Emergency Medicine Perspectives of Students – North America

Dear EM family,

The International Emergency Medicine Education Project (iem-student.org) has completed three years. As you may know, the iEM Education project aims to promote Emergency Medicine and provides copyright-free resources to students and educators around the world. Now we have reached more than 200 countries. We would like to thank again our contributors. Without them, such a project would not be possible. This experience has shown us once again how passionate our international EM community is to help and teach each other.

In May 2021, we started the fourth year of this journey. To celebrate, we are pleased to announce alive activity series, Emergency Medicine Perspectives of Students Around the World. Our guests for the third session are Kayla M. Ferguson, Brenda M. Varriano, and Dr. Halley J. Alberts.

Together, we can understand the experiences and needs of medical students from different backgrounds and discuss potential solutions.

Here are the video and audio records of this session. 

Cite this article as: Arif Alper Cevik, "Emergency Medicine Perspectives of Students – North America," in International Emergency Medicine Education Project, May 23, 2022, https://iem-student.org/2022/05/23/emergency-medicine-perspectives-of-students-north-america/, date accessed: July 6, 2022

Emergency Medicine Perspectives of Students – Central and South America

Dear EM family,

The International Emergency Medicine Education Project (iem-student.org) has completed three years. As you may know, the iEM Education project aims to promote Emergency Medicine and provides copyright-free resources to students and educators around the world. Now we have reached more than 200 countries. We would like to thank again our contributors. Without them, such a project would not be possible. This experience has shown us once again how passionate our international EM community is to help and teach each other.

In May 2021, we started the fourth year of this journey. To celebrate, we are pleased to announce alive activity series, Emergency Medicine Perspectives of Students Around the World. Our guests for the third session are Henrique Herpich from Brazil, Genesis Soto Chaves from Costa Rica, and William Gopar Franco from Mexico..

Together, we can understand the experiences and needs of medical students from different backgrounds and discuss potential solutions.

Here are the video and audio records of this session. 

Cite this article as: Arif Alper Cevik, "Emergency Medicine Perspectives of Students – Central and South America," in International Emergency Medicine Education Project, May 16, 2022, https://iem-student.org/2022/05/16/emergency-medicine-perspectives-of-students-central-and-south-america/, date accessed: July 6, 2022

Emergency Medicine Perspectives of Students – Asia

Dear EM family,

The International Emergency Medicine Education Project (iem-student.org) has completed three years. As you may know, the iEM Education project aims to promote Emergency Medicine and provides copyright-free resources to students and educators around the world. Now we have reached more than 200 countries. We would like to thank again our contributors. Without them, such a project would not be possible. This experience has shown us once again how passionate our international EM community is to help and teach each other.

In May 2021, we started the fourth year of this journey. To celebrate, we are pleased to announce alive activity series, Emergency Medicine Perspectives of Students Around the World. Our guests for the third session are Nanditha S. Vinod from India, Kezban Sila Kunt from Turkey, and Nanette B. Doroja from Phillipines.

Together, we can understand the experiences and needs of medical students from different backgrounds and discuss potential solutions.

Here are the video and audio records of this session. 

Part 1

Part 2

Cite this article as: Arif Alper Cevik, "Emergency Medicine Perspectives of Students – Asia," in International Emergency Medicine Education Project, May 9, 2022, https://iem-student.org/2022/05/09/emergency-medicine-perspectives-of-students-asia/, date accessed: July 6, 2022

Emergency Medicine Perspectives of Students – Europe

Dear EM family,

The International Emergency Medicine Education Project (iem-student.org) has completed three years. As you may know, the iEM Education project aims to promote Emergency Medicine and provides copyright-free resources to students and educators around the world. Now we have reached more than 200 countries. We would like to thank again our contributors. Without them, such a project would not be possible. This experience has shown us once again how passionate our international EM community is to help and teach each other.

In May 2021, we started the fourth year of this journey. To celebrate, we are pleased to announce alive activity series, Emergency Medicine Perspectives of Students Around the World. Our guests for the third session are Nadine Schottler from UK, Helena Halasaz from Hungary, and Gregor Prosen from Slovenia.

Together, we can understand the experiences and needs of medical students from different backgrounds and discuss potential solutions.

Here are the video and audio records of this session. 

Cite this article as: Arif Alper Cevik, "Emergency Medicine Perspectives of Students – Europe," in International Emergency Medicine Education Project, November 22, 2021, https://iem-student.org/2021/11/22/emergency-medicine-perspectives-of-students-europe/, date accessed: July 6, 2022

Emergency Medicine Perspectives of Students – World

EM perspectives of students - world

Dear EM family,

The International Emergency Medicine Education Project (iem-student.org) has completed three years. As you may know, the iEM Education project aims to promote Emergency Medicine and provides copyright-free resources to students and educators around the world. Now we have reached more than 200 countries. We would like to thank again our contributors. Without them, such a project would not be possible. This experience has shown us once again how passionate our international EM community is to help and teach each other.

In May 2021, we started the fourth year of this journey. To celebrate, we are pleased to announce alive activity series, Emergency Medicine Perspectives of Students Around the World. Our guests for the second session are Maryam Zadeh from Canada, Nawaf Alamri from Saudi Arabia, and Rebeca Barbara from Brazil, who are the leaders of the International Student Association of Emergency Medicine.

Together, we can understand the experiences and needs of medical students from different backgrounds and discuss potential solutions.

Here are the video and audio records of this session. 

Cite this article as: Arif Alper Cevik, "Emergency Medicine Perspectives of Students – World," in International Emergency Medicine Education Project, November 10, 2021, https://iem-student.org/2021/11/10/emergency-medicine-perspectives-of-students-world/, date accessed: July 6, 2022

Emergency Medicine Perspectives of Students – Africa

EM perspectives of students - africa

Dear EM family,

The International Emergency Medicine Education Project (iem-student.org) has completed three years. As you may know, the iEM Education project aims to promote Emergency Medicine and provides copyright-free resources to students and educators around the world. Now we have reached more than 200 countries. We would like to thank again our contributors. Without them, such a project would not be possible. This experience has shown us once again how passionate our international EM community is to help and teach each other.

In May 2021, we started the fourth year of this journey. To celebrate, we are pleased to announce live activity series, Emergency Medicine Perspectives of Students Around the World. Our guests for the first session are Adebisi Adeyeye from Nigeria, Jonathan Kajjimu from Uganda, and Mohamed Hussein from Egypt, who are Student Council Leaders of the African Federation for Emergency Medicine

Together, we can understand the experiences and needs of medical students from different backgrounds and discuss potential solutions.

Here are the video and audio records of this session. 

Cite this article as: Arif Alper Cevik, "Emergency Medicine Perspectives of Students – Africa," in International Emergency Medicine Education Project, October 27, 2021, https://iem-student.org/2021/10/27/emergency-medicine-perspectives-of-students-africa/, date accessed: July 6, 2022

Dermatological emergencies : Stevens-Johnson Syndrome

stevens johnson syndrome

Every medical student has three categories of topic division

Category 3 catches you by surprise when it makes it an entry in the ED and serves as a reminder of why it is essential always to know something about everything. Stevens-Johnson Syndrome was one of those for me. Although rare, dermatological emergencies are essential to spot and can be life-threatening if left untreated.

Stevens-Johnsons Syndrome is a rare type 4 hypersensitivity reaction which affects <10% of body surface area. It is described as a sheet-like skin loss and ulceration (separation of the epidermis from the dermis).

Toxic epidermal necrosis and Stevens-Johnsons Syndrome can be mixed. However, distinguishing between both disease can be done by looking at % of body surface area involvement.

  • < 10% BSA = Stevens-Johnsons Syndrome
  • 10-30% BSA = Stevens-Johnsons Syndrome/Toxic epidermal necrosis overlap syndrome
  • > 30%= Toxic epidermal necrosis – above image is an example of toxic epidermal necrosis.

Pathophysiology is unknown

Pathophysiology is not clearly known; however, some studies show it is due to T cells’ cytotoxic mechanism and altered drug metabolism.

Causes

The most common cause of Stevens-Johnsons Syndrome is medications. Examples are allopurinol, anticonvulsants, sulfonamide, antiviral drugs, NSAIDs, salicylates, sertraline and imidazole.

As one of the commonest cause is drug-induced, it is a vital part of history taking. Ask direct and indirect questions regarding drug intake, any new (started within 8 weeks) or old medications and previous reactions if any.

Other causes are malignancy and infections (Mycoplasma pneumonia, Cytomegalovirus infections, Herpesvirus, Hep A).

Risk Factors

The disease is more common in women and immunocompromised patients (HIV, SLE)

Clinical Presentations

  • Flu-like symptoms(1-14 symptoms)
  • Painful rash which starts on the trunk and spreads to the face and extremities.
  • Irritation in eyes
  • Mouth ulcers or soreness

Clinical Exam Findings

  • Skin manifestation – Starts as a Macular rash that turns into blisters and desquamation.
  • An important sign in SJS is Nikolsky’s sign: It is considered positive if rubbing the skin gently causes desquamation.
  • 2 types of mucosa are involved in SJS – oral and conjunctiva, which precede skin lesions.
  • Other findings in the examination may include –
  • Oral cavity – ulcers, erythema and blisters
  • Cornea – ulceration

Diseases with a similar presentation – in children, staphylococcal scalded skin syndrome can be suspected as it has a similar presentation and can be differentiated with the help of a skin biopsy.

Diagnosis

Clinical awareness and suspicion is the cornerstone step for diagnosis. Skin Biopsy shows subepidermal bullae, epidermal necrosis, perivascular lymphocytic infiltration, which help for definitive diagnosis.

Management

Adequate fluid resuscitation, pain management and monitoring of electrolytes and vital signs, basic supportive or resuscitative actions are essential, as with any emergency management.

The next step is admitting the patient to the burn-unit or ICU, arranging an urgent referral to dermatology and stopping any offending medications. If any eye symptoms are present, an ophthalmology referral is required.

Wound management is essential- debridement, ointments, topical antibiotics are commonly used to prevent bacterial infections and ease the symptoms.

Complications

  • Liver, renal and cardiac failure
  • Dehydration
  • Hypovolemic or septic shock
  • Superimposed infection
  • Sepsis
  • Disseminated intravascular coagulation
  • Thromboembolism
  • Can lead to death if left untreated

Prognosis

Prognosis of a patient with Stevens-Johnson Syndrome is assesed by the SCORTEN Mortality Assesment Tool. Each item equal to one point and it is used within the 24 hours of admission.

• Age >/= 40 years (OR 2.7)
• Heart Rate >/= 120 beats per minute (OR 2.7)
• Cancer/Hematologic malignancy (OR 4.4)
• Body surface area on day 1; >10% (OR2.9)
• Serum urea level (BUN) >28mg/dL (>10mmol/L) (OR 2.5)
• Serum bicarbonate <20mmol/L (OR 4.3)
• Serum glucose > 252mg/dL (>14mmol/L) (OR5.3)

Predicted mortality based on the above total:

  • 0-1 Point = 3.2%
  • 2 Points = 12.1%
  • 3 Points = 35.3%
  • 4 Points = 58.3%
  • 5 Points = 90.0%

References and Further Reading

Cite this article as: Sumaiya Hafiz, UAE, "Dermatological emergencies : Stevens-Johnson Syndrome," in International Emergency Medicine Education Project, February 15, 2021, https://iem-student.org/2021/02/15/stevens-johnson-syndrome/, date accessed: July 6, 2022

Recent Blog Posts by Sumaiya Hafiz

COVID-19 Clinical Readiness Course For Medical Students

COVID-19 clinical readiness course

Dear students,

We are pleased to open our fourth course for you; iEM/Lecturio – COVID-19 Clinal Readiness Course.

As we did in the EMCC course, we collaborated with Lecturio to provide you an excellent course to improve your knowledge in the clinical applications in COVID-19 cases.

The interactive course content is prepared by Lecturio’s expert educators Dr. Eisha Chopra, Dr. Julie Rice, Dr. Daniel Sweiden, Dr. Julianna Jung from John Hopkins University, Department of Emergency Medicine. Assessments of the course were prepared by Dr. Arif Alper Cevik from United Arab Emirates University, College of Medicine and Health Sciences.

One more time, we thank Lecturio for their amazing resources and support to our social responsibility initiative to help medical students in need during these challenging times.

As a part of our social responsibility initiative, iem-course.org will continue to provide free open online courses related to emergency medicine. We hope our courses help you to continue your education during these difficult times.

Please send us your feedback or requests about courses.

We are here to help you.

Best regards.

Arif Alper Cevik, MD, FEMAT, FIFEM

Arif Alper Cevik, MD, FEMAT, FIFEM

iEM Course is a social responsibility initiative of iEM Education Project

Course Length

This course requires 2-4 hours of study time. The course content will be available for 7 days after the enrolment.

Who can get benefit from this course?

  • Junior and senior medical students (course specifically designed for these groups)
  • Interns/Junior emergency medicine residents/registrars

Certificate

The candidates who successfully pass final summative assessment of the course will be provided course completion certificate.

Other Free Online Courses

Cite this article as: Arif Alper Cevik, "COVID-19 Clinical Readiness Course For Medical Students," in International Emergency Medicine Education Project, June 26, 2020, https://iem-student.org/2020/06/26/covid-19-clinical-readiness-course/, date accessed: July 6, 2022

Triads in Medicine – Rapid Review for Medical Students

triads in medicine

One of the most convenient ways of learning and remembering the main components of disease and identifying a medical condition on an exam are Triads, and medical students/interns/residents swear by them.

Be it a question during rounds, a multiple-choice exam question to be solved, or even in medical practice, the famous triads help physicians recall important characteristics and clinical features of a disease or treatment in an instant.

Since exam season is here, this could serve as a rapid review to recall the most common medical conditions.

While there are a vast number of triads/pentads available online, I have listed the most important (high-yy) ones that every student would be asked about at least once in the duration of their course.

1) Lethal Triad also known as The Trauma Triad of Death
Hypothermia + Coagulopathy + Metabolic Acidosis

2) Beck’s Triad of Cardiac Tamponade
Muffled heart sounds + Distended neck veins + Hypotension

3) Virchow’s Triad – Venous Thrombosis
Hypercoagulability + stasis + endothelial damage

4) Charcot’s Triad – Ascending Cholangitis
Fever with rigors + Right upper quadrant pain + Jaundice

5) Cushing’s Triad – Raised Intracranial Pressure
Bradycardia + Irregular respiration + Hypertension

6) Triad of Ruptured Abdominal Aortic Aneurysm
Severe Abdominal/Back Pain + Hypotension + Pulsatile Abdominal mass

7) Reactive Arthritis
Can’t See (Conjunctivitis) + Can’t Pee (Urethritis) + Can’t Climb a Tree (Arthritis)

8) Triad of Opioid Overdose
Pinpoint pupils + Respiratory Depression + CNS Depression

9) Hakims Triad – Normal Pressure Hydrocephalus
Gait Disturbance + Dementia + Urinary Incontinence

10) Horner’s Syndrome Triad
Ptosis + Miosis + Anydrosis

11) Mackler’s Triad – Oesophageal Perforation (Boerhaave Syndrome)
Vomiting + Lower Thoracic Pain + Subcutaneous Emphysema

12) Pheochromocytoma
Palpitations + Headache + Perspiration (Diaphoresis)

13) Leriche Syndrome
Buttock claudication + Impotence + Symmetrical Atrophy of bilateral lower extremities

14) Rigler’s Triad – Gallstone ileus
Gallstones + Pneumobilia + Small bowel obstruction

15) Whipple’s Triad – Insulinoma
Hypoglycemic attack + Low glucose + Resolving of the attack on glucose administration

16) Meniere’s Disease
Tinnitus + Vertigo + Hearing loss

17) Wernicke’s Encephalopathy- Thiamine Deficiency
Confusion + Ophthalmoplegia + Ataxia

18) Unhappy Triad – Knee Injury
Injury to Anterior Cruciate Ligament + Medial collateral ligament + Medial or Lateral Meniscus

19) Henoch Schonlein Purpura
Purpura + Abdominal pain + Joint pain

20) Meigs Syndrome
Benign ovarian tumor + pleural effusion + ascites

21) Felty’s Syndrome
Rheumatoid Arthritis + Splenomegaly + Neutropenia

22) Cauda Equina Syndrome
Low back pain + Bowel/Bladder Dysfunction + Saddle Anesthesia

23) Meningitis
Fever + Headache + Neck Stiffness

24) Wolf Parkinson White Syndrome
Delta Waves + Short PR Interval + Wide QRS Complex

25) Neurogenic Shock
Bradycardia + Hypotension + Hypothermia

Further Reading

Cite this article as: Sumaiya Hafiz, UAE, "Triads in Medicine – Rapid Review for Medical Students," in International Emergency Medicine Education Project, June 12, 2020, https://iem-student.org/2020/06/12/triads-in-medicine/, date accessed: July 6, 2022

Medical students’ ultrasound training – SURVEY

There are many studies showing benefits of ultrasound training about understanding anatomy, pathologies and improving clinical decision making. Countries show different approaches to implementing ultrasound training at the medical school level. There are many obstacles such as staff, equipment, training manikins, dedicated time in curriculum design. International organizations are trying to find solutions for these obstacles and encouraging to implement ultrasound training into the medical school curriculum. Ultrasound can be a valuable diagnostic and procedural tool in many low resourced countries, especially where the CT scans and x-rays are not available. However, even in developed countries, medical students’ training on ultrasonography skills is still an infancy period.

We conducted a 1-minute survey to explore the global situation in order to understand current applications in medical schools. We hope you fill and share this survey with your professional contacts and students.

1 minute SURVEY

Core EM Clerkship Topics

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