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
Category: Resuscitation
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.
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.
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.
Wide Complex Tachycardia WPW
A 37F with no past medical history presents with wide complex tachycardia. She is initially stable, and after unsuccessful treatments, will decompensate either with hypotension or with polymorphic atrial fibrillation, and require synchronized cardioversion. After stabilizing the patient, she is revealed to have undiagnosed Wolfe-Parkinson-White.
Ending a resuscitation
The medical aspect of this case is a relatively straight-forward out-of-hospital cardiac arrest where the team must recognize futility and make the decision to stop resuscitation efforts. The primary goal is simulating the experience of making a termination of resuscitation decision, and managing the impacts of a patient’s death. Other goals could also be scaffolded onto this scenario as deemed appropriate by the simulation instructor, including breaking bad news to family member or a simulated hot debrief with the team.
Accidental Hypothermia
A 24-year-old previously healthy male presents to the ED with absent vital signs. He is out for a trail run when he becomes trapped in waist deep cold water. When he is found by search and rescue, he is awake with altered mental status. He has a cardiac arrest on retrieval and is found to be severely hypothermic. CPR and ACLS is initiated and he is transferred to the nearest community ED. The resuscitation team is expected to perform ACLS specific to hypothermic arrest. The patient will require intubation, active rewarming, defibrillation and discussion with the ECMO physician on call for transport and ECMO assisted rewarming.
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.
EM Sim Cases 