IFEM Medical Student Symposium – Team Gulf

Dear medical students and EM community,

We invite you to the IFEM Medical Student Symposium, the first of its kind, to discuss the present and future of undergraduate emergency medicine education. The IFEM Medical Student Symposium will bring together speakers, facilitators, and attendees from seven regions of Africa, Asia, Central and South America, Europe, the Gulf, North America, and Oceania. You can find more details on the flyer below.

It will take place on June 14th, 2022, at 13:30 AEST (GMT +10). The symposium fee is 10 AUD. Thanks to IFEM leadership and the ICEM organising committee, participants intending to join the Medical Student Symposium only can use this link on the workshop page to register without an additional conference fee.

Please share this blogpost with your colleagues and trainees who might be interested in joining this conversation. We are looking forward to meeting you all virtually at the symposium.

Best regards,
Dr Elif Dilek Cakal & Dr Erin Simon
IFEM Medical Student Symposium Co-leads
IFEM Core Curriculum and Education Committee

 

 

 

IFEM Medical Student Symposium – Team North America

Dear medical students and EM community,

We invite you to the IFEM Medical Student Symposium, the first of its kind, to discuss the present and future of undergraduate emergency medicine education. The IFEM Medical Student Symposium will bring together speakers, facilitators, and attendees from seven regions of Africa, Asia, Central and South America, Europe, the Gulf, North America, and Oceania. You can find more details on the flyer below.

It will take place on June 14th, 2022, at 13:30 AEST (GMT +10). The symposium fee is 10 AUD. Thanks to IFEM leadership and the ICEM organising committee, participants intending to join the Medical Student Symposium only can use this link on the workshop page to register without an additional conference fee.

Please share this blogpost with your colleagues and trainees who might be interested in joining this conversation. We are looking forward to meeting you all virtually at the symposium.

Best regards,
Dr Elif Dilek Cakal & Dr Erin Simon
IFEM Medical Student Symposium Co-leads
IFEM Core Curriculum and Education Committee

 

 

IFEM Medical Student Symposium – Team Central and South America

Dear medical students and EM community,

We invite you to the IFEM Medical Student Symposium, the first of its kind, to discuss the present and future of undergraduate emergency medicine education. The IFEM Medical Student Symposium will bring together speakers, facilitators, and attendees from seven regions of Africa, Asia, Central and South America, Europe, the Gulf, North America, and Oceania. You can find more details on the flyer below.

It will take place on June 14th, 2022, at 13:30 AEST (GMT +10). The symposium fee is 10 AUD. Thanks to IFEM leadership and the ICEM organising committee, participants intending to join the Medical Student Symposium only can use this link on the workshop page to register without an additional conference fee.

Please share this blogpost with your colleagues and trainees who might be interested in joining this conversation. We are looking forward to meeting you all virtually at the symposium.

Best regards,
Dr Elif Dilek Cakal & Dr Erin Simon
IFEM Medical Student Symposium Co-leads
IFEM Core Curriculum and Education Committee

 

IFEM Medical Student Symposium – Team Europe

Dear medical students and EM community,

We invite you to the IFEM Medical Student Symposium, the first of its kind, to discuss the present and future of undergraduate emergency medicine education. The IFEM Medical Student Symposium will bring together speakers, facilitators, and attendees from seven regions of Africa, Asia, Central and South America, Europe, the Gulf, North America, and Oceania. You can find more details on the flyer below.

It will take place on June 14th, 2022, at 13:30 AEST (GMT +10). The symposium fee is 10 AUD. Thanks to IFEM leadership and the ICEM organising committee, participants intending to join the Medical Student Symposium only can use this link on the workshop page to register without an additional conference fee.

Please share this blogpost with your colleagues and trainees who might be interested in joining this conversation. We are looking forward to meeting you all virtually at the symposium.

Best regards,
Dr Elif Dilek Cakal & Dr Erin Simon
IFEM Medical Student Symposium Co-leads
IFEM Core Curriculum and Education Committee

 

IFEM Medical Student Symposium – Team Asia

Dear medical students and EM community,

We invite you to the IFEM Medical Student Symposium, the first of its kind, to discuss the present and future of undergraduate emergency medicine education. The IFEM Medical Student Symposium will bring together speakers, facilitators, and attendees from seven regions of Africa, Asia, Central and South America, Europe, the Gulf, North America, and Oceania. You can find more details on the flyer below.

It will take place on June 14th, 2022, at 13:30 AEST (GMT +10). The symposium fee is 10 AUD. Thanks to IFEM leadership and the ICEM organising committee, participants intending to join the Medical Student Symposium only can use this link on the workshop page to register without an additional conference fee.

Please share this blogpost with your colleagues and trainees who might be interested in joining this conversation. We are looking forward to meeting you all virtually at the symposium.

Best regards,
Dr Elif Dilek Cakal & Dr Erin Simon
IFEM Medical Student Symposium Co-leads
IFEM Core Curriculum and Education Committee

 

IFEM Medical Student Symposium – Team Africa

Dear medical students and EM community,

We invite you to the IFEM Medical Student Symposium, the first of its kind, to discuss the present and future of undergraduate emergency medicine education. The IFEM Medical Student Symposium will bring together speakers, facilitators, and attendees from seven regions of Africa, Asia, Central and South America, Europe, the Gulf, North America, and Oceania. You can find more details on the flyer below.

It will take place on June 14th, 2022, at 13:30 AEST (GMT +10). The symposium fee is 10 AUD. Thanks to IFEM leadership and the ICEM organising committee, participants intending to join the Medical Student Symposium only can use this link on the workshop page to register without an additional conference fee.

Please share this blogpost with your colleagues and trainees who might be interested in joining this conversation. We are looking forward to meeting you all virtually at the symposium.

Best regards,
Dr Elif Dilek Cakal & Dr Erin Simon
IFEM Medical Student Symposium Co-leads
IFEM Core Curriculum and Education Committee

Question Of The Day #60

question of the day
Which of the following is the most likely cause for this patient’s condition? 

This first-trimester pregnant patient presents with generalized weakness, nausea, and vomiting.  She is hypotensive and tachycardic with no sign of urinary infection on the urinalysis.  The many ketones in the urine indicate the patient has inadequate oral nutrition and is breaking down muscle and adipose tissue for energy.  This is likely related to the persistent vomiting the patient is experiencing.  This patient has hyperemesis, a common condition in the first trimester of pregnancy that is caused by rising levels of beta-human chorionic gonadotropin (BHCG).  Treatment for this patient should include IV hydration and antiemetics.  Admission criteria for these patients includes intractable vomiting despite antiemetic administration, over 10% maternal weight loss, persistent ketone or electrolyte abnormalities despite rehydration, or uncertainty in the diagnosis. 

The fluid losses caused by vomiting in this condition result in hypovolemic shock (Choice B).  Distributive shock (Choice C) is caused by other conditions, like sepsis, anaphylaxis, and neurogenic shock.  A ureteral stone (Choice D) is unlikely as the patient does not report any abdominal, back, or flank pain.  The urinalysis also does not show any hematuria, which is a common sign of a ureteral stone.  Pyelonephritis (Choice A) can cause vomiting and septic shock which can result in hypotension and tachycardia.  However, there is no sign of infection in the urinalysis provided, no fever, and no back or flank pain.  The best answer is choice B.  

References

Cite this article as: Joseph Ciano, USA, "Question Of The Day #60," in International Emergency Medicine Education Project, October 22, 2021, https://iem-student.org/2021/10/22/question-of-the-day-60/, date accessed: May 28, 2022

Question Of The Day #59

question of the day
38 - atrial fibrillation

Which of the following is the most likely cause for this patient’s respiratory condition?

This patient presents to the Emergency Department with palpitations, generalized weakness, and shortness of breath after discontinuing all her home medications.  She has hypotension, marked tachycardia, and pulmonary edema (crackles on lung auscultation).  The 12-lead EKG demonstrates atrial fibrillation with a rapid ventricular rate.  This patient is in a state of cardiogenic shock and requires prompt oxygen support, blood pressure support, and heart rate control. 

Pulmonary embolism (Choice A) can sometimes manifest as new atrial fibrillation with shortness of breath and tachycardia, but pulmonary embolism initially causes obstructive shock.  If a pulmonary embolism goes untreated, it can progress to right ventricular failure, pulmonary edema, and cardiogenic shock.  This patient has known atrial fibrillation and stopped all her home medications.  The abrupt medication change is a more likely cause of the patient’s cardiogenic shock.  Dehydration (Choice D) and systemic infection (Choice D) are less likely given the above history of abruptly stopping home maintenance medications.  Untreated cardiac arrythmia (Choice B) is the most likely cause for this patient’s pulmonary edema and cardiogenic shock. 

The chart below details the categories of shock, each category’s hemodynamics, potential causes, and treatments.  

 

References

Cite this article as: Joseph Ciano, USA, "Question Of The Day #59," in International Emergency Medicine Education Project, October 15, 2021, https://iem-student.org/2021/10/15/question-of-the-day-59/, date accessed: May 28, 2022

Question Of The Day #58

question of the day
720 - variceal bleeding

Which of the following is the most appropriate next step in management?   

This cirrhotic patient presents to the Emergency Department with epigastric pain after an episode of hematemesis at home.  His initial vital signs are within normal limits.  While waiting in the Emergency Department, his clinical status changes.  The patient has a large volume of hematemesis with hypotension and tachycardia.  This patient is now in hemorrhagic shock from an upper gastrointestinal bleed and requires immediate volume resuscitation.  The most common cause of upper gastrointestinal bleeding is peptic ulcer disease, but this patient’s cirrhosis history and large volume of hematemesis should raise concern for an esophageal variceal bleed.  IV Pantoprazole (Choice D) is a proton pump inhibitor that helps reduce bleeding in peptic ulcers, but it does not provide benefit in esophageal varices.  Volume repletion is also a more important initial step than giving pantoprazole.  IV Ceftriaxone (Choice C) helps reduce the likelihood of infectious complications in variceal bleed patients.  This has a mortality benefit and is a recommended adjunctive treatment.  However, rapid volume resuscitation is a more important initial step.  IV crystalloid fluids, like normal saline (Choice A), are helpful in patients with hypovolemic shock (i.e., dehydration, vomiting), distributive shock (i.e., sepsis, anaphylaxis), and obstructive shock (i.e., tension pneumothorax, etc.).  Hypovolemic shock due to severe hemorrhage (hemorrhagic shock) requires blood products, not crystalloid fluids which can further dilute blood and cause coagulopathy.  Administration of packed red blood cells (Choice B) is the best next step in management in this case.

References

Cite this article as: Joseph Ciano, USA, "Question Of The Day #58," in International Emergency Medicine Education Project, October 8, 2021, https://iem-student.org/2021/10/08/question-of-the-day-58/, date accessed: May 28, 2022

Question Of The Day #57

question of the day

Which of the following is the most likely cause for this patient’s condition?  

This young female presents with dizziness, fatigue, nausea, generalized abdominal pain, hypotension, tachycardia, and a positive urine pregnancy test.  The anechoic (black) areas on the bedside ultrasound indicate free fluid (blood) in the peritoneal space.  See the image below for clarification. Yellow arrows indicates free fluids.

This patient is in a state of physiologic shock.  Shock is an emergency medical state characterized by cardiovascular or circulatory failure.  Shock prevents peripheral tissues from receiving adequate perfusion, resulting in organ dysfunction and failure.  Shock can be categorized as hypovolemic, distributive, obstructive, or cardiogenic.  The different categories of shock are defined by their underlying cause (i.e., sepsis, hemorrhage, pulmonary embolism, etc.) and their hemodynamics which sometimes overlap.  The diagnosis of shock is largely clinical and supported by the history, vital signs, and physical exam.  Additional studies, such as laboratory investigations, bedside ultrasound, and imaging tests help narrow down the type of shock, potential triggers, and guide management. 

This patient’s condition is caused by a presumed ruptured ectopic pregnancy and intraperitoneal bleeding.  This is considered hypovolemic/hemorrhagic shock (Choice A). The other types of shock in Choices B, C, and D are less likely given the clinical and diagnostic information in the case.  The chart below details the categories of shock, each category’s hemodynamics, potential causes, and treatments.  

 

References

Cite this article as: Joseph Ciano, USA, "Question Of The Day #57," in International Emergency Medicine Education Project, October 1, 2021, https://iem-student.org/2021/10/01/question-of-the-day-57/, date accessed: May 28, 2022

Question Of The Day #56

question of the day

Which of the following is the most likely cause of this patient’s condition?

This trauma patient arrives with hypotension, tachycardia, absent unilateral lung sounds, and distended neck veins. This should raise high concern for tension pneumothorax, which is a type of obstructive shock (Choice C). This diagnosis should be made clinically without X-ray imaging. Bedside ultrasound can assist in making the diagnosis by looking for bilateral lung sliding, if available. Treatment of tension pneumothorax should be prompt and includes needle decompression followed by tube thoracostomy. Other types of shock outlined in Choices A, B, and D do not fit the clinical scenario with information that is given.

Recall that shock is an emergency medical state characterized by cardiovascular or circulatory failure. Shock prevents peripheral tissues from receiving adequate perfusion, resulting in organ dysfunction and failure. Shock can be categorized as hypovolemic, distributive, obstructive, or cardiogenic. The different categories of shock are defined by their underlying cause (i.e., sepsis, hemorrhage, pulmonary embolism, etc.) and their hemodynamics which sometimes overlap. The diagnosis of shock is largely clinical and supported by the history, vital signs, and physical exam. Additional studies, such as laboratory investigations, bedside ultrasound, and imaging tests help narrow down the type of shock, potential triggers, and guide management. The chart below details the categories of shock, each category’s hemodynamics, potential causes, and treatments.

 

References

Cite this article as: Joseph Ciano, USA, "Question Of The Day #56," in International Emergency Medicine Education Project, September 24, 2021, https://iem-student.org/2021/09/24/question-of-the-day-56/, date accessed: May 28, 2022

Question Of The Day #55

question of the day
738.2 - STEMI
Which of the following is the most likely cause for this patient’s condition?  

This patient presents with chest pressure at rest and an anterior ST segment elevation myocardial infraction (STEMI) seen on 12-lead EKG.  This patient should be given aspirin, IV fluids to increase the preload status, and receive immediate coronary reperfusion therapy.  This patient’s hypotension is likely due to infarction of the left ventricle causing poor cardiac output (Choice D).  This is known as cardiogenic shock.  The patient has been vomiting, but the acute onset of symptoms and STEMI on EKG make poor cardiac output (Choice D) more likely than hypovolemia (Choice A) as the cause for the patient’s condition.  Systemic infection (Choice B) and pulmonary embolism (Choice C) are also less likely given the clinical information in the case and the STEMI on EKG.  The best answer is Choice D.  Please see the chart below for further detailing of the different types of shock.   

References

Cite this article as: Joseph Ciano, USA, "Question Of The Day #55," in International Emergency Medicine Education Project, September 17, 2021, https://iem-student.org/2021/09/17/question-of-the-day-55/, date accessed: May 28, 2022