This is a case of a breathless 57-year-old male coming into a community emergency department with symptoms consistent with COPD exacerbation. During his ED stay, however, the patient will develop massive hemoptysis with airway compromise, requiring learners to secure the airway, reverse anticoagulation, and manage massive hemoptysis.
Category: Respiratory
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.
Tracheostomy Emergency
48-year-old male with a recent tracheostomy presents with sudden onset respiratory distress. The patient is unable to be oxygenated or ventilated through the tracheostomy tube. The team must recognize that the tracheostomy tube is either obstructed or displaced. Attempts to correct tracheostomy obstruction with suctioning and cuff deflation are not successful. Removal of the tracheostomy tube is required, followed by either oral intubation or placement of a new tracheostomy tube. The patient improves once oral or stomal intubation is performed. If tracheostomy tube is not removed, the patient worsens and goes into cardiac arrest secondary to respiratory failure.
Airway Obstruction from FB
This case involves a 60-year-old male patient who arrives VSA in PEA after collapsing while eating dinner with family. The collateral history included that he was suspected to be intoxicated. The patient is difficult to bag with EMS. The learner will have to work through the can’t ventilate/can’t oxygenate scenario once they identify that BVM is ineffective.
COVID-19: Difficult Airway
Mr. Johnson, a 60-year old man was found at the bottom of 3 steps at home by his wife. He is obtunded with obvious bruising to head. EMS has placed him in a C-spine collar and provided supplemental oxygen. He was swabbed for COVID yesterday due to a new cough and fever and the results are still pending.
Pediatric Asthma Exacerbation
Acute asthma exacerbations in children are extremely common. Most asthmatic exacerbations respond quickly to basic treatment with beta-agonists, anticholinergics, and steroids. This case highlights the management of those patients who need treatment that goes beyond the basics.
COPDE with Pneumothorax
A 68-year old man with COPD requiring home oxygen presents with respiratory failure. He is hypoxic, hypercarbic and agitated and will require intubation. Dissociative-dosed ketamine and BiPAP can facilitate pre-oxygenation. After a successful intubation, the high pressure alarms on the ventilator will go off. The team leader must troubleshoot the high ventilation pressures until they find and treat a tension pneumothorax.
COVID-19: Protected Intubation in the Sim Lab
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.
Pediatric Airway Obstruction
This case involves an 8 year-old boy with upper airway obstruction from sausage. When indirect treatment fails, removal with Magill forceps under direct visualization is required. The patient slowly recovers after removal of foreign body but will require admission for monitoring.
COVID-19: Ambulatory Care
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.
EM Sim Cases 