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.

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.


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.


It’s 5:00 am and you’ve been called to see a patient complaining of “chest discomfort”. This is a 64-year old man who is admitted to the floor with pneumonia and was transitioned to oral antibiotics yesterday. The chest discomfort started at 4:40 and didn’t respond to the patient’s regular antacid medication. 


In this scenario, the learner is called to the ward to assess a 64-year old male with new chest pain. The learner must order an EKG and recognize a ST-elevation myocardial infarction. They must then give appropriate medication and activate the interventional cardiology team.



Normal admission EKG (Life in the Fast Lane FOAMEd Blog)
Inferior STEMI (Life in the Fast Lane FOAMEd Blog)
15-Lead EKG showing RV Extension (Life in the Fast Lane FOAMEd Blog)

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