Pulmonary Embolism Presenting as ST-Elevation Myocardial Infarction: A Report of Two Cases.

Pulmonary embolism (PE) is often underrecognized due to its ability to mimic other conditions; however, ultrasound can provide diagnostic clues to aid in the diagnosis of PE. We describe two patients who presented with symptoms suggestive of cardiac ischemia and had electrocardiograms (EKGs) indicative of anteroseptal myocardial infarction. In both cases, cardiac point-of-care ultrasonography showed signs of large pulmonary emboli, which were then confirmed on computed tomography angiography of the chest. Both patients underwent successful aspiration thrombectomy with rapid resolution of cardiac dysfunction. Point-of-care ultrasonography should be used as an adjunct in patients presenting with anterior ischemia on EKG to evaluate for signs of PE.

Infective Endocarditis Presenting With Non-ST Elevation Myocardial Infarction: A Case Report.

Infectious endocarditis (IE) is a rare disease characterized by infection of the endocardial surface of the heart. IE predominately involves the left-sided valves; however, right-sided valvular IE has increased in incidence with intravenous drug use. Treatment of IE is centered on targeted antibiotic therapy and management of complications, including septic embolization, which can affect all of the major arterial beds. Acute coronary syndrome secondary to septic embolization can be difficult to identify and carries an increased risk of morbidity and mortality. Care is further complicated by a lack of formal guidelines from any organization to inform management. We present a case of Staphylococcus hominis endocarditis complicated by coronary artery embolization and non-ST elevation myocardial infarction at the time of presentation to the emergency department, followed by a discussion of available treatment modalities.

Emergency department management of methamphetamine toxicity.

Management of patients who are acutely intoxicated with methamphetamine (a member of the substituted amphetamine class of drugs) can be resource-intensive for most emergency departments. Clinical presentations of the methamphetamine sympathomimetic toxidrome range from mild agitation to rhabdomyolysis, acute kidney injury, seizures, and intracranial hemorrhage. High-quality evidence on how to best manage these patients is lacking, and most research focuses on symptomatic interventions to control patients' agitation and hemodynamics. This review analyzes the best available evidence on the diagnosis and management of emergency department patients with substituted amphetamine toxicity and offers best-practice recommendations on treatment and disposition.

Feasibility of a Multifaceted Social Emergency Medicine Curriculum for Emergency Medicine Residents.

INTRODUCTION: Emergency physicians are in a unique position to impact both individual and population health needs. Despite this, emergency medicine (EM) residency training lacks formalized education n the social determinants of health (SDoH) and integration of patient social risk and need, which are core components of social EM (SEM). The need for such a SEM-based residency curriculum has been previously recognized; however, there is a gap in the literature related to demonstration and feasibility. In this study we sought to address this need by implementing and evaluating a replicable, multifaceted introductory SEM curriculum for EM residents. This curriculum is designed to increase general awareness related to SEM and to increase ability to identify and intervene upon SDoH in clinical practice. METHODS: A taskforce of EM clinician-educators with expertise in SEM developed a 4.5-hour educational curriculum for use during a single, half-day didactic session for EM residents. The curriculum consisted of asynchronous learning via a podcast, four SEM subtopic lecture didactics, guest speakers from the emergency department (ED) social work team and a community outreach partner, and a poverty simulation with interdisciplinary debrief. We obtained pre- and post- intervention surveys. RESULTS: A total of 35 residents and faculty attended the conference day, with 18 participants completing the immediate post-conference survey and 10 participants completing the two-month delayed, post-conference survey. Post-survey results demonstrated improved awareness of SEM concepts and increased confidence in participants' knowledge of community resources and ability to connect patients to these resources following the curricular intervention (25% pre-conference to 83% post-conference). In addition, post-survey assessment demonstrated significantly heightened awareness and clinical consideration of SDoH among participants (31% pre-conference to 78% post-conference) and increased comfort in identifying social risk in the ED (75% pre-conference to 94% post-conference). Overall, all components of the curriculum were evaluated as meaningful and specifically beneficial for EM training. The ED care coordination, poverty simulation, and the subtopic lectures were rated most meaningful. CONCLUSION: This pilot curricular integration study demonstrates feasibility and the perceived participant value of incorporating a social EM curriculum into EM residency training.