Unstable Atrial Fib

This case was written by Drs. Pittman and Bridges, emergency physicians at Prisma Health-Upstate in Greenville, SC.  They both teach in the University of South Carolina School of Medicine-Greenville and in the emergency medicine residency program.   Dr. Pittman is the residency Director of Academic Success, completed residency at the Georgetown / Washington Hospital Center Emergency … Continue reading Unstable Atrial Fib

Virtual Resus Room

Physical distancing restrictions during the COVID-19 pandemic have dramatically impacted medical education, challenging educators around the world to create interesting, novel ways to engage learners remotely. Virtual alternatives to in-person simulation sessions have been of particular interest. From discussion with other educators, it seems like many programs have shifted to a model of sim that involves talking through challenging cases. This strategy is excellent for medical content review but misses the hands-on, interactive, nervous energy of simulation that makes it so valuable. This is why we set out to create the Virtual Resus Room.

PEA Arrest and Breaking Bad News

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.

COVID-19: Out-of-Hospital Cardiac Arrest

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.

Resuscitative Hysterotomy

The team receives advance notification from EMS about a 30 year-old female who is visibly pregnant and was in a car accident. Upon arrival to the ED the patient loses pulses and CPR begins. The team must begin ACLS/ATLS and proceed to resuscitative hysterotomy. After delivery they should begin neonatal resuscitation and continue management of the mother.  Early consultation should be made to trauma surgery, NICU, and OB. 

Nightmares Case 3: Seizure

The resident is called to the ward to manage a patient who may have had a seizure. The patient is somnolent when the resident arrives. Shortly afterward, the patient seizes again. Two doses of anti-epileptic will be required to terminate the seizure. Finally, when the patient has been stabilized, the resident will be required to discuss the case with their staff on call.