A 38 year-old man (Ethiopian refugee) with untreated HIV and past history of TB, presents to the emergency department (ED) with anterior chest pain, shortness of breath and hypotension. He was seen 3 days prior by a walk-in clinic and referred to the ED with chest pain and ECG showing pericarditis, but did not attend the ED until symptoms were severe. In the ED, patient quickly progresses to profound shock and has a PEA arrest. POCUS will show a large pericardial effusion and tamponade. Team members are to initiate CPR, manage the arrest and treat the effusion using bedside pericardiocentesis in order to obtain return of spontaneous circulation (ROSC).
A 70 year old man who had an unwitnessed cardiac arrest is brought to the ED via EMS from his local Tennis Club. Despite multiple rounds of appropriate resuscitative measures, the patient does not gain return of spontaneous circulation (ROSC). Learners will need to discuss the termination of resuscitation with team members and communicate with the patient’s wife.
The patient is found by a friend unresponsive after a 7 day history of cough and shortness of breath. He immediately receives bystander CPR. An advanced care paramedic crew attends the scene and manages a ventricular fibrillation arrest prior to transporting to hospital. The patient goes into cardiac arrest again shortly before arriving in the emergency department. The team will need to prepare for the patient's arrival and then manage a cardiac arrest using appropriate precautions for suspected COVID-19.
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 involves the diagnosis and management of hyperkalemia. If not treated appropriately the patient will progress to ventricular fibrillation 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, hypoxic, and hypertensive. The team should consider multiple possibilities but recognize pulmonary edema as the most likely cause.
This is a case of an elderly patient with syncope. He is found to be in third degree heart block. The team is expected to perform an initial assessment and obtain an ECG. Upon recognizing the heart block, they should ensure IV access and place pacer pads while calling for help.
An elderly male is brought in by ambulance from home with CPR in progress. He collapsed in front of his son/daughter who commenced CPR. His rhythm has been PEA throughout and his downtime is 20 minutes. Participants should assess the patient, gather information about his background and determine that CPR is futile. They should decide to cease CPR and inform his son/daughter in a sensitive manner that their father has died. They will also debrief the team following the termination of resuscitation.
An 85-year-old man presents after a fall at home. He is complaining of dizziness and has a HR of 30. Further assessment reveals chronic digoxin toxicity and a concurrent UTI with acute renal failure. The patient requires management of his bradycardia and acute renal failure with specific management of chronic digoxin toxicity including a discussion with toxicology and administration of Digibind.