USF Maintains a Strong Presence at the 2020 Symposium by the Sea Conference
USF Emergency Medicine recently attended Symposium by the Sea (SBS), the annual emergency medicine conference sponsored by Florida College of Emergency Physicians. Here are some highlights from our work featured at SBS!
Original Research
ACEP recommends that Emergency Medicine residents complete 25 transvaginal ultrasounds during their residency. Is that really enough? Dr. John Elkes, PGY 3, and his research team don’t think so.
What is the level of proficiency after performing 25 transvaginal ultrasound examinations?
Johnathon Elkes, MD, Charlotte Derr, MD, RDMS, FACEP, Alan Shteyman, Yuanyuan Lu, Ashley Grant, Saundra Jackson, Tabitha Campbell
In summary, this prospective study found that residents were able to successfully identify the bladder, uterus, and determine directionality but only agreed with experts 76% of the time when it came to identifying the ovaries suggesting that residents should obtain greater than 25 TVUS during their training. Surprisingly though, even beyond 25 exams there was no improvement in proficiency. Additional studies are needed to investigate the performance curve for ovary identification and what educational strategies are most effective. See their research poster below.
Case Reports
Two of our fantastic medical students, Christian Scheutz, MS4, and Rachael Chaska, MS3, worked with a team of residents to share two interesting case reports, both featuring Epsilon waves. Watch their presentations and learn more about the Epsilon wave, an ecg finding commonly associated with arrhythmogenic cardiomyopathy. Emergency physicians must recognize the epsilon wave in patients presenting with syncope or cardiac arrest because this ecg abnormality is associated with conditions that predispose patients to potentially life threatening arrythmias.
Interesting Case Presentation
Drs. Marti Gaccione and Adam Koby, two of our PGY3s participated in the case presentation competition. This is an event where one team presents a clinical case and another team determines the diagnostic work up and diagnosis to solve the case. Dr. Gaccione will be sharing his case with our EMSIG group at an upcoming event so we’re going to keep that case a secret for a few more weeks. Dr. Koby solved the case. See if you would have done as well!
The Case Dr. Koby Solved!
HPI:
● 48 male w/ hx of Afib and RHD s/p MV replacement on LMWH
● Presents w/ 2 days gradually worsening, atraumatic, non-radiating L hip, back, and inguinal pain that began spontaneously upon awakening
● Associated w/ LLE weakness and inability to ambulate
Read More Below
Pertinent Exam:
● Afebrile and hemodynamically normal
● Irregularly irregular rhythm
● Abd – TTP left inguinal region, but non-tender abd and normal GU exam.
● MSK – L lower back TTP. Pain w/ ROM of L hip. Distal pulses intact.
● Skin – no bruising or lesions noted
● Neuro – Sensation in LLE intact. Motor – Hip flexors/extensors 3/5 strength. Patellar reflex +1. No Babinski
Labs & Imaging:
What diagnostic test would you order?
CTA! This may reveal a bleeding vessel!
Diagnosis: Spontaneous retroperitoneal hematoma, a known complication of lovenox therapy, causing a lumbosacral plexopathy!
Key points: Spontaneous retroperitoneal bleeds are a rare complication that occurs most commonly in patients on anticoagulation. Retroperitoneal bleeds can cause physical exam findings such as Grey-Turner and Cullen signs. In this case, the patient had no skin findings but did have decreased patellar reflexes and a specific distribution of pain which helped localize the etiology of the patient’s symptoms.
Dr. Adam Koby Nailed It! Take that SBS!
Dr. Marti Gaccione presenting at the CPC competition. He will share his case with our Emergency Medicine Student Interest Group on September 16th, 2020.
Lectures
Dr. Jason Wilson, our Associate Medical Director and Research Director, gave a great talk entitled, Socially Situating Covid-19. During this lecture he discusses the current state of Covid-19 in Florida, the challenges our community faces including racial disparities, mask wearing, going back to school, and physician burnout. His talk concludes with reimaging emergency medicine in the time of Covid-19.