Journal of education & teaching in emergency medicine最新文献

{"title":"Enneagram in EM.","authors":"Megan Cifuni, Cami Pfennig, Caroline Astemborski","doi":"10.21980/J8ZM0G","DOIUrl":"https://doi.org/10.21980/J8ZM0G","url":null,"abstract":"<p><strong>Audience: </strong>This is a lecture paired with facilitated small group sessions and is targeted towards emergency medicine residents and physicians.</p><p><strong>Background: </strong>The enneagram is a well-established and popular personality theory that asserts that there are nine basic personality types, and that each enneagram type, 1-9, operates from a basic fear and a basic desire that produces predictable behavioral patterns and preferences.1-2 The enneagram has long been used as a tool to enhance self-awareness and to better understand internal defenses and reactions,3-5 and as such, it has been increasingly utilized to enhance self-growth and development in the fields of education, parenting, and business.6-7 While some studies have used the enneagram as a tool to predict natural empathy or stress levels of those in the medical field, particularly in nursing and medical school students,8-9 little has been published on the use of the enneagram as a tool to enhance self-awareness, leadership, and teamwork in the medical field. Emergency medicine is a specialty in which residents and physicians must not only be self-aware but must also be attuned to the dynamics of their healthcare team in order to succeed. We believe that the enneagram is the ideal tool to enhance these crucial skills.</p><p><strong>Educational objectives: </strong>The primary aim of this session was to enhance participants' self-awareness by identifying their enneagram type and therefore their predictable behavioral patterns. The secondary aim was to discuss strategies to improve teamwork and physician team leadership by directly addressing the type's strengths and weaknesses in these interactions.By the end of this session, the learner will be able to: 1) Self-identify with a primary enneagram personality type. 2) List the fears, desires, and motivations of the enneagram type. 3) Describe struggles in interacting with other disparate enneagram types. 4) Discuss strategies for success in facing conflict and interacting with other team members.</p><p><strong>Educational methods: </strong>This lecture was designed to educate emergency department physicians and residents on the enneagram tool. The introductory lecture takes about 20 minutes, and following this foundational presentation, learners split into small groups. Small group sessions take an additional 20 minutes during which facilitators guide learners through a discussion on their enneagram type and the potential strengths and challenges that each type might face in professional situations. This session was hosted during an Emergency Medicine Resident Education Conference. Due to COVID-19 restrictions, the session was presented virtually on a synchronous video platform with small group breakout rooms.</p><p><strong>Research methods: </strong>Following the session, the educational content was evaluated by our residents and faculty by a Likert reaction survey. The survey assessed both the form and effecti","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/PMC10631809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650583","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":"Little Patients, Big Tasks - A Pediatric Emergency Medicine Escape Room.","authors":"Jessica Pelletier, Ernesto Romo, Bryan Feinstein, Charles Smith, Gina Pellerito, Alexander Croft","doi":"10.21980/J89W70","DOIUrl":"10.21980/J89W70","url":null,"abstract":"<p><strong>Audience: </strong>The target audience for this small group session is post-graduate year (PGY) 1-4 emergency medicine (EM) residents, pediatric EM (PEM) fellows, and medical students.</p><p><strong>Introduction: </strong>Pediatric emergency department visits have been declining since the start of the COVID-19 pandemic, leading to decreased exposure to pediatric emergency care for EM residents and other learners in the ED.1 This is a major problem, given that the Accreditation Council for Graduate Medical Education (ACGME) mandates that a minimum of 20% of patient encounters or five months of training time for EM residents must occur with pediatric patients, with at least 50% of that time spent in the ED setting.2,3 A minimum of 12 months must be spent in the pediatric ED for PEM fellows,2 and an average of 7.1 weeks of medical school are spent in pediatric clerkships.4 This decrease in pediatrics exposure in the post-pandemic environment can be addressed through simulation and gamification. We selected the gamification method of an escape room to create an engaging environment in which learners could interface with key pediatric emergency medicine clinical concepts via group learning.</p><p><strong>Educational objectives: </strong>By the end of this small group exercise, learners will be able to:Demonstrate appropriate dosing of pediatric code and resuscitation medicationsRecognize normal pediatric vital signs by ageDemonstrate appropriate use of formulas to calculate pediatric equipment sizes and insertion depthsRecognize classic pediatric murmursAppropriately diagnose congenital cardiac conditionsRecognize abnormal pediatric electrocardiograms (ECGs)Identify life-threatening pediatric conditionsDemonstrate intraosseous line (IO) insertion on a pediatric modelDemonstrate appropriate use of the Neonatal Resuscitation Protocol (NRP^®) algorithms.</p><p><strong>Educational methods: </strong>An escape room - a form of gamification - was utilized to engage the learners in active learning. Gamification is an increasingly popular educational technique being utilized in graduate medical education and refers to the conversion of serious, non-trivial material into a fun activity fashioned like a game in order to enhance engagement in learning.5 This educational method seeks to enhance knowledge, attitudes, and skills via components of games - such as puzzles and prizes - outside of the context of a traditional game.6 Though high-quality research data on the effectiveness of gamification methods in graduate medical education is limited, studies have shown that gamification enhances learning, attitudes, and behaviors.5,7 One randomized, clinical-controlled trial investigating the use of gamification to enhance patient outcomes found that patients of primary care physicians randomized to the gamification group reached blood pressure targets faster than in the control group.8 Escape rooms as a modality for education have been suggested 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/PMC10631808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650585","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":"Low-Cost Fishhook Removal Simulation.","authors":"David Mitchell Baskin, Christopher Ashby Davis","doi":"10.21980/J8Q64P","DOIUrl":"10.21980/J8Q64P","url":null,"abstract":"<p><strong>Audience: </strong>The target audiences for this hands-on innovation are health care providers including medical students and emergency medicine residents. This simulation is also appropriate for small group sessions teaching the layperson.</p><p><strong>Background: </strong>While generally not life-threating fishhook injuries are commonplace. They can end a day of recreation or an outdoor trip and possibly result in a visit to an emergency department or urgent care. Hands-on education on fishhook removal techniques that minimize tissue damage is rarely provided in wilderness first aid or traditional medical education. To the best of our knowledge, to date there are only two studies on fishhook removal simulations in medical and wilderness first aid education.1,2 The previously described simulation models are limited by accessibility of materials, realism, and cost.</p><p><strong>Educational objectives: </strong>The goal of this small group session is to fill the gap in training on fishhook injuries. At the end of the session participants should be able to describe the parts of a fishhook, as well as demonstrate and have increased confidence in performing multiple fishhook removal techniques.</p><p><strong>Educational methods: </strong>Social learning theory is the conceptual framework for this small group session.3,4 This reflects the idea that students learn not only through repetition with trial and error, but through social interactions, observing and modeling successes of others. As a result, while this simulation requires a facilitator ensure the required items are available it does not necessitate a facilitator be present over the entire duration. Participants perform common fishhook removal techniques with hands-on skill development using commercially available silicone sponge injection pad trainers.</p><p><strong>Research methods: </strong>Evaluating this small group session at a wilderness medicine training attended by medical and physician assistant students and their guests, self-reported confidence in fishhook removal before and after the simulation was assessed with a paired t-test. Survey results of perceived effectiveness and value of the simulation were also evaluated.</p><p><strong>Results: </strong>The average confidence increased 58% after the simulation (p<0.005). The mean level of effectiveness was 87% and the participant perceived monetary value of the simulation materials was greater than actual cost.</p><p><strong>Discussion: </strong>This innovation is a cost-friendly way to provide education and practice on fishhook removal. It requires minimal set up time and pre-learning can be easily modified to the expected knowledge and experience of participants. Understanding the fishhook removal techniques and increased levels of confidence has the potential to make participants more efficient when caring for patients. It may result in greater likelihood of success in removing fishhooks with minimal tissue damage.</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/PMC10631813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650586","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":"Inhalational Injury Secondary to House Fire.","authors":"Ryan O'Neill, Benjamin M Ostro, Jennifer Yee","doi":"10.21980/J8TW7N","DOIUrl":"https://doi.org/10.21980/J8TW7N","url":null,"abstract":"<p><strong>Audience: </strong>This scenario was developed to educate emergency medicine residents on the diagnosis and management of patients with an inhalational airway injury secondary to a house fire.</p><p><strong>Background: </strong>Burn injuries are a common occurrence encountered by the emergency physician. According to the National Hospital Ambulatory Medical Care Survey, around 371,000 patients were treated in emergency departments for fire or burn injuries across the United States in 2020. This represents around 1% of emergency department visits related to injury, poisoning, or adverse effects.1 One of the most dangerous and time critical aspects of managing severely burned patients is inhalation injury. Inhalation injury is a relatively vague term which may refer to pulmonary exposure to a wide range of chemicals in various forms. In the context of burn patients, this is most often smoke exposure. It is critical that the emergency medicine provider rapidly identifies the potential for an inhalational injury in order to determine the need for definitive airway management. It is also important that the provider has the necessary skills and systematic approach to manage what is likely to be a difficult airway. Furthermore, providers must then have the knowledge of how to best manage and resuscitate these severely burned patients post-intubation.</p><p><strong>Educational objectives: </strong>At the conclusion of the simulation session, learners will be able to: 1) recognize the indications for intubation in a thermal burn/inhalation injury patient; 2) develop a systematic approach to an inhalational injury airway; and 3) recognize indications for transfer to burn center.</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 inhalational airway injury secondary to a house fire. 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. 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 Form² with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7.</p><p><strong>Results: </strong>Nine learners completed a feedback form. This session received all 6 & 7 scores (consistently effective/very good and extremely effective/outstanding, respectively) other than one isolated 5 score.</p><p><strong>Discussion: </strong>This is a cost-effective method for reviewin","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/PMC10631807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650584","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":"Infant Botulism.","authors":"Ashley Garispe,&nbsp;Steven Cherry","doi":"10.21980/J88350","DOIUrl":"https://doi.org/10.21980/J88350","url":null,"abstract":"<p><strong>Audience: </strong>This oral board case is appropriate for emergency medicine residents and medical students (with senior resident assistance) on emergency medicine rotation.</p><p><strong>Introduction: </strong>Although a somewhat rare disease, infant botulism is a true pediatric emergency that carried a 90% rate of mortality prior to the development of an antitoxin.1 While botulism infections can be iatrogenic, foodborne, or involve infected wounds, infant botulism remains the most common presentation of this disease and accounts for approximately 70% of new cases annually.2 Caused by <i>Clostridium botulinum</i>, the inactive spores are ingested by the infant and germinate in the large intestine.3,4 The resulting neurotoxin prevents the release of acetylcholine at the presynaptic membrane which results in flaccid paralysis. Classically, the bulbar musculature is affected before somatic muscular, which results in the typical presentation of \"descending paralysis.\"2,5 While confirmatory testing is important, it is often delayed by more than 24 hours, making both clinical recognition and implementation of treatment before confirmatory testing of vital importance.6,7 Treatment consists of providing airway, nutritional, and hydration support in addition to administering botulinum-specific antitoxin.8,9 While patients over the age of 12 months are treated with equine botulinum antitoxin, the Food and Drug Administration (FDA) has approved a human-derived immunoglobulin treatment, Botulism Immune Globulin Intravenous (BIG-IV, ie, \"Baby BIG\") for pediatric patients less than 12 months of age.1,2,6 Ordering BIG-IV is a complex and multidisciplinary process, requiring the treating physician to discuss any suspicious case with the Infant Botulism Treatment and Prevention Program (IBTPP) which is a branch of the California Department of Public Health.6 With early recognition and implementation of treatment, most infants will make a full recovery.</p><p><strong>Educational objectives: </strong>At the end of this oral board session, examinees will: 1) demonstrate an ability to obtain a complete pediatric medical history, 2) perform an appropriate physical exam on a pediatric patient, 3) investigate a broad differential diagnosis for neuromuscular weakness in a pediatric patient, 4) recognize the classic presentation of infant botulism and implement treatment with botulinum specific antitoxin before confirmatory testing, 5) recognize impending airway failure and intubate the pediatric patient with appropriately dosed medications and ET tube size, and 6) demonstrate effective communication with healthcare team members and parents.</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 f","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9988941","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":"Headache Over Heels: CT Negative Subarachnoid Hemorrhage.","authors":"Sarah Hogan,&nbsp;Sara Dimeo,&nbsp;Caroline Astemborski","doi":"10.21980/J8ND2C","DOIUrl":"https://doi.org/10.21980/J8ND2C","url":null,"abstract":"<p><strong>Audience: </strong>This simulation is intended for MS4 or PGY-1 learners.</p><p><strong>Introduction: </strong>Both headache and syncope are common chief complaints in the emergency department (ED); however, subarachnoid hemorrhage (SAH) is uncommon (accounting for 1-3% of all patients presenting to the ED with headache), with near 50% mortality.1-3 It is important to recognize the signs and symptoms that point to this specific diagnosis. Once subarachnoid hemorrhage is suspected, it is critical to understand the appropriate workup to diagnose SAH, depending on the timing of presentation. Once SAH is diagnosed, appropriately managing the patient's glucose, blood pressure, and pain is important.</p><p><strong>Educational objectives: </strong>By the end of this case, the participant will be able to: 1) construct a broad differential diagnosis for a patient presenting with syncope, 2) name the history and physical exam findings consistent with SAH, 3) identify SAH on computer tomography (CT) imaging, 4) identify the need for lumbar puncture (LP) to diagnose SAH when CT head is non-diagnostic > 6 hours after symptom onset, 5) correctly interpret cerebral fluid studies (CSF) to aid in the diagnosis of SAH, and 6) specify blood pressure goals in SAH and suggest appropriate medication management.</p><p><strong>Educational methods: </strong>High-fidelity simulation was utilized since this modality forces learners to actively construct a differential for syncope, recognize the possibility of subarachnoid hemorrhage, recall the need for lumbar puncture, and talk through management considerations in real time as opposed to a more passive lecture format.</p><p><strong>Research methods: </strong>Twenty emergency medicine residents and medical student learners completed the simulation activity. Each learner was asked to complete an eight question post-simulation survey. The survey addressed the utility and appropriate training level of the simulation activity while also including an open-ended prompt for suggestions for improvement.</p><p><strong>Results: </strong>Five PGY3, four PGY2, four PGY1, and seven medical students completed the survey. Ninety-five percent felt that the case was more helpful in a simulation format than in a lecture format. All learners felt that the simulation was an appropriate level of difficulty. Of the comments received, a few learners noted they preferred more complexity.</p><p><strong>Discussion: </strong>Overall, the educational content was effective in teaching about the SAH diagnostic algorithm, CSF interpretation, and blood pressure management in SAH. Overall, learners very much enjoyed the activity and felt it was appropriate for their level of training. The most common constructive feedback was to include more specific neurologic findings on physical examination to help guide the student to the diagnosis of SAH.</p><p><strong>Topics: </strong>Syncope, subarachnoid hemorrhage, cerebrospinal fluid interpretation, l","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9995308","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":"Everyday Water-Related Emergencies: A Didactic Course Expanding Wilderness Medicine Education.","authors":"Geoffrey B Comp,&nbsp;Erica Burmood,&nbsp;Molly Enenbach,&nbsp;Savannah Seigneur","doi":"10.21980/J8WS90","DOIUrl":"https://doi.org/10.21980/J8WS90","url":null,"abstract":"<p><strong>Audience: </strong>This small group session is appropriate for any level of emergency medicine resident physicians.</p><p><strong>Introduction: </strong>Drowning is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. It is the third leading cause of unintentional injury-related deaths worldwide, accounting for 7% of all injury-related deaths.1 Our group sought to improve resident education regarding the basics of water safety and rescues as an event developed by our wilderness medicine (WM) interest group. With the growing number of WM Fellowships, specialty tracks, interest clubs and the regular inclusion of WM topics in residency didactics, exposure to WM topics has increased greatly.2 There is a large overlap between wilderness medicine and the field of emergency medicine. Both require stabilization, improvisation, and the treatment of environmental/exposure illnesses. It is imperative that emergency medicine physicians understand the complex pathophysiology of drowning, as well as recognize and manage potential associated traumatic injuries including fractures and critical hemorrhage. Our goal is to provide additional curricular instruction on prehospital management of water-related emergencies and related injuries to emergency medicine residents.</p><p><strong>Educational objectives: </strong>By the end of the session, the learner will be able to: 1) describe the pathophysiology of drowning and shallow water drowning, 2) prevent water emergencies by listing water preparations and precautions to take prior to engaging in activities in and around water, 3) recognize a person at risk of drowning and determine the next best course of action, 4) demonstrate three different methods for in-water c-spine stabilization in the case of a possible cervical injury, 5) evaluate and treat a patient after submersion injury, 6) appropriately place a tourniquet for hemorrhage control, and 7) apply a splint to immobilize skeletal injury.</p><p><strong>Educational methods: </strong>A group of 16 resident learners received a thirty-minute introduction discussion (with open discussion) regarding water safety, basic water rescue methods, and submersion injury pathophysiology. They then progressed through three stations designed to emphasize select skills and knowledge related to submersion injury management, water rescue, and tourniquet and splint placement.</p><p><strong>Research methods: </strong>Participants completed a six-item questionnaire after the event designed to help gage participant comfort level of treatment, management, and experience regarding water safety, drowning, and related traumatic emergencies. Each item was ranked from 0 for \"strongly disagree\" to 10 for \"strongly agree.\" Total mean scores before and after were compared.</p><p><strong>Results: </strong>Sixteen individuals participated in the sessions and survey. The total mean score for the six-item analysis increased following the","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9995306","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 with Delirium Tremens.","authors":"Courtney Schwebach,&nbsp;Amrita Vempati","doi":"10.21980/J8S35N","DOIUrl":"https://doi.org/10.21980/J8S35N","url":null,"abstract":"<p><strong>Audience: </strong>Emergency medicine (EM) residents (1^st year and 2^nd year levels), 4th year medical students and advanced practice providers.</p><p><strong>Introduction: </strong>Alcohol use has played a major role in causing significant morbidity and mortality for patients. In 2016, it was the 7th leading risk factor for deaths and disability-adjusted life years globally.1 Among heavy alcohol users admitted for hospital management, the incidence of alcohol withdrawal syndrome is estimated to be 1.9 to 6.7%.1 Alcohol withdrawal (AW) in the ED has been associated with increased use of critical care resources, and frequent ED visits for alcohol-related presentations have been associated with mortality rates that are about 1-4% when withdrawal progresses to delirium tremens (DTs).1 Patients with alcohol withdrawal can present in many different ways to the ED including anxiety, tachycardia, delirium tremens (DTs), seizures and severe autonomic dysfunction leading to severe sickness and death.2 Therefore, it is extremely important for an EM physician to recognize the signs of AW in patients and to manage the critically ill patients. In addition, Clinical Institute Withdrawal Assessment (CIWA) of alcohol was developed to assess severity of alcohol withdrawal in 1989.3 EM physicians should utilize CIWA to help determine the severity of AW.</p><p><strong>Educational objectives: </strong>By the end of the session, learner will be able to 1) discuss the causes of altered mental status, 2) utilize CIWA scoring system to quantify AW severity, 3) formulate appropriate treatment plan for AW by treating with benzodiazepine and escalating treatment appropriately, 4) treat electrolyte abnormalities by giving appropriate medications for hypokalemia and hypomagnesemia, and 5) discuss clinical progression and timing to AW.</p><p><strong>Educational methods: </strong>This session was conducted using high-fidelity simulation, which was immediately followed by an in-depth debriefing session. The session was run during first year EM resident intern orientation, and it was run during two consecutive years. There was a total of 32 EM residents who participated. There was a total of 16 residents who actively managed the patient while the other 16 were observers. Each session had four learners and was run twice in two separate rooms. There was one simulation instructor running the session and one simulation technician who acted as a nurse.</p><p><strong>Research methods: </strong>After the simulation and debriefing session was complete, an online survey was sent via surveymonkey.com to all the participants. The survey collected responses to the following questions: (1) the case was believable, (2) the case had right the amount of complexity (based on their Gestalt), (3) the case helped in improving medical knowledge and patient care, (4) the simulation environment gave me a real-life experience and, (5) the debriefing session after simulat","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9995307","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":"Trauma by Couch: A Case Report of a Massive Traumatic Retroperitoneal Hematoma.","authors":"Cassandra Smith,&nbsp;Graham Stephenson,&nbsp;Alisa Wray,&nbsp;Matthew Hatter","doi":"10.21980/J84D2Q","DOIUrl":"https://doi.org/10.21980/J84D2Q","url":null,"abstract":"<p><p>The authors present the case of a 42-year-old male who was evaluated in a community hospital emergency department (ED) with right upper quadrant and flank pain after falling onto his couch. His evaluation included computed tomography (CT) of his abdomen with intravenous contrast that identified a large right retroperitoneal hematoma measuring an impressive 17 centimeters (cm) in length. The patient was transferred to a receiving trauma center. Upon arrival a focused assessment with sonography in trauma (FAST) ultrasound was obtained. The interpretation of the findings was complicated by distortion of his anatomy by the hematoma. The patient remained hemodynamically stable and was admitted for continued observation. He was ultimately discharged home in stable condition. This case report provides a concise overview of the approach to evaluating blunt abdominal trauma, imaging considerations, and a brief review of the management of retroperitoneal hematomas.</p><p><strong>Topics: </strong>Trauma, retroperitoneal hemorrhage, ultrasound, FAST, computed tomography, hepatorenal recess, Morrison's pouch.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9988938","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":"Acute Pulmonary Edema and NSTEMI.","authors":"Ashley Pilgrim","doi":"10.21980/J8CW67","DOIUrl":"https://doi.org/10.21980/J8CW67","url":null,"abstract":"<p><strong>Audience: </strong>Emergency medicine residents and medical students on emergency medicine rotation.</p><p><strong>Introduction: </strong>Acute pulmonary edema is a common and potentially fatal presentation in the emergency department. More than 1 million patients are admitted annually with a diagnosis of pulmonary edema secondary to cardiac causes.1 Pulmonary edema is broadly split into two main categories: cardiogenic and noncardiogenic. Cardiogenic pulmonary edema is characterized by acute dyspnea caused by the accumulation of fluid within the lung's interstitial and/or alveolar spaces, which is the result of acutely elevated cardiac filling pressures.2 Noncardiogenic pulmonary edema is characterized by fluid accumulation within the alveolar space in the absence of elevated pulmonary capillary wedge pressure.2 These patients often present critically ill, and rapid identification and aggressive management is paramount in caring for patients with pulmonary edema. Dyspnea is the most common presentation with a sensitivity of 89% but a low specificity of 51%.3 Workup of pulmonary edema often includes laboratory testing, electrocardiogram (EKG), chest x-ray (CXR), and often bedside ultrasound (US) and echocardiography.4 Pulmonary edema management depends on the etiology but is often focused on preload and afterload reduction. Diuretics, nitrates, and optimizing ventilatory support through non-invasive and invasive strategies are the mainstay of treatment.</p><p><strong>Educational objectives: </strong>At the end of this practice oral boards case, the learner will:1) recognize unstable vital signs (VS) and intervene to stabilize ventilation and oxygenation, 2) demonstrate the ability to obtain a complete medical history including the important characteristics of chest pain, 3) demonstrate an appropriate exam on a patient, 4) order the appropriate evaluation studies for a patient with complaints of dyspnea, 5) interpret the results of diagnostic evaluation and diagnose Non- ST elevation myocardial infarction (NSTEMI) and pulmonary edema, 6) order appropriate management of pulmonary edema and NSTEMI, and 6) demonstrate effective communication with patient and family members.</p><p><strong>Educational methods: </strong>Practice oral boards.</p><p><strong>Research methods: </strong>Immediate Feedback was solicited from the learners and observers participating in the case both by verbal discussion and completion of a rating for the case following the debriefing. The efficacy of the educational content was assessed by comparing scoring measures across residents based on the training year. Scoring measures of the American College of Graduate Medical Education (ACGME) core competencies were performed using a scale from 1 - 8, 1-4 being unacceptable performance and 5 - 8 being acceptable. Efficacy was assumed based on full completion of the case by the residents who acted as practice oral board candidates, and a debriefing session followed to disc","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9988939","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}