A 30 year-old female, G1P0 at 32 weeks, presents to the ED with headache, blurred vision, nausea, and vomiting. Her arrival BP is 175/115. As the team coordinates her initial workup, the patient will begin to seize. She will not stop seizing until magnesium sulfate is given. The patient will then require intubation for respiratory depression. The patient will also remain hypertensive, requiring administration of an appropriate antihypertensive agent. The case will end post intubation when the patient has been referred to OB.
Simulation olympics: innovations that showcase EM resident resuscitation skills
This post is written by Dr. Damon Dagnone. Dr. Dagnone is an Assistant Professor in the Department of Emergency Medicine and the Faculty Lead of CBME for Postgraduate MedEd at Queen's University. He is the Director of the Queen's Simulation Olympics and is also the Co-Chair of the CAEP Simulation Olympiad. When not in the sim … Continue reading Simulation olympics: innovations that showcase EM resident resuscitation skills
Massive Upper GI Bleed
A 58-year-old male known for alcoholism presents to the emergency department with an active, massive upper GI bleed due to esophageal varices. The patient deteriorates into hypovolemic shock requiring medical management, massive transfusion, intubation for airway protection, and insertion of a Blakemore tube.
Case progression: states, modifiers and triggers
In order for a simulated scenario to run smoothly, the case progression needs to be planned for in advance. This involves determining which states the patient simulator progresses through, how modifiers may change features of those states and what triggers will be used to change between states. A working understanding of these terms makes developing … Continue reading Case progression: states, modifiers and triggers
Tricyclic Antidepressant Overdose
A 27-year-old male presents to the emergency department with altered mental status after an intentional Amitriptyline overdose. He is found to have a wide QRS complex and an anticholinergic toxidrome. The patient deteriorates into PEA arrest necessitating advanced cardiac life support (ACLS) and intravenous sodium bicarbonate therapy.
Realism
What is it? Realism is the degree to which your simulation environment recreates or mimics the patient environment for your learners. A word on fidelity. The terms realism and fidelity are essentially interchangeable. However, many often associate the term fidelity with the amount of technology used to recreate the patient environment. For example, when educators … Continue reading Realism
CAH with adrenal crisis
A lethargic 1 week old presents from home after recurrent emesis and progressive sleepiness. He is hypovolemic, hypothermic, and hypoglycemic. If his hypoglycemia is not quickly corrected, he begins to seize and will continue to do so until the team gives glucose. If they do not, the patient will go on to have a VF arrest. If the team identifies and treats the hypoglycemia, orders blood work, and fluid resuscitates the child, they receive blood results demonstrating hyperkalemia and hyponatremia. If they correctly identify and treat the patient as a possible adrenal crisis, the neonate is safely transferred to the PICU. If they fail to treat the hyperkalemia or fail to administer steroids, the patient will have a VF arrest.
How to develop targeted simulation learning objectives – Part 1: The Theory
Simulation has filled a void that was once present in medical education. Written and oral examinations continue to be used to assess Miller’s “knows” and “knows how” levels of performance while clinical rotation evaluations rest at the top of the triangle: “Does”. Simulation completes Miller’s triangle by allowing learners to “show how” their knowledge and … Continue reading How to develop targeted simulation learning objectives – Part 1: The Theory
Ventricular Tachycardia due to Arrhythmogenic Right Ventricular Dysplasia (ARVD)
A 26-year-old man who suffered a syncopal event while playing soccer presents to the emergency department with a stable wide-complex tachycardia (WCT). The patient must be treated with an antiarrhythmic medication or by synchronized cardioversion. The patient later deteriorates into an unstable WCT and then ventricular fibrillation requiring advanced cardiac life support (ACLS) and defibrillation.
Crisis Resource Management
What is CRM? Crisis Resource Management refers to the extremely important but sometimes difficult to define “soft skills” that can make or break the function of a team. The concept was originally developed by the airline industry in response to research demonstrating that the large majority of airplane crashes occurred due to failures of the crew … Continue reading Crisis Resource Management
EM Sim Cases 