Emergency department management of pediatric blunt thoracic injuries.

Pediatric chest trauma can present with a wide array of symptoms and with varying rates of morbidity and mortality. Children have unique thoracic anatomical and physiological characteristics, often necessitating diagnostic and management considerations that differ from management of blunt chest injury in adults. This review discusses diagnostic and treatment modalities for commonly encountered injuries in pediatric blunt thoracic trauma, such as pulmonary contusions, rib fractures, pneumothoraces, and hemothoraces. Rarely encountered but high-mortality injuries, including blunt cardiac injury, commotio cordis, tracheobronchial injury, and aortic injury, are also discussed.

The Reemerging Condition of Vaccinia: A Case Report and Brief Review of Monkeypox and Vaccinia Vaccines.

BACKGROUND The emergence of the monkeypox virus (mpox) is causing a large-scale re-administration of vaccinia-based vaccines. Many physicians have not been exposed to the rare, but implicit, complications, revealing a glaring need for updated evidence and re-examination. We present a case of a Human Immunodeficiency Virus (HIV)-positive male patient who presented to the Emergency Department (ED) with vaccinia symptoms several days after receiving the JYNNEOS vaccine. CASE REPORT A 45-year-old man with a past medical history of well-controlled HIV presented to the ED for 5 days of nocturnal diaphoresis, chills, intermittent arthralgia, and myalgia that began shortly after receiving the JYNNEOS vaccine. The patient reported an intermittent fever of 101°F (38.3°C) but denied cough, chest pain, and dyspnea, and had otherwise normal vital signs. Serum lab test results were significant for elevated leukocytosis of 13.4 and CRP of 7.0, but were otherwise normal. The patient reported complete resolution of his symptoms after a 14-day follow-up via phone call. CONCLUSIONS Mpox is unfortunately spreading across the globe; therefore, many treatments and vaccines are being studied to address the outbreak. The latest generation of vaccines employ an attenuated vaccinia virus and are separated into replicating and non-replicating categories, and while generally safer than previous variola vaccines, they still are associated with rare complications and adverse effects. Generally, vaccinia symptoms are mild and self-resolving. Treatment is largely supportive and most patients can be discharged following general serum lab work-up and cardiopulmonary assessment.

Acute Spontaneous Colonic Perforation in a Case of Newly Confirmed Scleroderma: Case Report.

Scleroderma is a group of autoimmune diseases that principally affects the skin, blood vessels, muscles, and viscera. One of the more well-known subgroups of scleroderma is the limited cutaneous form of the multisystem connective tissue disorder known as CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasis) syndrome. In this report, we present a case of a spontaneous colonic bowel perforation in a patient with incomplete features of CREST. Our patient underwent a complicated hospital course involving broad-spectrum antibiotic coverage, surgical hemicolectomy, and immunosuppressives. She was eventually discharged home with a return to functional baseline status after esophageal dysmotility confirmation via manometry. Physicians managing patients with scleroderma ensuing to an emergency department encounter must anticipate the multitude of complications that can occur, as was seen in our patient. The threshold for pursuing imaging and additional tests, in addition to admission, should be relatively low, given the extremely high rates of complications and mortality. Early multidisciplinary involvement with infectious disease, rheumatology, surgery, and other respective specialties is crucial for patient outcome optimization.

Evaluating Family Medicine Resident Narrative Comments Using the RIME Scheme.

Background: In 2013, the Accreditation Council on Graduate Medical Education (ACGME) launched the Next Accreditation System, which required explicit documentation of trainee competence in six domains. To document narrative comments, the University of North Carolina Family Medicine Residency Program developed a mobile application to document real time observations. Objective: The objective of this work was to assess if the Reporter, Interpreter, Manager, Expert (RIME) framework could be applied to the narrative comments in order to convey a degree of competency. Methods: From August to December 2020, 7 individuals analyzed narrative comments of four family medicine residents. The narrative comments were collected from July to December 2019. Each individual applied the RIME framework to the comments and the team met to discuss. Comments where 5/7 individuals agreed were not further discussed. All other comments were discussed until consensus was achieved. Results: 102 unique comments were assessed. Of those comments, 25 (25.5%) met threshold for assessor agreement after independent review. Group discussion about discrepancies led to consensus about the appropriate classification for 92 (90.2%). General comments on performance were difficult to fit into the RIME framework. Conclusions: Application of the RIME framework to narrative comments may add insight into trainee progress. Further faculty development is needed to ensure comments have discrete elements needed to apply the RIME framework and contribute to overall evaluation of competence.