COVID-19: STEMI with VF Arrest

This is the third COVID-19 case that we are publishing to provide simulation tools to healthcare providers during the 2020 Coronavirus pandemic. It involves an unexpected cardiac arrest in a suspected COVID positive patient.

This case was written by Drs. Krista Dowhos and Alim Nagji for use to assess and improve team preparedness to care for a COVID positive patient in cardiac arrest.

Dr. Krista Dowhos is a 2nd year Family Medicine resident at McMaster’s Kitchener-Waterloo distributed campus. She is passionate about medical education, especially simulation-based medical education and the production of infographics for knowledge translation in Emergency Medicine.

Dr. Alim Nagji is an ER staff physician at Joseph Brant Hospital (JBH) and St. Joseph Healthcare Hamilton. He is the Director of Emergency Medicine Clerkship for McMaster University and the Director of Simulation Learning and Clinical Teaching Unit for JBH. He has interests in medical education, simulation and global health. Send him your favourite meme on twitter (@alimnagji)

Why It Matters

Outbreaks of novel respiratory illnesses occur with some regularity (e.g. Severe Acute Respiratory Syndrome (SARS) and Middle-East Respiratory Syndrome (MERS)). With world travel being a modern reality, disease spread can happen quickly requiring careful infection control practices. COVID-19 (aka 2019-nCoV) was first detected in Wuhan, China in December 2019 and has since been declared a pandemic by the WHO (see this link for further information).

The COVID-19 worldwide pandemic has overwhelmed healthcare systems in many countries and led to catastrophic loss of life. Many healthcare providers have been exposed and infected in the course of their work and protocols to protect providers have been rapidly evolving. Simulation is being used to test and improve systems in place for infection control, PPE, and management of exposure to COVID-19.

This simulation case tests the response to an unexpected cardiac arrest, and the ability of the staff to stay safe while caring for a critically ill patient. At the time of publishing, there is not a single consensus approach to code blue in the suspected or confirmed COVID-19 patient. However, in this case, we explore an approach that maximizes the protection of healthcare providers.

Clinical Vignette

A 50-year old woman presents to the emergency department with 1.5 hours of chest pain and left arm heaviness. She works at a long term care facility where she has been caring for COVID-19 positive patients. She has had two days of mild URTI symptoms. She looks moderately unwell and has been placed in a resuscitation room with droplet/contact precautions.

Case Summary

This 50-year old woman presents with typical cardiac chest pain and high suspicion for COVID-19. Her ECG shows an anterior STEMI. The team will start performing the initial work-up and management of a patient with STEMI. While this is occurring, the patient suffers a VF arrest. The team will need to go through the ACLS algorithm while taking all precautions required in caring for a patient with suspected COVID.

Download the case here: COVID STEMI and VF Arrest

ECG for the Case

Source: https://litfl.com/anterior-myocardial-infarction-ecg-library/

COVID-19: Ambulatory Care

Last week’s case featured a critically ill patient with COVID-19. However, not all patients will present that sick, and not always to a tertiary care centre. In a follow-up case, this patient presents moderately unwell and is a good case to use in an ambulatory care setting such as an urgent care or clinic.

This case was written by Dr. Alex Chorley, a staff emergency physician at Hamilton Health Sciences in Hamilton, Ontario. The case is part of the ongoing in situ simulation project designed to discover and fix or mitigate latent safety threats in the Emergency Department. (To learn more about using in situ simulation for quality improvement, read our previous two-part blog post.)

Why It Matters

Outbreaks of novel respiratory illnesses occur with some regularity (e.g. Severe Acute Respiratory Syndrome (SARS) and Middle-East Respiratory Syndrome (MERS)). With world travel being a modern reality, disease spread can happen quickly requiring careful infection control practices. COVID-19 (aka 2019-nCoV) was first detected in Wuhan, China in December 2019 and has since been declared an outbreak by the WHO (see this link for further information).

This simulation case, designed for a moderately unwell patient presenting to an ambulatory clinic, provides a way to test and improve systems in place for infection control, PPE, and management of exposure to COVID-19 or any high risk communicable respiratory illness.

Clinical Vignette

A 38-year old male has returned from a business trip in Asia last week.  Over the last 48 hours, he has developed fever, rigors, myalgias as well as nausea, vomiting and upper respiratory symptoms.  He initially was trying to ride it out at home, but is feeling increasingly short of breath and fatigued. He has now presented to your ambulatory care clinic.

Case Summary

This case was designed during the January 2020 COVID-19 outbreak in order to assess and improve team preparedness for safely and effectively caring for a moderately ill coronavirus patient from triage through to EMS transfer out of an ambulatory care setting.

Download the case here: Ambulatory COVID-19

CXR for the case found here:

Courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 31352

COVID-19: Respiratory Failure

We are interrupting our regular q2weeks cases with this bonus case for use in an in situ simulation setting for testing your emergency department’s response to acutely unwell patient’s with suspected COVID-19. This case was written by Drs. Alia Dharamsi, SooJin Yi and Kate Hayman who are academic staff emergency physicians in Toronto. This case has been used widely at a variety of community and academic EDs in the Greater Toronto Area to facilitate departmental preparedness.

Twitter – @alia_dh + @soojinder + @hayman_kate

Featured image used under creative commons licence by Pete Linforth via Pixabay.

Why It Matters

Outbreaks of novel respiratory illnesses occur with some regularity (e.g. Severe Acute Respiratory Syndrome (SARS) and Middle-East Respiratory Syndrome (MERS)). With world travel being a modern reality, disease spread can happen quickly requiring careful infection control practices. COVID-19 (aka 2019-nCoV) was first detected in Wuhan, China in December 2019 and has since been declared an outbreak by the WHO (see THIS link for further information).

This well developed simulation case provides a way to test and improve systems in place for infection control, PPE, and management of exposure to COVID-19 or any high risk communicable respiratory illness.

Clinical Vignette

A 35-year-old woman became febrile last night with coryza and woke up acutely short of breath with productive cough, rhinorrhea, and a subjective fever. She presents to triage where she screens positive for potential coronavirus exposure due to fever, respiratory symptoms and a high-risk travel history.

Case Summary

This case was designed during the January 2020 COVID-19 outbreak in order to assess and improve team preparedness for safely and effectively caring for a critically ill coronavirus patient from triage through to intubation.

Download the case here: COVID-19

Find the directions for the props here: Props for COVID-19

Video of the nasal secretion prop:

ECG for the case found here:

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(ECG Source: https://en.ecgpedia.org/wiki/Sinus_Tachycardia)

CXR for the case found here:

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(CXR Source: https://radiopaedia.org/cases/35985)

POCUS for the case found here:

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(POCUS Source: http://www.thepocusatlas.com/pulmonary)