Improving Emergency Department Airway Preparedness in the Era of COVID-19: An Interprofessional, In Situ SimulationDOI: https://doi.org/10.21980/J8V06M
At the conclusion of the simulation session, learners will be able to: 1) Understand the need to notify team members of a planned COVID intubation including: physician, respiratory therapist, pharmacist, nurse(s), and ED technician. 2) Distinguish between in-room and out-of-room personnel during high-risk aerosolizing procedures. 3) Distinguish between in-room and out-of-room equipment during high-risk aerosolizing procedures to minimize contamination. 4) Appropriately select oxygenation therapies and avoid high-risk aerosolizing procedures. 5) Manage high risk scenarios such as hypotension or failed intubation and be prepared to give push-dose vasoactive medications or place a rescue device such as an I-gel®.
A portable single-view radiograph of the chest was obtained upon the patient’s arrival to the ED resuscitation bay that showed diffuse reticulonodular airspace opacities (red arrows) seen throughout the bilateral lungs, concerning for disseminated pulmonary tuberculosis. Subsequently, a computed tomography (CT) angiography of the chest was obtained which again demonstrates this diffuse reticulonodular airspace opacity pattern (red arrows).
At the conclusion of the simulation session, learners will be able to: 1) Describe the spectrum of clinical presentations of necrotizing fasciitis. 2) Identify the microbial etiology of necrotizing fasciitis. 3) Describe the empiric antibiotics appropriate for necrotizing fasciitis. 4) Describe benefits and limitations of various imaging studies when working up necrotizing fasciitis.
At the conclusion of the simulation session, learners will be able to: 1) Obtain a relevant focused history, including immunization status, associated symptoms, sick contacts, and travel history. 2) Develop a differential for fever, rash, and altered mental status in a pediatric patient. 3) Discuss management of primary measles encephalitis, including empiric broad spectrum antibiotics and antiviral treatment. 4) Discuss appropriate disposition of the patient from pediatric emergency departments, community hospitals, and freestanding emergency departments, including appropriate time to call for transfer and the appropriate time to transfer this patient during emergency department (ED)workup. 5) Review types of isolation and indications for each.
A sagittal view from computed tomography (CT) of the abdomen and pelvis demonstrated fat stranding beneath the inferior margin of the liver (outlined in red). The axial view showed fat stranding adjacent to the ascending colon without significant colon wall thickening (arrow). Fat stranding can occur as a hazy increased attenuation (brightness) or a more distinct reticular pattern.
By the end of this instructional session learners should be able to: 1) identify and discuss the indications, contraindications, and complications associated with peritonsillar abscesses, 2) properly identify and measure a PTA through ultrasound, and 3) competently perform ultrasound-guided peritonsillar abscess drainage on a simulator and remove fluid.
After this simulation case, learners will be able to diagnose and manage patients with spinal epidural abscesses. Specifically, learners will be able to: 1) Obtain a detailed history, including past infectious, surgical, procedural and social history to evaluate for epidural abscess risk factors; 2) describe clinical signs and symptoms of spinal epidural abscesses and understand that initial clinical presentations can be variable; 3) perform a focused neurological exam including evaluation of motor, sensory, reflexes, and rectal tone; 4) order appropriate laboratory testing and imaging modalities for spinal epidural abscess diagnosis, including a post-void bladder residual volume; 5) select appropriate antibiotics for empiric treatment of spinal epidural abscess depending on patient presentation; 6) disposition the patient to appropriate inpatient care.
On arrival, radiographs of the neck soft tissues were obtained, which showed a markedly enlarged epiglottic shadow (red arrow) concerning for epiglottitis. A computed tomography scan of the neck soft tissues with contrast was then obtained which revealed edematous mucosal thickening of the oropharynx (blue arrow) and supraglottic larynx (green arrow) including the epiglottis (purple arrow) concerning for acute infectious pharyngitis and supraglottic laryngitis with severe narrowing of the supraglottic laryngeal lumen, as well as associated extensive inflammation and edema of the superficial and deep left neck spaces. The patient’s white blood cell count was elevated to 25.7x109/L with 87% neutrophils. Her rapid strep test was positive. Otolaryngology was consulted and performed a