Nightmares Case 2: Pneumonia

This is the second in a case series we will be publishing that make up “The Nightmares Course”.

The Nightmares Course at Queen’s University (Kingston, Ontario) was developed in 2011 by Drs. Dan Howes and Mike O’Connor. The course emerged organically in response to requests from first year residents wanting more training in the response to acutely unwell patients. In 2014, Dr. Tim Chaplin took over as the course director and has expanded the course to include first year residents from 14 programs and to provide both formative feedback and summative assessment. The course involves 4 sessions between August and November and a summative OSCE in December. Each session involves 4-5 residents and covers 3 simulated scenarios that are based on common calls to the floor. The course has been adapted for use at the University of Saskatchewan, the University of Manitoba, and the University of Calgary.

Why it Matters

The first few months of residency can be a stressful time with long nights on call and the adjustment to a new level of responsibility. While help should always be available, the first few minutes of managing a decompensating patient is something all junior residents must be competent at. This case series will help to accomplish that through simulation.

Clinical Vignette

Mr. Jim Smith is a 64 year old male that was admitted 3 days ago. He was diagnosed with a community acquired pneumonia and started on daily Moxifloxacin. The nurse is concerned about his increasing shortness of breath since she started the night shift 4 hours ago.

Case Summary

In this case, the patient has been admitted for pneumonia and treated with the usual antibiotics. However, the team has not yet recognized that the causative bacteria is resistant to this antibiotic. The pneumonia has progressed and the team must manage the patient’s respiratory distress and sepsis. The patient requires a change in antibiotics, non-invasive ventilatory support and IV fluid resuscitation.

Download the Case Here

Nightmares Course #2: Pneumonia

EKG for the Case

Pulmonary disease pattern COPD ECG
EKG: https://litfl.com/ecg-in-chronic-obstructive-pulmonary-disease/

Chest X-ray for the Case

Chest X-ray: https://radiopaedia.org/cases/right-upper-lobe-pneumonia-8

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