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
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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
Acetaminophen Overdose with an Uncooperative Patient
A 25-year old man presents to the emergency department after intentionally ingesting a significant amount of acetaminophen. He says that he was trying to kill himself and remains irritable and resistant to treatment.
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
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.
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.
Trauma Airway Management
Securing the airway of a severely traumatized patient is fraught with difficulties. There can be anatomic difficulties associated with facial and neck injuries. There are often physiologic difficulties from uncommon causes of shock (like pericardial tamponade). But emergency physicians have all the skills needed to safely handle any trauma airway!
Lateral Canthotomy
A 25 y/o M pitching in a Sunday baseball game is hit in the face by a line drive. He is brought to the ED by his friends complaining of decreased visual acuity to his right eye accompanied by significant right peri-orbital swelling. At triage his VA is OD 20/100 OS 20/25 but at the time of assessment VA OD is limited to detection of light and his pupil is fixed and dilated, extra-ocular movements are intact. The team should recognize the need for lateral canthotomy based on the history and physical exam findings (including IOP) and mobilize the appropriate resources for bed-side lateral canthotomy as well as the need for emergent ophthalmology consult.
EM Sim Cases 