Bradley Peckler

ACE Inhibitor-Induced Angioedema of the Bowel.

Angiotensin converting enzyme inhibitor ACEI-induced angioedema of the intestine is a rare occurrence and often unrecognized complication of ACEI. We present a case of a 45-year-old Hispanic female with angioedema of the small bowel progressing to facial and oral pharyngeal angioedema. Patients are typically middle-aged females on ACEI therapy who present to the emergency department with abdominal pain, nausea, vomiting, and diarrhea. This is a diagnosis of exclusion, and physicians must have a high index of suspicion to make the diagnosis. Symptoms typically resolve within 24–48 hours after ACE inhibitor withdrawal. Recognizing these signs and symptoms, and discontinuing the medication, can save a patient from unnecessary, costly, and invasive procedures.

Teamwork in the trauma room evaluation of a multimodal team training program.

Introduction: Poor teamwork leads to preventable medical errors, and thus negatively impacts medical care. One way to improve teamwork is training. A multimodality team training program was designed to impact the attitudes and behavior of first-year residents who will encounter medical situations in the trauma room. The training program included low-fidelity role plays, lectures, and high-fidelity simulation with feedback. Materials and Methods: The training program was a one-day workshop that was conducted twice, once for each of the two groups over two days at the beginning of the academic year in July. A total of 41 first-year interns (10 Emergency Medicine and 31 Surgery) were recruited for participation. Participants completed a Situational judgment test (SJT) on trauma teamwork before training. The training began with a low-fidelity simulation that served as an icebreaker to team concepts. Subsequently, a lecture with discussion provided key points regarding teamwork in the trauma room. A high-fidelity simulation then allowed participation in one of four trauma room scenarios with medical expert debriefing. The course concluded with a course summary and an assessment of participant attitudes regarding training along with a second administration of SJT. Results: Participant reactions to the training were positive overall. Results of SJT showed a positive effect for team training in three of the four possible comparisons. Conclusion: The program was well received by the residents. Results suggest that a comprehensive training approach using role play, lecture, and simulation can positively affect behavioral choices for teamwork in the trauma room.

An unusual presentation of Bell's palsy: A case report and review of literature.

In clinical medicine there may be times when clinical conditions manifest differently both when they present individually or concomitantly. Such scenarios warrant a broader differential diagnosis with thorough investigations. We present one such case of a patient of Bells palsy with unexplained eye pain on the ipsilateral side. The patient had a chronic retinal detachment which became worse due to the concomitant Bells palsy.