Inhalational Injury Secondary to House Fire

Audience: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. Background: 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. Educational Objectives: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. Educational Methods: 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. Research Methods: 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 Form2with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7. Results: 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. Discussion: This is a cost-effective method for reviewing inhalational airway injury diagnosis and management. The case may be modified for targeted audiences, expected resources, and learning objectives, such as removal of a bronchoscope availability in settings which are expected to be resource-limited. Some readers may choose to focus on other aspects of burn management instead of airway securement such as cyanide and/or carbon monoxide toxicity. We encourage readers to limit the number of learning objectives because airway algorithms and troubleshooting for this scenario was a rich, stand-alone debriefing. There was not enough time to review in detail all nuanced aspects of the burned patient, including: Lund-Browder versus rule of 9’s, modified Brooke versus Parkland formulas, indications for and completion of escharotomies, and/or identification and treatment of cyanide and carbon monoxide toxicity. Topics: Medical simulation, burns, airway emergencies, emergency medicine

Fungal Endophthalmitis on Ocular Ultrasound: A Case Report

Introduction: Endophthalmitis is a rare intraocular infection caused by numerous organisms from several possible sources. Fungal endophthalmitis is a rare subset of this pathology with limited diagnostics available. One of the few options to make this diagnosis is vitreous sampling, which is invasive, and results are not immediately available.Case Report: This case report describes the successful use of point-of-care ultrasound to visualize an intraocular fungal mass in a 60-year-old male who presented to the emergency department (ED) with two weeks of left eye pain and erythema approximately two months postoperative from a cataract extraction surgery.Conclusion: Fungal endophthalmitis is a rare and challenging diagnosis. Methods of diagnosing this pathology are not readily available in the ED. Point-of-care ultrasound may be a useful adjunct for the prompt diagnosis of fungal endophthalmitis

Novel Emergency Medicine Curriculum Utilizing Self- Directed Learning and the Flipped Classroom Method: Cardiovascular Emergencies Small Group Module

ABSTRACT: Audience: This curriculum, created and implemented at The Ohio State University Wexner Medical Center, was designed to educate our emergency medicine (EM) residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction: In 2013, chest pain alone was the principal reason for visit for over 6 million Emergency Department visits in the United States. This represents 4.9% of all Emergency Department visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of cardiovascular emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University Wexner Medical Center EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,11,13Aims/Goals: We aim to teach the presentation and management of cardiovascular emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents. Methods: The educational strategies used in this curriculum include small group modules authored by education faculty and content experts based on the core emergency medicine content. This program also includes resident-submitted questions that were developed during review of the content. The question and answer format of the Socratic Method--with a focus on fostering an open learning environment, not negative “pimping”-type questionin--is used during small group sessions to encourage active participation and discussion; small groups also focus on the synthesis and application of knowledge through the discussion of real life experiences. The use of free open access medical education (FOAM) resources allows learners to work at their own pace and maximize autonomy. Topics: Emergency medicine, flipped classroom, medical education, cardiovascular emergencies, pedagogy, teaching