Measles: Contemporary considerations for the emergency physician.

Measles, or rubeola, is a highly contagious acute febrile viral illness. Despite the availability of an effective vaccine since 1963, measles outbreaks continue worldwide. This article seeks to provide emergency physicians with the contemporary knowledge required to rapidly diagnose potential measles cases and bolster public health measures to reduce ongoing transmission.

Everyday Water-Related Emergencies: A Didactic Course Expanding Wilderness Medicine Education.

Audience: This small group session is appropriate for any level of emergency medicine resident physicians. Introduction: 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. Educational Objectives: 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. Educational Methods: 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. Research Methods: 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. Results: Sixteen individuals participated in the sessions and survey. The total mean score for the six-item analysis increased following the workshop (26.3 before versus 46.9 after, p = 0.001). The positive improvement in all categories indicated increased comfort in the topics of the small group sessions, with the largest improvement in the question about comfort in effectively evaluating and treating a patient presenting to the ED after a submersion injury. Discussion: Utilizing discussions and hands-on group sessions increased residents' perceived learning. This model can be applied to an extensive number of wilderness medicine topics for learners of all levels. For individuals with time-restrictive schedules, this model is an efficient mode of learning and teaching drowning and injury management skills with the potential for further topics and future courses. Topics: Wilderness medicine, water safety, pathophysiology of drowning, in-water rescues, in-water cervical spine stabilization, management of drowning in the ED, splinting, tourniquets.

Implanted Penile Prosthetic Visualized During Focused Assessment with Sonography for Trauma Examination: A Case Report.

INTRODUCTION: This is a case report of an implanted penile prosthetic visualized during focused assessment with sonography for trauma (FAST) examination. The case represents a unique finding near the lateral bladder that may confound assessment of intraperitoneal fluid collections during initial assessment of trauma patients. CASE REPORT: A 61-year-old Black male was brought to the emergency department from a nursing facility for evaluation after sustaining a ground-level fall. A FAST exam demonstrated an abnormal fluid collection anterior and lateral to the bladder, later identified as an implanted penile prosthetic. CONCLUSION: Focused assessment with sonography for trauma examinations are often performed on unidentified patients in a time-sensitive manner. Understanding of potential false-positive results is crucial to appropriate use of the tool. This report demonstrates a novel false-positive result that may be difficult to differentiate from a true intraperitoneal bleed.

Resident Wilderness Medicine Curriculum Consensus Guidelines: Summarization and Recommendations for Resident Rotations in Wilderness Medicine.

INTRODUCTION: Wilderness medicine education is one of the fastest growing facets of both graduate and undergraduate medical education. Currently, there are curriculum guidelines for both student electives and fellowships in wilderness medicine. However, there are no guidelines for resident elective curricula. The student/resident education committee of the Wilderness Medical Society (WMS) convened a task force to develop curriculum guidelines for these electives. METHODS: A survey of previously described core wilderness medicine topics was sent to a cohort of educators involved in wilderness medicine resident electives. They were asked to rank topics on the basis of their importance of being included on a Likert scale. Multivariate analysis of medians was used to distinguish among topics to determine which topics were voted most and least necessary for a curriculum. RESULTS: Of the database members contacted, 35 responded to the survey. The described current state of residency electives was that 16 institutions offered their own elective (46%). For subject preferences, multivariate analysis of scoring distribution medians demonstrated a significantly higher pattern of responses (P<0.01) for subjects with a median of 3 (must include) than for the lowest-scoring subjects that had a median of 1 (can include). Every topic was rated "must" by at least 1 respondent. Topics were further subdivided into an educational framework reflecting a common approach to education of wilderness medicine fellows focusing on education, leadership, knowledge, and skills. CONCLUSIONS: There was a wide variety in the ranking of topics; however, there were multiple topics on which a consensus for inclusion was reached. These topics are organized and presented here as a suggested curriculum by the student/resident education committee of the WMS.

Symjepi Epinephrine Injection Device Deconstruction and Residual Medication Retrieval in an Austere Environment.

Epinephrine is the primary therapy in the treatment of anaphylaxis. Epinephrine delivery devices are commonplace in out-of-hospital care of anaphylaxis because they administer a standardized dose of epinephrine, limit human error, and allow for ease of use by the operator. However, a major limitation of these devices is the single-use nature of the products. In an austere setting, the ability to obtain additional doses from an autoinjector may prevent further progression of anaphylaxis. Previous articles have demonstrated the deconstruction of spring-loaded epinephrine autoinjectors to extract additional medication doses. This article provides instruction and videography, outlining the process of deconstructing and obtaining additional doses of epinephrine from the Symjepi prefilled syringe.

Virtual Town Hall Meetings to Convey Emergency Medicine Residency Program Information to Students.

BACKGROUND: Applying to emergency medicine (EM) residency programs as a medical student is challenging and complicated in a normal year, but the 2020/2021 application cycle was further complicated by the COVID-19 pandemic. Due to the decrease of in-person opportunities for students to connect with residency programs, virtual "town-hall" meetings were developed. In this study our primary objective was to determine whether attendance at a virtual residency program information session improved the perceived knowledge of curriculum information and program exposure to medical students applying to an EM residency. METHODS: Four study sites hosted a total of 12 virtual events consisting of residents, faculty, or both. Standardized pre-event/post-event surveys were conducted to capture medical student perceptions before/after each of the virtual sessions. Apart from measuring the improvement in students' perceived knowledge of a program by gauging their responses to each question, we used a 10-question composite score to compare pre- vs post-event improvement among the participants. RESULTS: The pre-event survey was completed by 195 attendees, and the post-event survey was completed by 123 attendees. The median and mean composite score to this 10-question survey improved from 32.19 to 45, and 31.45 to 44.2, respectively, in the pre- to post-event survey. CONCLUSION: This study showed improvement of medical students' perceived knowledge of residency programs (reflected as increased agreement from pre- to post-event survey). The data demonstrates through question responses that students not only obtained information about the programs but also were able to gain exposure to the culture and "feel" of a program. In a non-traditional application season in which students are unable to pursue their interest in a program through audition rotations, virtual town hall events, along with other asynchronous events, may be a reasonable approach to increasing medical student understanding and awareness of a program and its culture.

A 56-Year-Old Female With Acute ST-Segment Elevation Myocardial Infarction, Complete Heart Block, and Hemodynamic Instability.

Chest pain is a common emergency department complaint, but a small percentage of patients with this complaint experience acute coronary syndrome, with a still smaller percentage having ST-elevation myocardial infarction (STEMI) with hemodynamic instability and arrhythmia. A 56-year-old female presented to our emergency department with acute chest pain. She was diagnosed with inferior wall STEMI, had complete heart block and hemodynamic instability, and underwent emergent reperfusion via coronary catheterization. This combination of signs and symptoms required thoughtful assessment and treatment along with diagnostic accuracy and proper disposition. This case offers a review of this uncommon presentation, including pathophysiology and treatment.

Teaching about the Wild: A Survival Course as a Novel Resident Educational Experience.

Audience: Emergency medicine residents. Introduction: Wilderness medicine (WM) is the practice of resource-limited medicine under austere conditions. Emergency physicians in training should gain additional exposure to wilderness medicine knowledge and outdoor skills to allow for the development of problem solving and improvisation abilities. However, there is limited data on the instruction of general survival skills to residents interested in WM. Educational Objectives: By the end of the session the learner will be able to: 1) differentiate at least three different methods for water purification 2) describe how to erect a temporary survival shelter 3) construct a survival pack for personal use emphasizing multi-use items 4) demonstrate how to make a fire without a direct flame supply. Educational Methods: A small group of resident learners progressed through five survival stations designed to allow for an emphasis on select skills, wilderness medicine knowledge, and improvisation. Resident instructors led the discussion and skills demonstration. Research Methods: Participants completed a six item before and after questionnaire. Each item was ranked from 0 for "strongly disagree" to 10 for "strongly agree." Total mean scores before and after were compared. Results: Twelve individuals participated. The total mean score for the six-item analysis increased following the workshop (39.1 before versus 51.0 after, p = 0.0008). Discussion: General survival skills are traditionally acquired through time-intensive experiences; however, this is often unfeasible during residency training. We developed an alternative, more efficient mechanism for incorporating wilderness medicine skills into residency training that appears to improve understanding and confidence of participants, as well as to provide a teaching opportunity for new resident educators. Topics: Wilderness medicine, survival skills, emergency medicine, graduate medical education.

Utilization of Simulation Techniques to Enhance Quality Improvement Processes in the Emergency Department.

Introduction Quality improvement projects can help improve clinical practice in an emergency department (ED). However, it is difficult to measure outcomes in rare clinical conditions. We used a simulation program to evaluate a new protocol and workflow in the emergency blood transfusion process as well as provide additional trauma training. To determine if implementing a trauma simulation would help improve the self-reported understanding of the emergency blood transfusion process by both the ED and laboratory staff. Methods Emergency medicine residents and nursing staff participated in a high-fidelity trauma simulation. ED nursing and hospital laboratory staff used the simulation to test a new process for notification and transport of blood within the hospital. All of the participants were provided a four-item Likert scale questionnaire immediately after the training to evaluate their understanding of the ED blood process.  Results There was a significant improvement in overall scores based on paired t-tests in the full group (pre 15.0 versus post 17.6, p = 0.0005) and ED group (pre 14.7 versus post 17.8, p = 0.0007) but not in the lab group (pre 15.8 versus post 17.2, p = 0.296).  Conclusion Simulation appears to be helpful to evaluate and implement a new ED protocol or workflow.

ED Stories: An Online Emergency Medicine Residency Community Building and Wellness Initiative.

The "ED Stories" project is a novel method for promoting individual wellness and interpersonal relationships on a virtual platform in an emergency medicine residency program. We engaged multiple individuals across all levels of medical training on a virtual platform to facilitate discussion regarding difficult situations, patient interactions, and tips on how to succeed in challenge circumstances in the future. The platform was outlined as a "safe space," free of judgment and criticism. We engaged 54 participants with a culmination of 131 interactions; there were 14 original posts with a total of 22 comments. We believe that this virtual platform allowed for safe discussion of difficult concepts related to our jobs and served as an outlet to promote physician wellness and reduce burnout in the future.