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.
Category: Cases
Critical Care 4 – Post-extubation Stridor
This is the fourth case in a series looking at critical care medicine. A 59-year old man in your ICU was just extubated 30 minutes ago. He is four days post blunt polytrauma and has ongoing agitation but no other requirement for intubation. Since extubation, he has required several sedatives and has now developed stridor at rest.
Organophosphate Poisoning
A 60-year old farmer presents to the ED with a runny nose, vomiting and diarrhea. He feels short of breath and dizzy. He looks so unwell that he is placed into the resuscitation bay. Initial vital sign show tachypnea, hypoxia, and bradycardia. You are immediately concerned about the copious nasal and oral secretions.
Critical Care 3 – Spinal Cord Injury
This is the third case in a series looking at critical care medicine. A 46-year-old woman pinned between truck and car has been resuscitated in ED and multiple injuries were identified, including bilateral rib fractures with flail chest, liver laceration and unstable T5-6 fractures with reduction of canal diameter. ICU has admitted the patient while she awaits OR later today to stabilize the spine.
Heat related illness
This case comes from Dr. Jared Baylis and Dr. Kelly Huang Dr. Baylis is the Simulation Medical Director at University of British Columbia - Southern Medical Program and Interior Health, as well as an editor of EM Sim Cases. Dr. Huang a PGY5 Emergency Medicine resident at University of British Columbia and is currently completing … Continue reading Heat related illness
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.
Critical Care 2 – Myasthenic Crisis
This is the second case in a series looking at critical care medicine. A 57-year-old female with history of thymoma and myasthenia gravis is currently admitted to a general medical ward for pneumonia develops respiratory distress 48 hours after admission. A respiratory therapist (RT) was paged to assess the patient and then called you urgently because the patient appears unwell.
EM Sim Cases 