Board Review: Debunking Dysbarism

This post was peer reviewed. Click to learn more.

Image credit: Brett Seymour

Authors: Patrick Wallace, DO PGY-2

Emergency Medicine Resident

University of Nevada Las Vegas

AAEM/RSA Education Committee

Laurie Bezjian Wallace, DO PGY-2

Family Medicine Resident

Mike O’Callaghan Military Medical Center

Intro
“Dysbarism” collectively refers to diving-related disorders. These disorders are relatively common and range in severity. This topic is high yield on board exams and is also important for emergency medicine providers to recognize so as to administer timely interventions. This article differentiates and categorizes disorders by those occurring with descent, at depth, and with ascent (Table 1).


DISORDERS OF DESCENT
Facial Barotrauma (Mask Squeeze)
Negative pressure within the mask and over the eyes must be equalized. This is often done by exhaling through the nose. Failure to equalize leads to a negative pressure effect on the periorbital and ocular vessels, resulting in edema and subconjunctival hemorrhage.[1,2] Emergent complications are rare but may include hyphema, subperiosteal orbital hemorrhage, and intraorbital hematoma. In these cases, emergent ophthalmology consultation should be obtained as surgery or needle aspiration may be required.[3,4] However, the majority of facial barotrauma cases are benign and do not require treatment.[1,3,4]
Key Phrases: Conjunctival edema, subconjunctival hemorrhage, and petechial hemorrhage after diving.

Case Report: Detecting an Occult Open Globe Laceration with Pneumotonometry

This post was peer reviewed. Click to learn more.

Image credit: Wikimedia Commons

Author: Conner Murphy, MSIV
Medical Student
Uniformed Services University School of Medicine

Additional Authors:
Ivan Yue, MSIV
Medical Student
Uniformed Services University School of Medicine
AAEM/RSA Publications and Social Media Committee

Melisa Walsh, MSIII
Medical Student
Uniformed Services University School of Medicine


David Supinski, DSc EMPA-C
Emergency Medicine PA
Fort Belvoir Community Hospital Emergency Department

Grigory Charny, MD MS FAAEM
Assistant Professor
Department of Military and Emergency Medicine, Uniformed Services University School of Medicine

Introduction
An open globe laceration is defined as a full-thickness penetration of the eye by a sharp object.[1] Observational studies suggest that male patients ages 10-19 are at highest risk for this type of injury due to types of sports they participate in, occupations, and involvement in physical altercations.[2,3] Obvious signs of trauma are not always apparent, and a negative Seidel’s test does not rule out an occult intraocular foreign body as the wound may temporarily seal itself if small enough.[4] Decreased visual acuity, chemosis, hypotony, and pain are often the only clues that the patient has an open globe injury.[5] Early diagnosis and evaluation by an ophthalmologist are crucial to preserving vision.[6] In this case report we present an atypical case of a 24-year-old male patient with penetrating eye trauma to his right eye that was not apparent on physical exam or computed tomography.

How to Approach Third Year (M3) as an EM-bound Medical Student

Image credit: Wikimedia

Author: Taylor Petrusevski, MS4
Loyola Stritch School of Medicine
AAEM/RSA Publications & Social Media Committee

You made it through the seemingly endless lectures and question blocks that consume the pre-clinical years of medical school. In third year, it’s time to bring your classroom knowledge to the bedside. It is an exciting and overwhelming transition, but it is such a transformative year and a pivotal point in your training. You are building the foundation of your clinical skills and the formulation of your practice patterns start now. Among many variables, including Standard Letters of Evaluation (SLOEs), performance on the emergency medicine (EM) clerkship, interviews, and Step scores, third year clerkship performance continues to be an important parameter that program directors use when evaluating candidates.[1] While some studies note that your third year clerkship grades do not carry as much statistical weight as these aforementioned application components, your third year clerkships serve as the foundation of clinical skills that will allow you to succeed on your EM rotations, which is heavily weighted.[2] There are several methods to successfully navigate this transition. Different learning models emphasize the best cognitive practices to bridge this transition, noting that active reflection is just as important as preparing and actually getting the clinical experience.[3] Ultimately, do what works for you. Here are some suggestions on how to approach M3 as an emergency medicine (EM) bound student:

Ketamine for Acute Pain Relief in the Emergency Department

Image credit: Flickr

Author: Kasha Bornstein, MSc EMT-P MSIII
University of Miami Miller School of Medicine MD/MPH Program, AAEM/RSA Modern Resident Blog Copy Editor

Bottom Line Up Front:
In comparison to 0.1mg/kg intravenous morphine, multiple studies demonstrated 0.3-0.5mg/kg ketamine was as effective in short term management of acute pain, without any increased risk of severe adverse effects. In addition to primary analgesia, ketamine may be effective as an analgesic adjunct in situations where opioids are contraindicated or for patients who have pain refractory to conventional pharmacologic approaches.

Introduction:
In the setting of the contemporary opioid epidemic, use of opioids for pain relief in the emergency department (ED) has been scrutinized. Opioid prescription presents increased risk for development of opioid use disorder and presents challenges for attainment of adequate pain control in opioid tolerant patients. Alternatives to opioids are an important topic of discussion in emergency medicine as well as in pain management subspecialties. Many institutions are adopting ketamine for analgesic use based on observational data and/or provider choice, but until recently, the high-quality evidence validating ketamine using randomized controlled trials (RCTs) has been limited. This article details a meta-analysis of RCTs comparing low-dose ketamine (LDK) to morphine for analgesia.

Top 10 Most Read Posts of 2019

Image Source: Pexels

As 2019 comes to an end, we look forward to recognizing the year’s top 10 articles! Join me in congratulating this amazing group of authors at all levels of training and from across the USA!

Additionally, I would like to thank each of the AAEM/RSA Modern Resident Blog authors, reviewers, mentors, and editorial staff members for their tireless contributions to the blog. Without all of them, the blog would not be what it is today. Thanks for a successful 2019!

We are currently accepting articles for 2020 and are always looking for additional faculty mentors as well. Feel free to contact us at info@aaemrsa.org with questions.

Sincerely,

Alex Gregory, MD
Editor-in-Chief
AAEM/RSA Modern Resident Blog