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
Tag: atrial fibrillation
Aortic Stenosis with A Fib and CHF
A 78-year-old male presents with increased SOB over the past 4 days. A recent ECHO will be presented showing severe AS. The ECG will demonstrate new A Fib with a HR of 150 and the CXR will show CHF. The patient will be normotensive at first but will become hypotensive shortly after. The team will then need to decide whether to cardiovert the patient or attempt rate control. If these are done safely, the patient will respond and then develop worsening CHF. Definitive management should be sought with early cardiology/cardiac surgery consult. If management is not carried out judiciously, the patient will become profoundly hypotensive.
Thyroid Storm
A 31 year-old-female presents by EMS with altered LOC and fever due to thyroid storm precipitated by recent parturition. The patient is tachycardic and hypoxic on arrival. Her level of consciousness will continue to deteriorate despite IV fluids and antibiotics and will require intubation. The husband will be at the bedside, and the team will need to discuss the need for intubation with him. After intubation, lab results will come back indicating possible thyrotoxicosis. The patient's rhythm will change to atrial fibrillation at this time. The team will be expected to manage the thyroid storm in consultation with Endocrinology and ICU.
EM Sim Cases 