This case was written by Drs. Pittman and Bridges, emergency physicians at Prisma Health-Upstate in Greenville, SC. They both teach in the University of South Carolina School of Medicine-Greenville and in the emergency medicine residency program. Dr. Pittman is the residency Director of Academic Success, completed residency at the Georgetown / Washington Hospital Center Emergency … Continue reading Unstable Atrial Fib
A 70-year old female is brought to the ED after lighting herself on fire while trying to light a cigarette. She will have a 15% TBSA burn (upper anterior chest and neck only) with inhalational injury. Preparation for intubation should be an early priority. Her prognosis is poor but survivable and it will be key to discuss goals of care with the family before proceeding with intubation and further burn care. A difficult intubation should be anticipated but is not encountered in this case.
This patient is in respiratory failure and requires intubation. Participants must prepare for her arrival, organize the care team, communicate effectively and secure the patient's airway according to the principles of a protected intubation.
This 50-year old woman presents with typical cardiac chest pain and high suspicion for COVID-19. Her ECG shows an anterior STEMI. The team will start performing the initial work-up and management of a patient with STEMI. While this is occurring, the patient suffers a VF arrest. The team will need to go through the ACLS algorithm while taking all precautions required in caring for a patient with suspected COVID.
This case was designed during the January 2020 COVID-19 outbreak in order to assess and improve team preparedness for safely and effectively caring for a moderately ill coronavirus patient from triage through to EMS transfer out of an ambulatory care setting.
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.
In this scenario, the learner is called to the ward to assess a 65-year old male with new VT. The learner must recognize the rhythm and institute appropriate work-up and management including electrical cardioversion.
This case involves the approach to the patient with acute dyspnea. The patient is tachypneic but with an otherwise normal respiratory exam. ECG shows new right heart strain. The team should consider multiple possibilities but recognize PE as the most likely cause.
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.
This is the sixth and final case in a six-part mini-series focusing on the management of geriatric patients in the ED. This series of cases was written by Drs. Rebecca Shaw, Nemat Alsaba, and Victoria Brazil. Dr. Rebecca Shaw is an emergency physician currently working as a medical education fellow within the Emergency Department of … Continue reading Geriatric Case 6: Elder Abuse