25 year old male is involved in a boating accident. He was in the lake waterskiing and struck by another boat, sustaining blunt abdominal and pelvic injuries and significant propeller injuries to his leg. The trauma team will be activated and he will be brought to the ED. Treatment includes tourniquet application to the limb and rapid blood product administration. Intubation for clinical course and pain management need to be addressed with disposition to the operating room.
Author: Jared Baylis
Atrial Fibrillation
This case comes from Dr Aneesha Thouli and Dr Brad Stebner. Dr Brad Stebner is a staff emergency physician at Kelowna General Hospital. His interests include medical education and leadership, sports medicine, and health care administration. He is particularly interested in using simulation to evaluate system efficiency, crisis resource management, and interprofessional collaboration. Dr Aneesha … Continue reading Atrial Fibrillation
Classic heat stroke
This case comes from Aneesha Thouli and Dr. Brad Stebner. Aneesha Thouli is a 4th-year medical student from the University of British Columbia. Dr Brad Stebner is a staff Emergency physician in Kelowna, BC, Clinical Instructor at UBC and one of our editors at EM Sim Cases. WHY IT MATTERS Classic heat stroke is a … Continue reading Classic heat stroke
LVAD Pump Thrombosis
A 70 y/o male post LVAD implantation presents to the emergency department with a chief complaint of shortness of the breath. The team will need to progress through the initial assessment of an LVAD patient, ultimately leading to a diagnosis of pump thrombosis. They will initiate anticoagulation, consult cardiothoracic surgery, and admit to CTICU.
Alcohol and opioid use
These cases come to us from Drs. Jessica Pelletier and Anne Ickes. Jessica Pelletier, DO is an Emergency Medicine Education Fellow at Washington University School of Medicine in St. Louis. Her interests include harm reduction, the use of simulation for difficult conversations and procedural preparedness, and the use of osteopathic manipulation for pain control in … Continue reading Alcohol and opioid use
Asthma in Pregnancy
A third trimester patient presents with a severe asthma exacerbation that deteriorates and requires BiPAP/ICU admission. The learner will need to identify severe asthma and manage accordingly accounting for differences in physiology during pregnancy.
Pediatric Drowning
A three-year-old child was swimming with their family, when they wandered into the deep end and submerged under water. The parents noticed the child was below the surface. When the child was brought to the surface, they were unconscious and coughing up foam. EHS arrived, provided oxygen supplementation, and brought them to your tertiary emergency department, with access to PICU. In the ED, the child is unconscious with increasing respiratory distress, requiring intubation. Despite intubation, the child remains hypoxemic and the team works through an approach to post-intubation hypoxemia. Unfortunately, the child becomes bradycardic. The team should begin CPR and follow the PALS pediatric bradycardia algorithm. PICU should be called if not already involved. After one round of CPR, the patient’s heart rate will increase and the consulting team should arrive.
GSW Vascular Injury
Adult male with penetrating extremity and chest trauma (gun shot wounds) with peripheral vascular compromise. The patient needs a thorough and systematic approach despite distracting injuries. For both junior and senior learners, the patient progresses from threatened limb (requiring emergent investigation) to a pulseless limb (requiring emergent OR). For senior learners, there will be an additional element of instability from the penetrating chest injury requiring chest tube.
Multi-case Resuscitation
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.
Bronchiolitis
Four days ago, an older sibling who recently started pre-school had a cold. The next day, Zarah fell sick. She has had a runny nose and cough but seemed to be doing fine until yesterday when she did not eat or drink very much. This morning, she had some noisy breathing, and her chest looked funny while she was breathing. When it did not go away after a couple of hours, Zarah’s parents called 811 for advice. They were directed to go to the emergency department. The patient will progress through escalating respiratory support and eventually require intubation and transfer to higher level of care.
EM Sim Cases 