January 5, 2018
By the end of this simulation session, the learner will be able to: 1) Recognize severe sepsis (please note – Centers for Medicare and Medicaid Services (CMS) Sepsis-I and II definitions are used throughout the case, as Sepsis-III has not been adopted by any emergency medicine organizations), 2) recognize atrial fibrillation, 3) review the importance of a thorough history and physical exam, 4) discuss the sepsis spectrum, 5) discuss the acute management of severe sepsis, 6) discuss common and uncommon sources of sepsis, 7) discuss appropriate empiric antibiotic options, 8) discuss common causes of newly-diagnosed atrial fibrillation, 9) review the different emergency medicine-based treatment modalities for uncomplicated atrial fibrillation, specifically atrial fibrillation with rapid ventricular rate.
January 8, 2018
The unilateral distribution of vesicular lesions over the patient’s left naris, cheek, and upper lip are consistent with Herpes zoster reactivation with Hutchinson’s sign. Hutchinson’s sign is a herpes zoster vesicle present on the tip or side of the nose.1 It reflects zoster involvement of the 1st branch of the trigeminal nerve, and is concerning for herpes zoster ophthalmicus.1 Herpes zoster vesicles may present as papular lesions or macular vesicles on an erythematous base.2,3 Emergent diagnosis must be made to prevent long-term visual sequelae.4
January 8, 2018
A non-contrast CT (Figure 1) revealed a large hypoattenuating left parietal lesion. When the CT was enhanced with intravenous contrast (Figure 2), the same lesion showed peripheral rim enhancement, suggestive of a brain abscess.
January 8, 2018
POCUS reveals a large, hypoechoic soft tissue abscess with debris and tracks extending to the bottom of the image. Furthermore, when compressed, movement of the abscess contents is appreciated. There is also superficial cobble-stoning consistent with overlying cellulitis and soft tissue edema.
January 8, 2018
Computed Tomography (CT) of the Pelvis with intravenous (IV) contrast revealed a 5.7 cm x 2.4 cm air-fluid collection in the right perianal soft tissue along the right gluteal cleft, with surrounding fat stranding, consistent with a perianal abscess with cellulitis.
January 8, 2018
A CT abdomen and pelvis with IV contrast showed neither nephrolithiasis nor diverticulitis, and instead showed heterogeneous enhancement of the left kidney with mild edematous enlargement and striated left nephrogram. Significant perinephric stranding (red arrows) was also noted and was consistent with severe acute pyelonephritis.
January 8, 2018
The chest X-ray shows a large fluid collection in the right lung demonstrated by the opacification that blunts the costophrenic angle on the right side. There is also a meniscus present, which is generally indicative of fluid. Chest computed tomography (CT) demonstrated an infiltrate with a mixture of densities within the same collection, consistent with a loculated effusion and concerning for an empyema.
October 11, 2017
By the end of this simulation session, the learner will be able to: 1) Recognize toxic shock syndrome. 2) Review the importance of a thorough physical exam. 3) Discuss management of toxic shock syndrome, including supportive care and the difference in antibiotic choices for streptococcal and staphylococcal toxic shock syndrome. 4) Appropriately disposition a patient suffering from toxic shock syndrome. 5) Communicate effectively with team members and nursing staff during a resuscitation of a critically ill patient.
