An 8 year old girl who has been tired and “unwell” for several days presents to the ED with an acute decline in her mental status. She is confused and lethargic. It becomes quickly apparent that the child is in DKA and requires immediate treatment. Due to decreasing neurologic status and vomiting, she eventually requires an advanced airway. The challenge is to optimize the peri-intubation course and to appropriately ventilate to allow for compensation of her metabolic acidosis.
Tag: intubation
ASA Overdose
22 year-old female presents saying she just ingested 60 tablets of ASA because she wants to die. Her mom found her while she was finishing the bottle of 325mg tabs approximately 60 minutes ago and called EMS. The patient is complaining of nausea and tinnitus and is tachypneic. The team should consider activated charcoal and alkalinize the urine. If they do not initiate treatments, they will receive a critical VBG showing a mixed respiratory alkalosis and metabolic acidosis. The patient will then become somnolent. The team will be expected to check her blood sugar and call for dialysis. They will also need to intubate and recognize the need to hyperventilate and dialyze.
Acute Respiratory Distress
A 78 year old woman post-op from a TAH+ BSO for ovarian CA has just been transferred to the ward when she develops acute shortness of breath. When the resident arrives, the patient is in significant respiratory distress saturating 80% on RA. Oxygen and medical therapy will not adequately relieve the patient’s distress. The resident will need to recognize that the patient has a Grade 3-4 LV and received 2L of fluid intra-operatively. When BiPAP is called for, it will be unavailable. Ultimately, the patient will require intubation.
Altered LOC
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.
Severe Asthma Exacerbation
22 y.o. male is brought by EMS to the emergency department with increasing SOB and chest tightness x12 hours with rapid deterioration over the last hour resulting from a severe asthma exacerbation. He will require multiple pharmaceutical treatments, rapid sequence intubation and proper ventilation.
EM Sim Cases 