This case was written by Dr. Jared Baylis. Jared is currently a PGY-4 in emergency medicine at UBC (Interior Site – Kelowna, BC) and is completing a simulation fellowship in Vancouver, BC.
Twitter – @baylis_jared + @KelownaEM
Why It Matters
Referral-consultant interactions occur with regularity in the emergency department. These interactions are critically important to safe and effective patient care. Several frameworks have been developed for teaching learners how to communicate during a consultation including the 5C, PIQUED, and CONSULT models. This case allows simulation educators to incorporate whichever consultation framework they prefer into a simulation scenario that allows deliberate practice of the consultation process.
Clinical Vignette
You are a junior resident working in a tertiary care centre and you are asked to see a 58-year-old female patient who was sent in from the cancer centre. She is known to have metastatic non-small-cell lung cancer and has been increasingly dyspneic with postural pre-syncope over the last few days. Her history is significant for a previous malignant pericardial effusion that was drained therapeutically a few months ago.
Case Summary
In this case, learners will be expected to recognize that this 58-year-old female patient with metastatic non-small-cell lung cancer has tamponade physiology secondary to a malignant pericardial effusion. The patient will stabilize somewhat with a gentle fluid bolus but the learners will be expected to urgently consult cardiology or cardiac/thoracic surgery (depending on the centre) for a pericardiocentesis and/or pericardial window.
Download the case here: Learner-Consultant Communication
Checklists for 5C, PIQUED, and CONSULT frameworks: Consult Framework Checklists
FOAMed article on 5C framework: 5C CanadiEM
FOAMed article on PIQUED framework: PIQUED CanadiEM
ECG for the case found here:
(ECG Source: https://lifeinthefastlane.com/ecg-library/basics/low-qrs-voltage/)
CXR for the case found here:
(CXR Source: https://radiopaedia.org)
POCUS for the case found here:
(Ultrasound Source: https://www.youtube.com/watch?v=qAlU8qhC1cU)
