An 81-year-old (wo)man is brought to the ED by her/his friend as she/he is confused and agitated. In the ED, her/his confusion worsens. Initially she/he is fidgety but as the case progresses she/he becomes more agitated and confused. She/he will be fairly uncooperative, moving around and not able to follow many commands. The participants should be looking for a source of infection and evidence of any recent trauma. They are expected to use both non-pharmacological and safe pharmacological options in order to control the situation, ensure patient safety, and facilitate investigations.
A 68-year old woman is found at a bus stop exhibiting bizarre behaviour. She is brought to the ED by paramedics. In the ED, she is expressing paranoid delusions. Her agitation escalates and does not respond to verbal de-escalation or an overwhelming show of force. She will require physical and chemical sedation to facilitate the work-up for her new onset psychosis.
An 82 year old man arrives to the ED by EMS with a GCS of 7. He smells of urine and feces, and apparently has not been seen in 4 days. He is hypotensive and tachycardic. With simple fluid resuscitation (1-2L), the BP will improve. Learners are to organize a broad diagnostic work-up and coverage with broad-spectrum antibiotics. They must also recognize the need to intubate. If they do not, the patient will vomit and have a resultant desaturation. The case ends after successful workup and intubation.