusion, vision loss, point-of-care ultrasound, ocular ultrasound, emboli.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650642","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}