This is the eighth and final case in a 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.
You are covering an in-patient surgical floor. Its 2300 and you are called to assess a 47-year old man who has been admitted for cholecystitis and is currently awaiting a cholecystectomy. The nurse called because she is worried about new confusion and fever that has developed over the last 3 hours.
This case involves the approach to severe sepsis, more specifically acute cholangitis. If treated aggressively (IV fluids, early broad spectrum antibiotics and source control) the patient will stabilize. If not, the patient will deteriorate into a PEA arrest.
Media for the Case
No imaging or ultrasound required for this case. If they are asked for:
– X-rays will be normal
– Ultrasound unavailable overnight
– EKG shows sinus tach