Journal of Education and Teaching in Emergency Medicine

Audience:

This clinical decision-making case (CDM) is intended for emergency medicine residents (interns, juniors, seniors).

Introduction/Background:

Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease and can be a common cause of ICU admission in these patients. Emergency physicians must rapidly identify, diagnose, and treat ACS to prevent deterioration. Acute chest syndrome is the most prevalent pulmonary disorder in individuals with sickle cell.1,2 Approximately 50% of patients with sickle cell disease will experience more than one episode of acute chest syndrome, with 78% of episodes secondary to vaso-occlusive pain episodes in adults. It is the most common cause of death in individuals with sickle cell, accounting for almost 25% of all deaths.3 

Educational Objectives:

By the end of this clinical decision-making case, learners will be able to: 1) demonstrate familiarity with a case, 2) identify focused historical and physical exam findings in ACS, 3) develop a differential diagnosis for chest pain in a sickle cell patient, 4) select and interpret appropriate diagnostic studies, 5) initiate ED management including oxygen, antibiotics, and pain control, 6) recognize when to consult hematology and consider transfusion, 7) appropriately disposition the patient and communicate a transition of care, and 8) explain the pathophysiology of ACS.

Educational Methods: 

The development of this case was grounded in Kolb's experimental learning theory.4 This process includes four stages: experience, reflection, conceptualization, and experimentation to solidify learning of skills and concepts.  This case was delivered in three phases to encompass all stages of Kolb's learning theory: flipped classroom instructional video simulated practice and role play and formal assessment (the scoring checklist). This case uses a structured oral board simulation based on American Board of Emergency Medicine’s (ABEM) Clinical Decision-Making format (CDM).5 First, the residents were asked to watch a video from the ABEM website on how to perform the CDM model.  Immediately afterwards, they were asked to reflect on whether they had had previous experience with this model of teaching and to fill out the survey. Finally, on a simulation didactic day, residents were randomized into groups of three to four.  An emergency medicine attending administered the case over 15 minutes to one resident in the group, while the other group members observed over 15 minutes, with 25 minutes to debrief. Learners answer standardized prompts in a timed, non-roleplay format, enhancing diagnostic reasoning and management planning. The attending and a separate resident then scored the participant using the provided scoring. Immediately afterwards a brief debrief was held and the scores were reviewed. The method aligns with constructivist learning theory and supports deliberate practice.

Research Methods: Residents were consented and then randomly assigned a study number, and they filled out pre- and post- confidence level surveys based on their experience with the clinical decision-making format. A Likert scale was used from 1-5, 1=Not at all confident, 5 = Very confident. After completing the in-person case session, the residents were asked to fill out a post-confidence level survey. To assess whether the intervention led to statistically significant changes in confidence levels, we conducted a paired t-test across the pre- /post- groups.

Results: Thirteen residents consented to and participated in the study by completing both the pre-and post-confidence level survey. Eight of the residents were PGY 1, and five were PGY 2. Between both groups, the confidence level improved overall from 1.86 pre- to 2.92 post (P=0.005). PGY 1 residents had a lower confidence level, starting out at an average of 1.5 with improvement to 2.63 (P=0.026), compared to PGY 2’s who started out at 2.4 and improved to 3.4 (p=0.089). The PGY 2 improvement was not statistically significant.

Discussion: 

The structured format allowed for targeted feedback and consistent assessment. Residents appreciated the immediate feedback and felt more confident in their preparation with the oral boards clinical decision-making format.  Interns had the greatest improvement in confidence levels when compared between residency classes. This could represent PGY 2’s increased clinical experience. This format was done in the first months of residency as well, and it would be interesting to see if there was improvement from the beginning of the year to the end in the intern class just from patient exposure. Our program does not currently have PGY 3's but repeating this study in the future would be beneficial to compare and see if the largest gains are in the intern and junior residents with less clinical experience.

Audience: This session is intended for learners and educators interested in medical education, including medical students, residents, fellows, and faculty.

Introduction/Background: Gamification is increasingly recognized as an effective strategy to enhance engagement, motivation, and active learning in medical education. Despite its potential, many educators are unsure how to implement gamified strategies effectively. This session demonstrates a practical, interactive approach to applying gamification principles in a collaborative educational setting.

Educational Objectives: By the end of this session, learners will be able to (1) describe key principles of gamification in medical education, (2) identify resources and tools for implementing gamification, (3) actively participate in a gamified educational activity, and (4) design a simple plan to implement gamification in their own teaching, considering benefits and potential challenges.

Educational Methods: The session started with brief didactic lecture on game-based learning and gamification intended to orient participants to the material. Participants then engaged in a Candy Land-inspired, team-based activity. Twenty-five prompts covering aspects of gamification were arranged along a winding pathway drawn with chalk. Teams of 3–4 learners advanced along the path by rolling a large inflatable die and answering questions or discussing scenarios associated with the prompts. Correct answers earned points or allowed teams to advance, while debriefing discussions linked gameplay to the principles and strategies of gamification. Incorrect answers were not penalized. This approach leveraged experiential learning, active learning, and social constructivist principles to support both knowledge acquisition and practical application.

Research Methods: The session was evaluated through direct observation and informal feedback from learners and instructors. Engagement, discussion quality, and participation were used as primary indicators of effectiveness. Modifications and recommendations for future implementation were derived from observed challenges and learner feedback.

Results: Fifteen learners of varied training levels participated. Observations indicated high engagement, lively discussion, and collaborative problem-solving. Feedback was universally positive, with learners reporting increased confidence in understanding gamification principles and motivation to apply these strategies in their own teaching. Several participants subsequently incorporated gamified activities into educational sessions in the following weeks. Key lessons for implementation included ensuring sufficient space, clarifying scoring systems, and preparing materials in advance.

Discussion: This session demonstrates that gamification can effectively engage learners across multiple levels, promote collaborative learning, and provide practical insights into implementation strategies. Learners experienced the mechanics and benefits of gamification firsthand, while also reflecting on challenges and planning for real-world application. The activity highlights how structured games can create a safe and inclusive learning environment, fostering participation from all learners. Future iterations may further optimize space, scoring, and team organization to enhance learning outcomes.

Audience: This small group session is appropriate for any level of medical student, emergency medicine resident physicians, and faculty.  

Introduction: Burnout is a major issue in medicine, with over half of physicians experiencing burnout at some point in their career.¹ Physicians who regularly participate in self-care activities, such as regularly exercising, having a well-balanced diet, and appropriate amount of sleep, experience less burnout.^2,3,4 As a resident, it is difficult to find time to practice self-care.² This session sought to combine education on how to implement appropriate self-care as a trainee and how to carry that forward after training in a way that was fun, provided a period of physical exercise, and provided time outdoors for those participating. 

Educational Objectives: By the end of this session, the learner will be able to: 1) implement basic ways to improve sleep quality, 2) avoid common pitfalls in diet and nutrition, 3) incorporate more physical activity into their lives. 

Educational Methods: Learners were divided into teams of three to four. A scavenger hunt was created using Google Forms and QR codes. The initial QR code was displayed in the lecture hall at the start of the session. Fifteen other QR codes were either physically distributed throughout the Emergency Medicine Offices and the Emergency Department or provided to participants via text message when they completed certain tasks. Each QR code led to a different Google Form with a question about physical wellbeing. Participants were allowed to use any resource they had with them, including their mobile devices. After the question was answered correctly, an explanation was provided in the Google Form. A riddle was also provided to help locate the next QR code. An incorrect answer required the participants to try to answer the question again. Participants were not given any hints after answering incorrectly. There were no formal penalties for incorrect answers. However, incorrect answers increased the time it took to complete the task.  At the end of the session, each question was debriefed by the instructor. 

Research Methods: Participants completed a five-question pre-survey to rate their level of physical wellbeing using a 1-5 Likert Scale. Participants also completed a 10-question post survey that asked them the same initial 5 questions to rate their physical wellbeing on the same scale as the pretest, as well as additional questions asking how likely they were to change their physical habits based on the session and how much they enjoyed the session on a different 1-5 Likert Scale. They were also asked to provide recommendations for future changes. Pre- and post-test Likert scores were compared using the Mann-Whitney U Test. 

Results: Twelve participants, all resident physicians, took part in the exercise. Twelve completed the pre-survey, and ten completed the post-survey. There was no difference in physical wellbeing score (median 3 before vs median 2.5 after, P=0.62). All participants except one were at least moderately likely (3 or above on a 1-5 Likert scale) to change their sleep habits based on the exercise. All were at least moderately likely (3 or above on a 1-5 Likert scale) to change their eating and exercise habits based on the activity. All respondents found the activity to be at least moderately enjoyable (3 or above), with 8 of 10 finding it extremely enjoyable (5).

Discussion: This wellbeing scavenger hunt effectively taught learners how to incorporate simple changes into their lives to improve the self-care habits. This model could be applied to other educational topics to incorporate a component of physical wellbeing and exercise and has been used during new resident orientation and wilderness education within our department.  

Topics: Wellbeing, physical wellbeing, exercise, nutrition, sleep habits, self-care.

Audience: This module was developed for emergency medicine (EM) residents, though may also be used for medical students on an emergency medicine clerkship or attending physicians.

Length of Curriculum: This frailty and end-of-life care module consists of two 60-minute small group sessions. 

Introduction: Emergency medicine physicians often care for patients with significant comorbidities, physical frailty, and acute and chronic life-limiting conditions, including those at end-of-life. Over 60% of emergency department (ED) patients older than 65 years old meet established criteria for physical frailty, and at least half of older adults present to the ED in their final month of life.^1,2 Therefore, it is critical that EM physicians understand end-of-life trajectories and adopt a thoughtful approach to end-of-life communication, clinical decision-making and symptom management to support both patients and their caregivers.³ To address this need, we developed a flipped-classroom case-based small group discussion session for emergency medicine learners that augments self-learning, followed by a small group discussion with peers. 

Educational Objectives: At the end of this module, learners should be able to: 1) recognize and classify end-of-life trajectories, 2) define physical frailty, including risk factors, prevalence and prognosis in ED patients, 3) develop a differential diagnosis and diagnostic and treatment plan for a patient with metastatic cancer presenting with fatigue, constipation, labile mood, and diffuse osseous pain, 4) review Medicare Hospice Benefit eligibility, 5) understand the differential diagnosis and medical management of chemotherapy-related nausea, 6) discuss the assessment and management of dyspnea in end-of-life patients, and 7) review how to estimate and communicate prognosis using practical timeframes.

Educational Methods: This exercise consists of two 60-minute small group sessions (two clinical cases per session) using a “flipped classroom” design.^4–20 The facilitator should distribute the learner responsible content one week in advance. Learners are instructed to complete the assigned readings and review four cases to prepare for an in-person discussion guided by the facilitator. Questions are included to guide their learning and structure the subsequent discussion. The facilitator uses the Physical Frailty and End-of-Life Care Preceptor Notes, which is organized around the handout questions, to stimulate discussion and answer questions.

Research Methods: Learners evaluated the content using end-of-session anonymous feedback forms. Faculty small-group facilitators assessed learner participation.

Results: We received open-ended responses from 11 learners. All felt the workload to prepare for the small-group session was reasonable and beneficial to their residency education. Some respondents requested additional sessions to discuss personal and/or difficult patient care experiences based on this “bite-sized” introduction to frailty and end-of-life care. 

Discussion: Overall, this split two-hour flipped classroom educational activity was an effective method to introduce the concept of frailty and end-of-life care to emergency medicine residents. Following the initial session, the authors added an additional case to expand the curriculum into two sessions to allow more time for free-form discussion.

Topics: Emergency medicine, flipped classroom, medical education, teaching, end-of-life, frailty, hospice, palliative care, terminal dyspnea, malignant hypercalcemia, chemotherapy-induced nausea.

ABSTRACT:

Audience: This is a simulation module intended to train residents at all levels in giving targeted, critical feedback to medical students on shift.

Introduction: Residents as teachers (RAT) curricula are an important component of graduate medical education for residents who teach medical students.¹ Developing residents’ skills in teaching, feedback, and supervision is therefore a critical component of training.  Medical students receive a substantial portion of their clinical education from residents,^2,3and timely, specific feedback in the clinical setting improves learner performance and professional development.⁴ Despite the importance of these skills, residents have limited opportunities to practice delivering challenging feedback beyond introductory teaching experiences.^5,6 This curriculum addresses that gap by providing simulation-based practice in identifying learner gaps and delivering targeted, critical feedback to medical students. 

Educational Objectives: The purpose of this module was to provide a safe learning environment for residents to practice giving critical feedback to medical students. By the end of the session, residents will be able to 1) identify gaps in student proficiency through analysis of a simulated student’s clinical performance as demonstrated by a simulated case presentation, 2) formulate specific feedback for student learners to target identified gaps, and 3) apply a newly learned strategy for providing feedback to a “student” during two simulation-based communication cases.

Educational Methods: We developed two simulation communication cases wherein resident participants of all training years were placed in the roles of a simulated medical student and a simulated resident. Both roles are structured for resident participants only and the simulated student role was performed by another resident before the roles were then switched for the second case.  This educational session was held in small groups during resident didactics with a facilitator present with each of the small group sessions. The first case involves a presentation of a patient with leg pain with an underlying diagnosis of necrotizing fasciitis, and the second involves a presentation of a patient with chest pain with an underlying diagnosis of pulmonary embolism.  Face sheet information gives the simulated student and simulated resident unexpectedly different perspectives, leading the simulated student to omit can’t-miss diagnoses and requiring the resident to recognize an opportunity for feedback and practice delivering teaching points. The simulated student, played by another resident, is also invited to provide comments to their partner on the teaching strategies used during a facilitator-led debrief following the completion of each case

Research Methods: Twenty-one participants completed pre-and post- surveys to gauge comfort with teaching and providing feedback to medical students on shift. Participants ranked their perceived importance of a “Residents as Teachers” curriculum in their medical education. We used a paired t-test to assess the change in rating before and after the cases. Statistical calculations were done using Excel.  Participants provided qualitative data through open-ended feedback comments.

Results: Resident confidence in teaching medical students on shift increased from 3.65 to 3.9 (P=0.01), and confidence in giving critical feedback increased from 3.2 to 3.95 (P<0.001). The perceived importance of a “Residents as Teachers” curriculum was overall unchanged from 4.4 to 4.5 (P>0.2). Review of feedback comments demonstrated an overall positive experience and several requests to receive further training on effective teaching. One resident playing the role of a “student” shared that they felt it was particularly helpful to play the role of the student to understand their perspective better, and several comments included a request for further opportunities for practice in the future. One resident suggested providing additional teaching on how to approach teaching students of different levels of training

Discussion: The utilization of these modules was well-received by participants and proved to be an effective way to improve resident comfort in providing critical feedback and teaching medical students on shift. Providing the simulated student and simulated resident with divergent clinical perspectives allowed for a nuanced discussion regarding how the residents felt in their individual roles and their perceived efficacy of the feedback provided to the simulated student. Residents communicated that the cases were reflective of experiences they have had on shift and appreciated the ability to practice their skills in a safe environment. They reported overall satisfaction with the cases and a desire to use similar cases in the future.

Audience: The target audience includes individuals involved in the education and training of emergency medicine (EM) residents, such as program directors, assistant program directors, core faculty, and academic attendings, as well as learners including residents, physician assistant (PA) fellows, and medical students (MS).

Introduction: Gamification has increasingly been incorporated into emergency medicine (EM) residency education to enhance learner engagement, motivation, and active participation. Prior studies have demonstrated benefits of game-based learning across multiple areas of medical education, including improved knowledge retention, teamwork, communication, and learner satisfaction.^1-4 However, most gamification interventions in EM involve isolated activities rather than comprehensive, multi-station conference curricula. To address this gap, we developed a casino-themed, multi-station educational conference designed to reinforce core EM knowledge, procedural skills, and clinical reasoning through competitive, team-based learning. The intervention incorporated simulation, rapid-response scenarios, board-style trivia, and wagering poker chips during a protected half-day residency conference. 

Educational Objectives: By the end of this educational intervention, participants will be able to: 1) demonstrate airway management skills through simulation, including equipment setup and timely interventions for both adult and pediatric cases, 2) interpret various electrocardiograms (EKGs) in high-pressure scenarios, 3) analyze cases and apply evidence-based management in various rapid-response scenarios, 4) demonstrate rapid recall of EM knowledge by answering board-style trivia questions, and 5) demonstrate increased confidence in team-based decision-making, effective communication under pressure, and leadership in high-stress emergency situations.

Educational Methods: This prospective educational innovation was delivered as a single, four-hour casino-themed EM conference session featuring interactive stations modeled after casino games and held during the residency program’s weekly Wednesday educational conference. The session featured interactive, competition-based stations designed to replicate high-pressure ED scenarios. Learners rotated through four game-based stations: “Play Your Cards Right” for rapid-recall trivia using EM board-style questions, “Diagnostic Craps” for EKG interpretation and management, “High Stakes Airways” for hands-on airway management using mannequins and rapid sequence intubation scenarios, and “Rapid Response Roulette” for discussion of ED cases focusing on team dynamics, leadership, resuscitation, and escalation of care. The games were designed to reflect real-world ED challenges, with content and expectations tailored to postgraduate years (PGY) levels. Participants wagered poker chips based on confidence in their responses, reinforcing self-assessment and accountability. This method encouraged active participation, peer-to-peer learning, and application of clinical reasoning in high-pressure scenarios.

Research Methods: The casino-style conference featured six tables each with an EM attending facilitator. Participants included EM residents, physician assistant (PA) fellows, and medical students. Learners started with 15 poker chips and engaged in four game-based sessions over four hours. The games “Play Your Cards Right,” “High Stakes Airways,” “Diagnostic Craps,” and “Rapid Response Roulette” incorporated either case-based simulation, procedural skill stations, rapid decision-making, EKG interpretation, and/or evidence-based medicine (EBM) trivia. Learners wagered chips based on confidence, with gains/losses tied to performance. Faculty provided real- time feedback and facilitated discussions. Pre- and post- conference surveys (Appendix A) assessed educational value, skill improvement, confidence, and clinical applicability. Instructors also evaluated feasibility and effectiveness. The study was Institutional Review Board exempt.

Results: Of the 33 learners who attended the conference, 32 completed surveys (97% response rate) including 26 EM residents (10 PGY-1, 8 PGY-2 and 8 PGY-3), 4 medical students, and 2 physician assistants. One hundred percent of participants answered “yes” when asked if they would recommend this type of conference to peers and 100% preferred this learning style to traditional didactics. Eighty-eight percent of the respondents reported they are “very likely” to incorporate skills learned from this activity into future practice.

Facilitators rated the game-based learning activities as highly effective teaching tools, with 92% rating 4 or 5 (on a 5-point scale). Facilitators were also asked if they found the games easy to implement, and 83% answered rating a 4 or a 5 (on a 5-point scale). Responses derived from the open-ended questions emphasize the conference’s effectiveness in engaging participants, providing meaningful learning experiences and fostering a positive and well-organized environment.  

Discussion: This casino-style, game-based learning conference was highly rated for both educational value and engagement. Participants reported increased confidence in managing emergency scenarios, particularly in EKG interpretation and team-based critical decision-making. The format was viewed as feasible and effective, with most participants preferring game-based learning over traditional didactics, supporting its continued use in EM education.

Audience: This simulation is intended for interprofessional clinical decision unit (CDU) teams. 

Introduction: Emergency department (ED) observation units or clinical decision units (CDU) are a common care model found in many hospitals due to their ability to provide high-quality care and reduce length of stay while also minimizing costs.^1,2,3 Despite initial clinical stability, deterioration while in the CDU may occur. Due to the unique environment of the CDU, it is essential that the interprofessional team is prepared to manage unstable patients; yet there is minimal literature on how to best train observation unit teams. 

Educational Objectives:  By the end of this simulation session, learners will be able to: 1) prioritize and coordinate team-based tasks within the CDU environment upon recognizing patient decompensation and cardiac arrest, 2) optimize clinical decision unit (CDU) team member roles and interprofessional communication, 3) adapt resuscitation principles in the resource-variable setting of a CDU to manage a critically ill patient.

Educational Methods:  This is run as an in-situ simulation with an interprofessional team as an experiential learning intervention. The in-situ format enables exploration of the team-specific and unit-specific context during the debrief. 

Research Methods: Participants completed a pre- and post-self-assessment via QR code along with responses to three program evaluation questions. 

Results: Twenty-five team members participated in six in-situ CDU simulations. On the pre-assessment, participants had a median of 4 (scale of 1- strongly disagree to 5 - strongly agree) across all categories including confidence in their role during a Code Blue, roles of team members, team priorities, trust in team members, equipment location, and comfort in providing hand-off. On the post-assessment, team priorities and trust in team members increased to a median of 5. In the program evaluation, participants found the experience valuable, particularly the debrief.  

Discussion: Team members started the simulation with confidence in cardiac arrest management, but participation increased their understanding of trust in team members and team priorities within the CDU context. This simulation and debrief session could help support team performance during cardiac arrest within the distinct clinical and interprofessional environment of the CDU. 

Audience: This simulation is intended for Post-Graduate Level 1-4 Residents and Attending Physicians.   

Introduction: Although uncommon in the Northeastern United States, emergency physicians may encounter exotic envenomation through zoological institutions, research facilities, or privately owned exotic reptiles.¹ These cases present unique diagnostic and logistical challenges because management frequently requires species-specific antivenom and early consultation with regional toxicology experts.^1,2,3 Emergency providers may be unfamiliar with such presentation, evaluation, and treatment steps. Simulation-based education can bridge this gap by allowing interprofessional teams, including residents, attendings, nurses, and pharmacists, to practice coordinated management in a safe environment.^4,5This project evaluates the feasibility, learner-reported preparedness, and educational outcomes associated with a multidisciplinary snakebite simulation.

Educational Objectives: By the end of the simulation, participants will be able to recognize and appropriately manage neurotoxic snakebite envenomation, including initiating first-line management and toxicology consultation, coordinating antivenom administration, recognizing and treating antivenom-associated anaphylaxis, assessing and managing progressive respiratory failure, demonstrating effective interprofessional communication using TeamSTEPPS principles,⁴and coordinating timely consultation, handoff, and disposition with toxicology, pharmacy, and the critical care team.

Educational Methods: High-fidelity simulation will be used to provide an immersive environment. TeamSTEPPS (team strategies and tools to enhance performance and patient safety), an evidence-based communication training toolkit, will be used.⁴ High-fidelity simulation for snakebite education has been shown to enhance clinical skills, foster teamwork, and enable more timely and proficient provider care in snakebite cases.⁵ The simulation will depict an Indian Cobra snakebite case with evolving neurotoxicity and potential anaphylaxis after antivenom. Teams will manage airway, antivenom reconstitution, and anaphylaxis using TeamSTEPPS principles.⁴ Scenario branches depend on learner actions; facilitators will provide physiologic cues accordingly. 

Research Methods: The study consisted of a prospective, single-center, pre/post simulation-based educational pilot study. Physician participants completed pre- and post-surveys and objective multiple-choice tests. Observers used checklists to assess performance. Given the pilot nature of the simulation, no a priori sample size calculation was performed. The simulation was conducted using an interprofessional team model that included emergency medicine physicians, bedside nurses, pharmacists, and a toxicologist. Although all disciplines participated in the simulation to replicate real-word emergency department management of snakebite envenomation, only physician participants completed the pre- and post-intervention knowledge and confidence assessments. The educational study was designed to evaluate physician learning outcomes. 

Results: Seven emergency medicine physicians from varying training levels participated in the simulation, with a post-test response rate of 85.7% (n=6). Participants demonstrated significant improvements in self-reported knowledge regarding overall snakebite management (p = 0.042), appropriate first aid (p = 0.010), antivenom complications (p = 0.010), and recognition of both neurotoxic (p = 0.012) and hemotoxic envenomation patterns (p = 0.010). Confidence in administering antivenom (p = 0.025) and working effectively within a team during high-stress emergencies (p = 0.042) improved as well. No significant improvement was observed in objective multiple-choice knowledge scores. Critical action checklists demonstrated that all members were able to identify key clinical findings, communicate with toxicology, and recognize anaphylaxis, although adherence to antivenom preparation steps varied. 

Discussion: The simulation-based didactic was feasible and associated with improvements in self-reported knowledge, confidence, and perceived teamwork related to snakebite management among physician participants. However, objective knowledge scores did not significantly improve, highlighting the need for continued reinforcement of cognitive knowledge and anti-venom related procedural and systems-based skills. Given the pilot design and limited sample size, these findings should be interpreted as preliminary and hypothesis-generating. Future iterations of the simulation will include larger sample sizes, expand emphasis on antivenom logistics, and incorporate deliberate practice stations to ensure both cognitive and procedural fidelity.

Topics: Snakebite, antivenom, anaphylaxis, neurotoxicity, communication, teamwork.

Audience: This simulation is intended for medical students, interns, junior residents, and senior residents.

Introduction: Patient safety event reporting and disclosure of medical errors to patients and families are critical components of high-quality, transparent care and a necessary skill for emergency medicine (EM) physicians. Accurate reporting of errors, near misses, and unsafe conditions provides institutions with the data needed to investigate vulnerabilities, implement system-based solutions, and prevent recurrence. Disclosure of medical errors fosters trust, supports just culture principles, and reinforces professional accountability.¹ Physicians have historically reported few adverse events, accounting for only 1–2% of all reports.² To address this gap, the Accreditation Council for Graduate Medical Education (ACGME) now emphasizes patient safety and quality improvement as a part of resident education.

The ACGME Emergency Medicine Milestones have established clear expectations for resident education in patient safety.³ Residents, fellows, and faculty must know their responsibilities for event reporting. The milestones include ability to identify patient safety events, understand the system factors that lead to events, and how to complete institutional safety event reports.³ ACGME requires residents to participate in real or simulated interprofessional patient safety events and quality improvement activities as part of systems-based practice milestones.³  These requirements underscore the importance of experiential learning, feedback, and practice in order to achieve true competence in identifying causes and enacting sustainable safety interventions.

Medication errors, particularly dosing errors, are among the most common patient safety threats in the emergency department (ED).⁴ The ED environment—with high patient volumes, time-sensitive decision-making, and frequent weight-based dosing—places EM physicians at especially high risk for ordering or administering incorrect doses. In this simulation, the wrong concentration of a sedation medication is administered and creates a scenario in which the learner must recognize the error, disclose it to the patient/family, and complete a patient safety report (PSR). This approach integrates clinical management with communication and systems-based practice and provides an avenue for residency programs to facilitate ACGME requirements while preparing residents for real-world patient safety responsibilities in scenarios that otherwise may not yet be encountered during the period of residency. 

Educational Objectives: By the end of this simulation activity, learners will be able to: 1) disclose a medical error to a patient and/or their family, 2) understand the different types of patient safety events that should be reported, 3) locate the form for disclosing a patient safety event at their institution, and 4) appropriately complete a patient safety report at their institution. 

Educational Methods: The simulation was conducted with a high-fidelity pediatric mannikin. A total of 19 residents and three medical students participated in the simulation during their monthly didactic session. Afterwards, they were guided through completing a patient safety report for their institution. 

Research Methods: Learners completed a survey before and after the simulation case assessing their comfort with disclosing medical errors and completing an institutional patient safety report form. The survey questions were formatted in a Likert scale where 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree. Results collected were analyzed using Wilcox rank-sum test. 

Results: The participants completed a survey before and after the experience, and there was a statistically significant improvement in the learners’ comfort level after completing the simulation. The free text responses were also universally positive. 

Discussion: Overall, the learners received the simulation well. General feedback was positive; the consensus was that there was increased confidence in patient safety reporting. 

Audience: Senior Medical Students and Interns

Introduction: Central venous catheter (CVC) placement is a critical, high-risk procedure, and it is considered a core component of emergency medicine training.¹ Iatrogenic complications from improper technique—including arterial dilation, pneumothorax, and line-associated bloodstream infections—can significantly impact patient outcomes.^2-7Therefore, emergency medicine trainees should ideally demonstrate procedural competence and adherence to safety practices before performing CVC insertion in clinical settings. These videos serve as part of a mastery-based curriculum designed to reinforce standardized, evidence-based techniques and institutional safety protocols for internal jugular CVC placement.⁸  The procedural preparation video focuses on sterile technique, ultrasound setup, and CVC kit preparation, and the procedural performance video focuses on sterile technique, the leapfrog technique for ultrasound-guided needle cannulation, and the safe insertion of the central venous catheter.

Educational Objectives: 

By the end of these videos, learners will be able to:

1.     Identify and gather all necessary materials for internal jugular (IJ) CVC placement.

2.     Describe the appropriate positioning of the patient, ultrasound machine, and proceduralist for CVC placement.

3.     List common complications of IJ CVC placement.

4.     Demonstrate sterile field preparation, including donning personal protective equipment (PPE), placing a sterile drape, and placement of a sterile ultrasound probe cover.

5.     Perform a proper pre-procedural time-out including at least two patient identifiers and site verification.

6.     Prepare and organize CVC kit components for efficient procedural flow.

7.     Identify key anatomical landmarks and optimal patient positioning for right IJ CVC placement using ultrasound guidance.

8.     Demonstrate stepwise needle insertion with real-time ultrasound visualization to safely cannulate the 

internal jugular vein.

9.     Verify proper guidewire placement using both short- and long-axis ultrasound views before vessel dilation.

10.  Perform safe dilation and catheter advancement using standard procedural technique.

11.  Exhibit best-practice behaviors, including port flushing, line securement, and sterile dressing application.

12.  Document the procedure and identify post-placement safety steps such as confirmatory chest imaging.

Educational Methods: These videos were watched by emergency medicine-bound, fourth-year medical students as asynchronous study material prior to their mastery-based central venous catheter assessment. Students watched these videos, underwent individual pre-test (baseline) assessments using a 58-item checklist, witnessed a faculty member perform a group demonstration, and then performed deliberate observed practice. The previously published, procedure checklist was developed by a multidisciplinary team of experts, and minimum passing standards were determined using the Mastery-Angoff Technique.

Research Methods: Efficacy of the videos may be inferred through baseline assessment scores, since students were given access to the videos prior to completing their baseline assessment.  Utilizing a quasi-experimental design, these scores were compared to previously published data from the previous 2 years in which students completed the baseline assessment without access to the videos.⁹

Results: Ten fourth-year emergency medicine-bound medical students participated in a simulation-based mastery learning procedural course in March 2025. As part of their asynchronous preparation, they watched these two instructional videos: 1. Preparation to Place a Central Venous Cather and 2. Placement of a Central Venous Catheter. Learners were individually assessed in a simulation lab using a 58-item checklist. Pre-test scores ranged from 17 to 89% correct, with a median score of 67%.  Previous cohorts from 2022 and 2023 had scores ranging from 19 to 84% with a median score of 43%.  After deliberate practice, first post-test scores improved for participants and ranged from 89 to 98% correct. 

Discussion: These educational videos were an effective component of a broader simulation-based mastery learning curriculum for central venous catheter placement.  These videos provided a standardized introduction to both general and institution-specific patient safety practices related to CVC kit setup and CVC insertion. Although video views were not tracked, learners demonstrated significant improvement between pre- and post-testing, indicating the combined instructional approach was effective. Compared to previous years’ cohorts, the students who had access to the instructional videos scored better on the baseline assessment, though the small number of participants kept this difference from reaching statistical significance.  The videos also allowed students to engage with the material at their own pace, reinforcing safety principles and procedural preparation in a consistent and accessible way.

Audience and type of curriculum: This mentorship training curriculum is designed for faculty seeking to improve mentoring skills in an academic health system setting. The curriculum offers interactive small-group skill practice supported by brief didactic lectures, paired peer mentoring, and large group reflections.

Length of curriculum: The curriculum is designed as three one-hour interactive workshops to be delivered over three to six months to allow for spaced skill practice in between sessions.

Introduction/Background: This mentorship training curriculum addresses critical gaps in mentorship quality and availability for emergency medicine faculty and learners. Faculty rarely are trained to be mentors, limiting mentoring quality and accessibility for mentees. We addressed these scarcity and quality gaps by offering concise experiential workshops for mid-career and senior faculty mentors to shift their mentoring mindset from expert advisor to curious and non-judgmental thinking partner, expanding their mentoring skills.

Educational Goals: The aim of this curriculum is to train mentors to approach mentoring with a curious and non-judgmental mindset. The curriculum offers specific, practical exercises to increase mentors’ ability to foster a mentee-driven relationship that meets the needs of all mentees, which in turn enhances career development and faculty retention at the department level.

Educational Methods: The educational strategies used in this curriculum include brief mentor check-ins, concise didactics with illustrative examples of personal experiences applying the workshop’s mentoring tools, peer mentoring practice time in paired breakout sessions, and large group debriefs.

Research Methods: This curriculum was implemented at Oregon Health & Science University in three departments including Emergency Medicine, Ophthalmology, and Hospitalist Division within Internal Medicine. This study was reviewed and approved by the Institutional Review Board at Oregon Health & Science University. We electronically collected survey data after each mentoring session to determine whether the participants found the workshops engaging and effective as well as whether their confidence and mentorship skills improved. The surveys gathered data using a 5-point Likert scale as well as free text responses.

Results: Five faculty cohorts from three different departments completed the mentorship curriculum. Of the 35 total participants, 60%, 51%, and 5% completed the post-program feedback surveys for Workshops 1, 2, and 3, respectively. 95% of respondents rated the format as either very engaging or engaging and reported finding the workshop content very useful or moderately useful. All respondents stated they learned new information or skills they could apply to their own work or mentorship.

Discussion: An accessible and applicable faculty development mentoring skills curriculum was implemented in three distinct academic departments with favorable assessment by participants. Combining concise lectures, personal mentorship stories, structured mentoring practice sessions, and group reflection effectively advanced faculty members’ skill and confidence in a mentee-centered mentorship approach. We learned that this curriculum is versatile enough to be tailored to various faculty settings and offers an engaging format that motivates faculty to voluntarily participate.

Audience: This task trainer was designed to instruct emergency medicine (EM) residents and faculty at all levels of training. 

Introduction: Priapism management is time-sensitive, and the clinical opportunities to perform dorsal penile nerve block and corporal aspiration are seldom practiced. Despite knowledge of the importance of prompt recognition and management of priapism, many emergency physicians may not actually perform the recommended procedures to manage it for a variety of reasons.¹ Due to the sensitive nature of the condition, physicians are eager to learn about and practice these intimate maneuvers in the safe setting of simulation; however, there is not a commercial task trainer available.²Some low-fidelity creations have been published as solutions, but they are less realistic and time consuming to make, limiting feasibility and usability.^3-7 One published creation inspired this task trainer, but the main structure is no longer available to be purchased, underscoring the need for a model that can be reproduced and recreated by the educator with flexible starting materials.³ Others are more time-consuming to make and require specific simulation equipment⁴ or may not be easily reused.^{5, 6} Other published low-fidelity creations are less anatomically accurate, limiting the fidelity of practice regarding the most intimate aspects of the procedure.^{7, 8}

Educational Objectives: By the end of this educational session, participants should be able to: 1) identify indications, contraindications, and potential complications of priapism management, 2) gather appropriate supplies and describe relevant landmarks, anatomy, and patient positioning for management of priapism, 3) demonstrate a dorsal penile nerve block, aspiration of corpus cavernosum, and intracavernosal phenylephrine administration to treat priapism, and 4) develop an approach to manage common pitfalls of priapism care.

Educational Methods: We developed a more realistic and replicable priapism task trainer using materials readily accessible in a simulation lab. Emergency medicine faculty and simulation center staff collaborated to create a task trainer constructed from silicone and internal tubing, using the mold of a phallic-shaped candle (see attachment). This model was then used in a 30-minute training session, which included ten minutes of interactive discussion reviewing the steps of dorsal penile block and priapism management with PowerPoint images as a visual aid. Next, learners performed the procedure from start to finish with faculty guidance, followed by an opportunity to ask questions. The training session was open to EM residents, pediatric emergency medicine (PEM) fellows, EM community physicians, and EM academic faculty.

Research Methods: This study was approved as exempt status by the Indiana University Institutional Review Board. Following the educational session, participants completed a voluntary survey evaluating the task trainer’s realism, its usefulness as a teaching tool, and their change in confidence in performing priapism management. 

Results: The mixed group included 14 EM residents, five PEM fellows, four EM community physicians, and four EM academic physicians. Of 27 participants who used the task trainer, the majority (92.6%) of survey respondents agreed or strongly agreed that the task trainer was realistic.  Learners reported increased confidence in knowledge of the procedural steps and increased confidence in potentially performing the procedure in the clinical setting (Table 1). Most participants would recommend the training to a provider of a similar level of training. 

Discussion: Overall, the educational content was effective since learners reported an increase in knowledge of the steps of the procedure in addition to improved confidence to perform the procedure safely and successfully in the clinical environment. While many learners had never performed this procedure before in the clinical setting, the majority would recommend this training to a colleague of the same level of training. While the need for training in this procedure is clear,^1-2 the options for available task trainers have remained limited. There is no commercial priapism task trainer, and published creations have varied strengths and weaknesses in balancing fidelity, cost-effectiveness, reproducibility, and reusability.^3-7 The main takeaway from this training is that a realistic, durable, and low-cost task trainer can be developed to effectively teach how to treat a rare and sensitive procedure.

Topics: Priapism, penile nerve block, dorsal nerve block, urology, aspiration, decompression.

Audience: This rectal foreign body removal model is designed to instruct emergency medicine residents. However, the innovation is appropriate for medical students, advanced practice providers (APPs), attending physicians, and clinicians in other medical specialties.

Introduction: Rectal foreign bodies are relatively uncommon emergency department presentations but are associated with significant morbidity and mortality.¹ These foreign bodies require prompt recognition and skilled management, which can be challenging due to stigma, patient discomfort, and procedural complexity. Learners often have limited opportunities for hands-on experience with rectal foreign body removal, and to our knowledge, no established simulation tool currently exists for training in this procedure. This task trainer was designed as an easily assembled, cost-effective simulation tool to support procedural practice and promote safe, effective performance when applied in the emergency department setting.

Educational Objectives: This task trainer is intended to facilitate hands-on training in rectal foreign body removal. By the end of this training session, learners should be able to: 1) describe the indications and contraindications for rectal foreign body removal in the emergency department, and 2) demonstrate the ability to remove rectal foreign bodies of varying sizes, shapes, and depths of insertion using multiple techniques.

Educational Methods: This innovation consists of a task trainer for the simulated removal of rectal foreign bodies. The tool was constructed using readily available, inexpensive materials to accommodate the removal of foreign bodies of varying sizes and depths, allowing for customizable scenarios of variable difficulty. The session began with a brief didactic overview covering anatomy, tools, procedural steps, and complications of rectal foreign body removal, followed by supervised hands-on practice using the model. Faculty provided individualized feedback to help learners refine their techniques.

Research Methods: A pre- and post-activity survey was administered to participants to assess comfort with rectal foreign body removal and gather feedback on the educational session and task trainer. The pre-activity survey asked learners to report the number of rectal foreign body removals they had performed and to rate their comfort with the procedure on a 7-point Likert scale (1 = totally comfortable, 7 = totally uncomfortable). The post-activity survey included the same comfort scale to allow for comparison, along with additional items evaluating the model and session. Learners rated the model’s realism (1 = extremely realistic, 5 = not at all realistic), the degree to which the session increased their confidence performing the procedure (1 = extremely, 5 = not at all), and the overall usefulness of the model for teaching rectal foreign body removal (1 = extremely useful, 5 = not useful at all). This evaluation approach addressed the reaction and learning levels of the Kirkpatrick model.

Results: Thirty-nine learners completed the pre-activity survey and 37 completed the post-activity survey. Most learners (79%) had never previously performed a rectal foreign body removal. Following the session, learners reported significant improvements in comfort with the procedure. The task trainer received favorable ratings for realism, educational usefulness, and its ability to build confidence in performing the procedure on real patients.

Discussion: This educational session was both effective and well-received. Learners began with limited experience performing rectal foreign body removal, a procedure that may be infrequently encountered but carries significant risk. Providing a structured opportunity for supervised practice in a low-risk environment likely contributed to the observed improvements in reported comfort and confidence.

Beyond numerical gains, this session highlighted an important educational gap: most learners have limited exposure to this procedure that they are likely to encounter in their careers, underscoring the need for accessible methods of training in rare procedures. The favorable feedback regarding realism, confidence, and usefulness suggests that even a simple model can provide meaningful educational value.

The main takeaway is that this rectal foreign body removal task trainer offers a practical, reproducible approach to improving learner preparedness in managing a sensitive and technically challenging procedure in the emergency department setting.

Topics: Rectal foreign bodies, medical simulation, hands-on training, emergency medicine education, rare procedures.

Audience: The gastrostomy-assisted simulated pneumothorax (GASP) model is designed to train residents in emergency medicine, anesthesiology, pulmonology, cardiothoracic surgery, and paediatric surgery in the various techniques used to perform chest drainage (CD).

Introduction: Pneumothorax is a life-threatening emergency, particularly in the case of a tension pneumothorax. Failure to perform timely CD can rapidly result in cardiorespiratory arrest.¹ Needle decompression, chest tube insertion, and finger thoracostomy are the three main CD procedures that healthcare professionals must master. However, these are technically challenging procedures with potentially severe and sometimes fatal complications. The literature reports significant complication rates (19%) and failure rates (18-21%).^2,3

Synthetic simulators for CD are commonly used in simulation centres due to their availability. While they are useful in the early stages of training to teach the fundamental steps of the procedure, they lack realism, are expensive, and do not provide the tactile feedback essential for safe and effective performance. The GASP model was developed to provide a realistic, easily reproducible, and accessible pneumothorax simulation tool aimed at improving CD training for medical trainees.

Educational Objectives: By the end of this educational session using the GASP model, learners should be able to: 1) identify the two main thoracic anatomical landmarks commonly used in clinical practice for CD: the second intercostal space at the midclavicular line, and the fifth intercostal space at the midaxillary line, 2) become familiar with the tactile sensation of palpating the superior border of the rib, a key landmark for directing the chest tube safely and with the correct angulation, 3) mastering the three main techniques of CD: needle decompression, chest tube insertion, and finger thoracostomy, and 4) demonstrate proficiency while performing the procedure within a complex simulation scenario.

Educational Methods: The GASP model utilises fresh cadavers prepared with an insufflation device and a gastrostomy button to simulate pneumothorax or haemopneumothorax. Manual or automated ventilation may be added to enhance realism. This model can be used to teach residents how to perform the three main CD procedures effectively and safely. Each learner can perform multiple repetitions on each cadaver.

Research Methods: At the Institute of Anatomy and Surgical Simulation (IASC) in Toulouse, France, 10 fresh cadavers preserved by refrigeration were used for this study. Each donor had provided informed and written consent during their lifetime for the use of their body in experimental research. Demographic data related to the cadavers, such as age, sex, and body mass index, were collected. 

The GASP model was tested on 20 hemithoraces from the 10 cadavers. The presence and quality of the pneumothorax were assessed via ultrasound by an experienced radiologist. The two main CD approaches commonly used in clinical practice (axillary and anterior) were tested, along with several CD techniques: needle decompression, direct insertion using a Pleurocath^® drain and Monod trocar, the Seldinger technique with a Fuhrman-Cook drain, and finger thoracostomy. 

The GASP model was subsequently introduced to first-year residents in anesthesiology, emergency medicine, and pulmonology. Participants used Likert scales to evaluate the model’s realism, its transferability to clinical practice, and its overall educational value. Additionally, the study assessed learners' perceived self-efficacy and the level of discomfort associated with performing simulations on cadaveric specimens.

Results: In all 20 hemithoraces (10 right and 10 left), a large pneumothorax was confirmed by ultrasound. All major CD techniques were successfully performed, using a variety of drainage devices appropriate to different clinical scenarios. The model provided a realistic simulation of the procedure, offering the same tactile sensation as on a live patient. It enabled repeated CD in each hemithorax (exceeding 40 procedures per side) without compromising the structural integrity of the model.

Eight first-year residents (from anesthesiology, emergency medicine, and pulmonology) were enrolled in the first CD course on cadaver-based training at our faculty, using the GASP model. Pre- and post-training assessments based on 10-point questionnaires demonstrated significant improvements in baseline confidence in technical skills, stress management, and overall performance. The GASP model was also evaluated by participants using a 5-point Likert scale, revealing high levels of realism, strong transferability to patient care, and increased perceived self-efficacy among learners. Finally, the cadaveric model was associated with minimal discomfort for participants.

Discussion: The GASP model is realistic, easy to implement, reproducible, low-cost, and reusable multiple times. It serves as a valuable tool for enhancing skill acquisition among a wide range of healthcare professionals who need to master this procedure, providing a level of tactile realism that is often lacking in synthetic models. Its successful integration within our medical simulation centre supports the development of additional cadaveric simulation models for other emergency procedures.

Ovarian hyperstimulation syndrome (OHSS) is a rare but potentially life-threatening complication of assisted reproductive technology (ART). Prompt recognition and management are essential to reduce morbidity. This case describes a 30-year-old woman undergoing ART who presented to the emergency department (ED) with abdominal pain, distention, lightheadedness, nausea, vomiting, and shortness of breath following transvaginal oocyte retrieval. Physical examination revealed a tense, diffusely tender abdomen, and point-of-care ultrasound (POCUS) demonstrated enlarged ovaries bilaterally with multiple follicles and moderate peritoneal free fluid, confirming the diagnosis of OHSS. Laboratory findings included leukocytosis, hemoconcentration, and hypoproteinemia. The patient received supportive care with intravenous fluids and analgesia and, during admission, underwent therapeutic paracentesis, resulting in the removal of roughly three liters of ascitic fluid. Her symptoms resolved, and she was discharged on hospital day three with complete recovery noted at follow-up. This case highlights the diagnostic value of POCUS in the emergency setting for early identification of OHSS. As the use of ART increases, emergency clinicians should be aware of OHSS presentations and consider bedside ultrasound as a key diagnostic tool to expedite care and improve outcomes.

Anti-amyloid beta (Aß) immunotherapies are an emerging treatment for Alzheimer’s disease (AD) with a rare but significant risk of amyloid-related imaging abnormalities (ARIA). This visual case report describes a patient with lecanemab-induced ARIA to familiarize emergency providers with this critical adverse effect of novel anti-amyloid therapies. 

An 85-year-old female receiving lecanemab infusions presented to the emergency department (ED) with abruptly worsening confusion, an unsteady gait, and new left-sided deficits, including homonymous hemianopia and hemineglect. A non-contrast head computed tomography (CT) revealed extensive right parieto-occipital vasogenic edema, prompting magnetic resonance imaging (MRI), which confirmed extensive ARIA with edema (ARIA-E) on fluid-attenuated inversion recovery (FLAIR) sequences and microhemorrhages (ARIA-H) on T2-weighted sequences. Lecanemab was discontinued, and the patient experienced partial neurologic recovery after a four-day admission. However, she was discharged with persistent functional limitations, including an inability to drive and a need for caregiver assistance. 

This case underscores the need for emergency physicians to maintain a high index of suspicion for ARIA in patients on anti-Aß immunotherapies who present with new neurologic symptoms. Definitive diagnosis requires MRI, and management warrants prompt neurologic consultation.

Uterine leiomyomas, or fibroids, are the most prevalent benign tumor pathology affecting women.1 Fibroids are reportedly found in nearly 70% of Caucasian women and more than 80% of women with African ancestry.1 Rarely, fibroids progress to uterine intravenous leiomyomas (IVL), a neoplastic growth pattern characterized by intravascular proliferation of this smooth muscle cell tumor.2 This tumor is typically confined to the pelvic vasculature but can occasionally spread with venous blood flowing to the heart, ultimately penetrating the inferior vena cava, right heart chambers, and pulmonary arteries.3 If the tumor reaches the heart, this intracardiac leiomyomatosis (ICL) can result in severe cardiac symptoms including arrythmias, murmurs, and sudden death.3,4 The case presentation shows both IVL and ICL in a patient.

Approximately 12 months following hysterectomy due to fibroids, the patient presented with mild dyspnea on exertion, retrosternal chest pain, and a syncopal episode. She was diagnosed with saddle embolism with extension into right ventricle and complete occlusion of the inferior vena cava (IVC). Informed by imaging from echocardiogram, computed tomography (CT) angiogram of the chest, CT of the abdomen and pelvis with contrast and magnetic resonance imaging (MRI) of the abdomen and pelvis, providers proceeded with mechanical thrombectomy followed by IVC filter, tumor debulking surgery, resection of a pelvic mass, and proximal vaginectomy. To facilitate early detection and treatment, providers should factor the risk of IVL and ICL into ongoing care and patient education post hysterectomy or fibroid diagnosis.

Airway compromise and impending collapse should be considered in all patients presenting with a neck mass. This patient presented to the emergency department (ED) two weeks prior with concerns for rapid growth of a neck mass; after being sent home with an outpatient referral to specialty services, she re-presented when she developed progressive dyspnea and stridor. Imaging was concerning for anaplastic thyroid carcinoma that had grown over two centimeters (cm) in the past 15 days from 10.1 cm to 12.2 cm with new tracheal deviation and adjacent thrombus compression of the internal jugular vein and superior vena cava. Emergency medicine physicians should be cautious when discharging a patient with a neck mass. Outpatient referral should be considered only when the stability of the size of the mass can be reliably confirmed and close outpatient follow-up is guaranteed. Without these stipulations, ED physicians should advocate for admission of these patients so that specialty teams, such as otolaryngology, interventional radiology, and hematology/oncology, can begin management before airway compromise poses a significant threat to the life of the patient.

Point-of-care ultrasound (POCUS) is used frequently in the emergency department (ED) as a non-invasive diagnostic tool. Ocular POCUS is utilized in patients with vision changes to detect pathologies including retinal detachment, vitreous hemorrhage and central retinal artery occlusion. This case demonstrates the capability of POCUS to detect choroidal hemangiomas, a pathology strongly associated with Sturge-Weber syndrome (SWS). A 31-year-old male with no significant medical history presented with two years of progressive vision changes and headaches. A large right-sided facial birthmark was noted, though the patient had no prior diagnosis. Examination revealed right eye blindness and an afferent pupillary defect. Ocular POCUS revealed retinal detachment and choroidal thickening, which were interpreted as choroidal hemangiomas. Findings were corroborated by MRI. Together with input from our ophthalmology and neurology specialists, a diagnosis of SWS was made. This case demonstrates the utility of POCUS in the rapid identification of choroidal hemangiomas in an adult patient, facilitating an expedited diagnosis of SWS. Because there is no cure for SWS, early diagnosis and management by a multidisciplinary team, including ophthalmology and neurology, is essential to limit the progression of the disease and mitigate its effects.

Infectious flexor tenosynovitis (IFT) of the lower extremity is rare but serious, requiring early recognition and aggressive management to prevent severe morbidity. Often associated with penetrating trauma or hematogenous spread, IFT can lead to devastating complications if not promptly identified and treated.

A 57-year-old female with cirrhosis, diabetes mellitus, and hypertension presented to the emergency department with progressive right ankle pain, swelling, and systemic symptoms. Despite prior emergency visits, her condition worsened. Imaging revealed infectious tenosynovitis involving the flexor hallucis longus and flexor digitorum longus tendons, with concerning signs of soft tissue necrosis. She received broad-spectrum antibiotics and underwent emergent surgery, ultimately requiring a below-the-knee amputation due to extensive necrosis. Blood cultures confirmed group B Streptococcus as the pathogen. Her postoperative course was complicated by hepatic encephalopathy and hematochezia, necessitating multidisciplinary care.

This case highlights the importance of early recognition of IFT, particularly in immunocompromised patients, and the role of imaging in diagnosing deep soft tissue infections. Delayed diagnosis can lead to severe outcomes, emphasizing the need for heightened clinical suspicion and timely intervention. Increased awareness and prompt management of IFT are crucial for improving patient outcomes and limb preservation.

The incidence of syncope in the setting of ruptured ectopic pregnancy can vary widely; however, data specifically focusing on syncope as the primary presenting symptom without accompanying abdominal pain or vaginal bleeding are scarce.^1,2 Our 23-year-old female patient, who is post-liver transplant and currently on immunosuppressive therapy, experienced syncope without significant pain or bleeding and presented to the ED with stable vital signs. Initial investigations revealed mild left lower quadrant tenderness, a serum beta-hCG of 95 mIU/mL, and moderate free pelvic fluid with a 28 mm left ovarian “cyst” on transvaginal ultrasound. These findings raised concerns for a ruptured ectopic pregnancy. Diagnostic laparoscopy, however, ultimately revealed a ruptured ovarian hemorrhagic cyst. Subsequent negative urine beta-hCG tests confirmed the initial serum beta-hCG as a false positive likely due to heterophile antibody interference, which is common in immunosuppressed patients. This case represents a rare mimic of a ruptured ectopic pregnancy which can occur in post-transplant patients and a nuanced interpretation of clinical workup.

Abdominal pain is one of the most common presenting complaints in emergency medicine. This case report summarizes a 61-year-old male with worsening abdominal pain and no bowel movement for multiple days. Computer tomography (CT) scan demonstrated a large intraluminal mass at the anastomosis, concerning for a bezoar formation, with associated stercoral colitis and partial bowel obstruction. The patient was subsequently admitted to the general surgery service for further management. During hospitalization, the patient’s stool burden improved with osmotic laxatives, and he underwent a colonoscopy. The patient was discharged with outpatient follow-up. This report will help inform management in a patient with a history of colon cancer presenting with a large bowel obstruction post-colectomy.

Treating foreign body ingestion in the emergency department (ED) is common; however, certain ingestions may be immediately life-threatening, depending on the object because sharp objects pose the greatest risk for gastrointestinal injury, including perforation and obstruction.1 This is a case of an adult male who arrived at the ED with suicidal ideation and reported ingesting a pencil two days prior. He presented with abdominal pain and hematochezia. A computed tomography (CT) scan of the abdomen and pelvis identified the pencil in the distal ileum. The patient was admitted for surgical evaluation and monitoring. Remarkably, the pencil was passed spontaneously in the stool on hospital day six without signs of colonic perforation. This case illustrates how selected cases of high-risk foreign body ingestion may be managed conservatively, though close monitoring is critical given the risks of perforation, obstruction, or failure of progression.

Synchronized cardioversion is a standard treatment for unstable ventricular tachycardia. While modern defibrillators are designed with safety mechanisms, synchronization failure can result in catastrophic complications. We present the case of a 65-year-old woman with unstable wide-complex tachycardia with a pulse who underwent emergent synchronized cardioversion. Despite activation of the “sync” mode, the device failed to capture appropriately and delivered a shock on the T-wave, precipitating ventricular fibrillation and cardiac arrest. After 26 minutes of resuscitation and multiple defibrillations, return of spontaneous circulation (ROSC) was achieved. The patient ultimately recovered and was discharged home in stable condition. This case underscores the rare but serious risk of synchronization failure, particularly in obese patients where pad placement and capture may be impaired,¹ and emphasizes the importance of visually confirming synchronization prior to shock delivery.