This case as written by Drs. Stephen Jensen, Brandon Bowdoin, and Kristen Whitworth as well as Spring Lutzen.
Stephen Jensen is a third-year emergency medicine resident at Spectrum Health Lakeland. He is completing a longitudinal track in Medical Education during his residency with a focus in simulation and curriculum development.
Brandon Bowdoin is the Chief Resident at Spectrum Health Lakeland. He is completing a longitudinal track in Medical Education during his residency with a focus on podcasting and on shift teaching and evaluation.
Kristen Whitworth is an emergency medicine physician and the Simulation Director for the Spectrum Health Lakeland Simulation Training Center. She completed a Medical Education longitudinal track during her residency with a focus on simulation and educational design.
Spring Lutzen is the manager of the Spectrum Health Lakeland Simulation Training Center. She is a Certified Healthcare Simulation Educator through the Society for Simulation in Healthcare and has many years of clinical experience as a respiratory therapist.
WHY IT MATTERS
The rapid evaluation and treatment of patients is a vital skill required of emergency medicine physicians. EM physicians are required to task switch numerous times, often assessing a new patient immediately after critical interventions have been implemented on their current patient. The skill of task switching is not often evaluated with simulation as cases are often a single patient encounter. This multi-case simulation reproduces a series of critical patient presentations encountered on a busy shift. This multi-case was created to provide formative feedback regarding the senior residents’ ability function with a heavy cognitive load while transitioning between critical patients.
This is a multi-case simulation. The initial patient will present with a STEMI. The resident will need to arrange for cardiac catheterization and provide appropriate medical treatment. The exact moment these orders are completed, a stroke activation will be called for a patient eligible for tPA. Stroke protocol needs to be followed and tPA will need to be given. As soon as tPA is pushed, the resident will be handed an EKG with signs of hyperkalemia and told that a patient with depression has checked in. The resident will need to immediately evaluate the patient with hyperkalemia and give appropriate medications or they will decline. As they are pushing the medications, a Trauma Level One will be called. The trauma will be an open book pelvic fracture with hypotension and a positive FAST. The patient will need a pelvic binder, blood products, and go immediately to the OR. At this time, the resident will need to follow up on the stroke and hyperkalemia patients before evaluating the patient presenting with depression.