iEM Image Feed: Viscus perforation

iem image feed

A 35 years old previously healthy gentleman presented to the Emergency Department with a sudden-onset severe and diffuse abdominal pain which started an hour ago. Chest X-ray was ordered; what do you see?

Abdominal pain is one of the commonest ED presentations. Like acute MI, AAA rupture, or DKA, viscus perforation should be in our worst-case scenario list. The image shows free air under the diaphragm.

The expected hints for this type of patient are a history of peptic/duodenal ulcer disease, severe abdominal pain that patients do not want to move, and a rigid and very tender abdomen, which any palpation gives much pain to the patient. 

We need to remember that this situation is a surgical emergency. There are some steps that we need to do immediately for this patient.

  1. Proper history and examination
  2. Attaching to monitor and following vital signs and intervene if necessary to normalize them
  3. Opening 2 large-bore IV lines and fluid resuscitation as needed
  4. IV pain medication
  5. IV antibiotics
  6. Stopping oral ingestion and placing NG tube
  7. Contact surgery
  8. Sending basic biochemistry lab, coagulation profile, blood type and cross, CBC, which will be asked by surgery soon. 
  9. Arranging transfer to the OR
887.1 - viscus perforation

Abdominal pain is one of the commonest ED presentations. Like acute MI, AAA rupture, or DKA, viscus perforation should be in our worst-case scenario list. The image shows free air under the diaphragm.

887.2 - viscus perforation

The expected hints for this type of patient are a history of peptic/duodenal ulcer disease, severe abdominal pain that patients do not want to move, and a rigid and very tender abdomen, which any palpation gives much pain to the patient. 

We need to remember that this situation is a surgical emergency. There are some steps that we need to do immediately for this patient.

  1. Proper history and examination
  2. Attaching to monitor and following vital signs and intervene if necessary to normalize them
  3. Opening 2 large-bore IV lines and fluid resuscitation as needed
  4. IV pain medication
  5. IV antibiotics
  6. Stopping oral ingestion and placing NG tube
  7. Contact surgery
  8. Sending basic biochemistry lab, coagulation profile, blood type and cross, CBC, which will be asked by surgery soon. 
  9. Arranging transfer to the OR

Additional reading

Cite this article as: iEM Education Project Team, "iEM Image Feed: Viscus perforation," in International Emergency Medicine Education Project, April 14, 2021, https://iem-student.org/2021/04/14/viscus-perforation/, date accessed: April 20, 2021

iEM Image Feed: Plateau Fracture

iem image feed

A 60-year-old man known to have DM type 2 was brought by the family as a camel hit his knee. He was not able to walk on it at the scene and in ED. It was swollen with no open wound.

Tips
Although patients come with isolated injuries, we always have to make sure that they do not have other injury findings. Therefore, approaching systematically to the patient is important. At this moment, please remember primary and secondary surveys of multiple trauma. The animal attacks may create multiple injuries on patients, and they should be evaluated as multiply injured patients. After you ruled our multiple or life, organ, extremity threatening injury, you can deep dive into isolated injuries. In this case, knee injury after a direct hit.

Of course, inspection and palpation are essential in every extremity injury. Evaluating the patient for neurovascular problems and range of motions are applied in almost every extremity trauma. But sometimes, clinical presentations or findings can be subtle and you may need a better tool. In these case, we recommend using Ottawa Knee Rules.

The image shows tibia plateau fracture on AP knee x-ray.

885.1 plateau fracture
885.2 plateau fracture copy

Additional reading

Cite this article as: iEM Education Project Team, "iEM Image Feed: Plateau Fracture," in International Emergency Medicine Education Project, April 7, 2021, https://iem-student.org/2021/04/07/plateau-fracture/, date accessed: April 20, 2021

iEM Image Feed: Radius and Ulna Fracture

iem image feed radius and ulna fracture
radius and ulna fracture

Her father brought a 9-year-old girl due to deformed right extremity. He was playing at home and fell from a hight on his hand. No open wounds. No past medical and surgical. Vaccination: up to date.

Examination: radial pulse is intact. He can move the fingers but with limitation due to pain. Sensation is normal. The X-ray showed both radius and ulna fracture. The patient underwent procedural sedation with IV ketamine, and the reduction was made with ortho oncall.

Cite this article as: iEM Education Project Team, "iEM Image Feed: Radius and Ulna Fracture," in International Emergency Medicine Education Project, March 31, 2021, https://iem-student.org/2021/03/31/radius-and-ulna-fracture/, date accessed: April 20, 2021

iEM Image Feed: Humerus Shaft Fracture

image feed
humerus fracture
humerus fracture 2

The EMS brought a 39-year man as his right upper extremity was stuck in a machine in a factory where he works. He came with deformity and severe pain in his right arm. Pain management was given. He received tetanus toxoid as well. X-ray shows oblique humeral shaft fracture with shortening and angulation. He underwent procedural sedation to reduce it.

Cite this article as: iEM Education Project Team, "iEM Image Feed: Humerus Shaft Fracture," in International Emergency Medicine Education Project, March 17, 2021, https://iem-student.org/2021/03/17/humerus-shaft-fracture/, date accessed: April 20, 2021

iEM Image Feed: Mandibular Fracture

image feed
mandibular fracture

A 39-year-old woman presented to ED with mouth pain. She was cleaning the bathroom and suddenly slipped and fell. She hit her mandible with the floor. She was able to speak minimally—no avulsed teeth. She had teeth 23 and 24 subluxations.

This is a high energy impact trauma. Ensure that you evaluate the patient systematically for trauma and not forget to pay attention to a neck injury. Violence, assault, partner abuse should be in your mind. Specific mandibular and panoramic imaging may give excellent views for diagnosis. In some cases, CT may be necessary to evaluate the maxillofacial injury. Besides, know the teeth universal numbering. If you see this kind of damage in the examination, always rule out an alveolar fracture.

Cite this article as: iEM Education Project Team, "iEM Image Feed: Mandibular Fracture," in International Emergency Medicine Education Project, March 3, 2021, https://iem-student.org/2021/03/03/mandibular-fracture/, date accessed: April 20, 2021

iEM Image Feed: Camel Bite

iem image feed camel bite
camel bite injury

EMS brought a 24-year-old man due to camel bite happened while feeding the camel in the early morning. The injury was basically on the right arm and forearm. No other injuries, vitally stable.

Students should know the following while taking care of these patients.

  1. Systematic evaluation of the patient – remember ATLS, primary and secondary survey.
  2. Focused neurologic and vascular examination.
  3. Exposing the wound and ordering an x-ray
  4. Wound cleaning and management
  5. Be aware of fracture – Open Fracture!
  6. Antibiotic coverage and tetanus toxoid/IG
  7. For open fractures – Look for Gustilo-Anderson Classification and choose appropriate antibiotics.  
  8. Do not forget – pain medication.
Cite this article as: iEM Education Project Team, "iEM Image Feed: Camel Bite," in International Emergency Medicine Education Project, February 10, 2021, https://iem-student.org/2021/02/10/camel-bite/, date accessed: April 20, 2021

Emergency Medicine Course Experience

It has been two years that the International Emergency Medicine (iEM) Education Project (iem-student.org) met with medical students. The project, which aims to promote emergency medicine and provide free, reusable education resources for medical students and educators, reached another important milestone during the COVID-19 pandemic.

iEM education project, which supported by United Arab Emirates University College of Medicine and Health Sciences and endorsed by the IFEM, announced a 4-week free open online emergency medicine core content course for medical students via IFEM newsletter and multiple emergency medicine platforms at the end of the April. In the first 24 hours, the course website (iem-course.org) was visited more than 3000 times from 57 countries. Syria (13%), Indonesia (10.6%), Thailand (8.1%), United States (7.3%), and Vietnam (6.5%) were the top five countries where registered students are coming from. The report of this social responsibility initiative shows a great collaboration of academic,  non-profit and commercial organisations during a pandemic. The background and the first 24 hours of this journey has now been published as an editorial in the African Journal of Emergency Medicine. 

You can read the editorial “From the pandemic’s front lines: A social responsibility initiative to develop an international free online emergency medicine course for medical students” from this link – (https://www.sciencedirect.com/science/article/pii/S2211419X2030135X).

iEM Monthly – August 2020

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

Recent News

Recent Posts

Top Countries

Top Reads

News

Brenda Varriano

Brenda Varriano

Brenda has just completed her first year of medical school at Central Michigan University. She has an interest in Emergency Medicine, and participated in the 2020 STAR-EM (Summer Training and Research in Emergency Medicine) at Toronto Western Hospital. Aside from school she loves working out, drawing and listening to music. At school she volunteers with Special Olympics, designed a study that aims to develop a crisis preparedness toolkit for rural Older Adults Impacted by COVID-19 through CMU-CARES, and is working with a group of students to host Pre-Medical School Workshops. Brenda loves to see others succeed while keeping a healthy lifestyle and avoiding burnout.

Sheza Qayyum

Sheza Qayyum

My name is Sheza Qayyum, and I am a third-year medical student at the University of Toronto in Canada. My interests include medical education, FOAMed, and inner-city health. I am one of the podcast co-directors at the International Student Association of Emergency Medicine (ISAEM), which I enjoy greatly. I also love baking (and really all things food-related), chasing waterfalls with pretty hikes, and laughs with my friends and family.

Joseph Ciano

Joseph Ciano

Joey Ciano, DO is an Emergency Medicine Physician from New York, USA. He completed his Emergency Medicine Residency in Brooklyn, NY and is the current International Emergency Medicine Fellow in the Northwell-LIJ Health System. One of his main professional interests is building the educational infrastructure of EM in countries where EM is not yet recognized as a field and in countries that are in the early stages of this process. He has partnered with international NGOs in EM educational projects and works as a visiting EM faculty member in West Bengal, India. He is excited to collaborate with the other authors of the iEM Education Project to contribute to world of FOAM-ed.

Blog Posts of July

Top Countries

These countries viewed iEM content the most in July 2020. 

Top Three Chapters of May 2020

How to read chest x-raysby Ozlem Koksal

336.3 - normal PA chest x-ray AIRWAY STRUCTURES

How to Read C-Spine X-Ray, by Dejvid Ahmetović and Gregor Prosen

626.4 - Figure 4 - c-spine lateral x-ray - alignement

How to read pelvic x-rays, by Sara Nikolić and Gregor Prosen

628.12 - femur neck fx

Top Four Post of June 2020

iEM Monthly – July 2020

july 2020 newsletter

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

Recent News

Recent Posts

Top Countries

Top Reads

News

Blog Posts of June

Top Countries

These countries viewed iEM content the most in June 2020. 

Top Three Chapters of May 2020

How to read chest x-raysby Ozlem Koksal

336.3 - normal PA chest x-ray AIRWAY STRUCTURES

How to read pelvic x-rays, by Sara Nikolić and Gregor Prosen

628.12 - femur neck fx

How to Read C-Spine X-Ray, by Dejvid Ahmetović and Gregor Prosen

626.4 - Figure 4 - c-spine lateral x-ray - alignement

Top Four Post of June 2020

iEM Monthly – June 2020

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

Recent News

Recent Posts

Top Countries

Top Reads

News

Blog Posts of May

Top Countries

These countries viewed iEM content the most in May 2020. 

Top Three Chapters of May 2020

How to read chest x-raysby Ozlem Koksal

336.3 - normal PA chest x-ray AIRWAY STRUCTURES

How to read pelvic x-rays, by Sara Nikolić and Gregor Prosen

628.12 - femur neck fx

How to Read C-Spine X-Ray, by Dejvid Ahmetović and Gregor Prosen

626.4 - Figure 4 - c-spine lateral x-ray - alignement

Top Three Post of May 2020

iEM Monthly – May 2020

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

New Authors

Recent News

Recent Posts

Top Countries

Top Reads

New Blog Authors

Keerthi Gondy

Keerthi Gondy

I'm a fourth-year medical student at the University of Michigan applying to Emergency Medicine. I am passionate about medical education, especially end-of-life care in the ED, and resilience/wellness. Outside of medical school, I am an avid triathlete, nature-lover, and an advocate on sustainability and climate change.

Joey Ciano

Joey Ciano

My name is Joey Ciano, I am a born and raised New Yorker currently working and living in Queens, NY. I am finishing my first year of International Emergency Medicine Fellowship in the Northwell Health system. My main interest in International EM is promoting EM systems building. This focuses on promoting the development of the specialty of EM in countries that have not yet recognized EM as a field or are in the early stages of this process. My main interest is working on the post-graduate educational infrastructure. I have done EM educational work in Uganda and continue to work in West Bengal, India to help educate practitioners in EM to help specialty development. COVID-19 has changed the way we teach locally and internationally, so I thought this project would be a great opportunity to reach international students in EM during these challenging times.

Amita Sudhir

Amita Sudhir

Amita Sudhir, MD is the Emergency Medicine Residency Program Director at the University of Virginia, USA. She was also the third year emergency medicine clerkship director for 8 years. She has authored several textbook chapters, an ACEP clinical policy (on NTSEMI ACS), lectured both nationally and internationally and created multiple curricula and educational modules. She is also on the Scientific Advisory Council (First Aid subcommittee) for the American Red Cross.

David Wiercigroch

David Wiercigroch

David Wiercigroch is a senior medical student at the University of Toronto in Canada. His interests are in health policy, international EM and global health. He enjoys collaborating with medical students around the world to advance EM through free-open access to medical education (FOAMed) and student leadership as part of the International Student Association of Emergency Medicine (ISAEM). He is an avid writer, aspiring chef and camping enthusiast.

News

Some highlights from social media

Blog Posts of April

Top Countries

These countries viewed iEM content the most in April 2020. 

Top Three Reads of March 2020

How to read chest x-raysby Ozlem Koksal

336.3 - normal PA chest x-ray AIRWAY STRUCTURES

How to read pelvic x-rays, by Sara Nikolić and Gregor Prosen

628.12 - femur neck fx

How to Read C-Spine X-Ray, by Dejvid Ahmetović and Gregor Prosen

626.4 - Figure 4 - c-spine lateral x-ray - alignement

iEM Monthly – April 2020

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

Recent News

Recent Posts

Top Countries

Top Reads

News

Blog Posts of March

Top Countries

These countries viewed iEM content the most in March 2020. 

Top Three Reads of March 2020

How to read chest x-raysby Ozlem Koksal

336.3 - normal PA chest x-ray AIRWAY STRUCTURES

How to read pelvic x-rays, by Sara Nikolić and Gregor Prosen

628.12 - femur neck fx

How to Read C-Spine X-Ray, by Dejvid Ahmetović and Gregor Prosen

626.4 - Figure 4 - c-spine lateral x-ray - alignement