A 67yr old male with multiple comorbidities is brought by ambulance with a 3-day history of diffuse abdominal pain. The history is vague and the differential of his symptoms remains very broad. He develops significantly worsening pain and hypotension and becomes obtunded. As the patient’s condition deteriorates, the team must initiate management of abdominal pain plus shock and support the hemodynamics with vasopressors/inotropes. The team will need to intubate to facilitate advanced imaging and definitive care.
NIGHTMARES CASE 9: STEMI
We are returning to a case series that we published two years ago! This is the ninth case in a series we are publishing that make up “The Nightmares Course” - a Sim Bootcamp for new residents. It’s 5:00 am and you’ve been called to see a patient complaining of “chest discomfort”.
Airway Obstruction from FB
This case involves a 60-year-old male patient who arrives VSA in PEA after collapsing while eating dinner with family. The collateral history included that he was suspected to be intoxicated. The patient is difficult to bag with EMS. The learner will have to work through the can’t ventilate/can’t oxygenate scenario once they identify that BVM is ineffective.
Pediatric Traumatic Brain Injury
An 18-month old previously well child presents to the emergency department of a community hospital with a head injury following an unwitnessed fall from significant height on a play structure with initial loss of consciousness. He is awake but irritable in the trauma bay, with obvious head injury.
Armed Overdose
In this case a 44 y/o M is brought in via EMS after receiving 0.4mg of naloxone for what is suspected to be an opioid overdose. He remains GCS 7 upon arrival in the resuscitation bay. The team will need to work through the differential for altered LoC and will find drug paraphernalia and a loaded weapon on the patient upon inspection. The case will end with successful treatment and consultation with local police with regard to weapon and contraband protocols.
Gun Shot Wound
A 20-something year old unknown male is brought to your community ED in a wheelchair by friends. They were at a party and a fight broke out. It was loud and dark and then they saw the patient collapse. His low back is covered in blood. He is awake but moaning.
Lateral Canthotomy
A 25 y/o M pitching in a Sunday baseball game is hit in the face by a line drive. He is brought to the ED by his friends complaining of decreased visual acuity to his right eye accompanied by significant right peri-orbital swelling. At triage his VA is OD 20/100 OS 20/25 but at the time of assessment VA OD is limited to detection of light and his pupil is fixed and dilated, extra-ocular movements are intact. The team should recognize the need for lateral canthotomy based on the history and physical exam findings (including IOP) and mobilize the appropriate resources for bed-side lateral canthotomy as well as the need for emergent ophthalmology consult.
Late Post Partum Pre-eclampsia
Alice, a 20-year old female with no significant past medical history is brought in by ambulance with worsening upper abdominal pain onset 1 week ago when she woke up. She has felt nauseous and has vomited one time this morning. Two days ago, she began to feel short of breath. She states that it has been getting worse and she is now having trouble lying flat. She was hypertensive with EMS.
Introducing SimLab
Check out SIMLab HERE! This post comes to us from Dr. Tristan Jones who is an Emergency Physician working in Victoria, BC, Canada. He completed medical school in Calgary, and EM residency in Victoria through the University of British Columbia Island Program. Prior to medicine, he studied electrical engineering, and has been programming and developing … Continue reading Introducing SimLab
COVID-19: Difficult Airway
Mr. Johnson, a 60-year old man was found at the bottom of 3 steps at home by his wife. He is obtunded with obvious bruising to head. EMS has placed him in a C-spine collar and provided supplemental oxygen. He was swabbed for COVID yesterday due to a new cough and fever and the results are still pending.
