Unstable Atrial Fib

This case was written by Drs. Pittman and Bridges, emergency physicians at Prisma Health-Upstate in Greenville, SC.  They both teach in the University of South Carolina School of Medicine-Greenville and in the emergency medicine residency program.   Dr. Pittman is the residency Director of Academic Success, completed residency at the Georgetown / Washington Hospital Center Emergency … Continue reading Unstable Atrial Fib

Virtual Resus Room

Physical distancing restrictions during the COVID-19 pandemic have dramatically impacted medical education, challenging educators around the world to create interesting, novel ways to engage learners remotely. Virtual alternatives to in-person simulation sessions have been of particular interest. From discussion with other educators, it seems like many programs have shifted to a model of sim that involves talking through challenging cases. This strategy is excellent for medical content review but misses the hands-on, interactive, nervous energy of simulation that makes it so valuable. This is why we set out to create the Virtual Resus Room.

Inhalational Injury

A 70-year old female is brought to the ED after lighting herself on fire while trying to light a cigarette. She will have a 15% TBSA burn (upper anterior chest and neck only) with inhalational injury. Preparation for intubation should be an early priority. Her prognosis is poor but survivable and it will be key to discuss goals of care with the family before proceeding with intubation and further burn care. A difficult intubation should be anticipated but is not encountered in this case.

PEA Arrest and Breaking Bad News

A 70 year old man who had an unwitnessed cardiac arrest is brought to the ED via EMS from his local Tennis Club. Despite multiple rounds of appropriate resuscitative measures, the patient does not gain return of spontaneous circulation (ROSC). Learners will need to discuss the termination of resuscitation with team members and communicate with the patient’s wife.

COVID-19: Out-of-Hospital Cardiac Arrest

The patient is found by a friend unresponsive after a 7 day history of cough and shortness of breath. He immediately receives bystander CPR. An advanced care paramedic crew attends the scene and manages a ventricular fibrillation arrest prior to transporting to hospital. The patient goes into cardiac arrest again shortly before arriving in the emergency department. The team will need to prepare for the patient's arrival and then manage a cardiac arrest using appropriate precautions for suspected COVID-19.

COVID-19: STEMI with VF Arrest

This 50-year old woman presents with typical cardiac chest pain and high suspicion for COVID-19. Her ECG shows an anterior STEMI. The team will start performing the initial work-up and management of a patient with STEMI. While this is occurring, the patient suffers a VF arrest. The team will need to go through the ACLS algorithm while taking all precautions required in caring for a patient with suspected COVID.