Simulation

Tracheoinnominate Artery Fistula

Emily M Tarver, MD^*, Anna A Lerant, MD, CHSE^{^}, Jeffrey D Orledge, MD^*, Benjamin P Stevens, MD^‡, and Gina D Jefferson, MD, MPH, FACS^‡

DOI: https://doi.org/10.21980/J8K05R Issue 6:3 No ratings yet.

By the end of this simulation, learners will be able to: 1) perform a focused history and physical exam on any patient who presents with bleeding from the tracheostomy site, 2) describe the differential diagnosis of bleeding from a tracheostomy site, including a TIAF, 3) demonstrate the stepwise management of bleeding from a suspected TIAF, including cuff hyperinflation and the Utley Maneuver, 4) verify that definitive airway control via endotracheal intubation is only feasible in the tracheostomy patient when it is clear, upon history and exam, that the patient can be intubated from above, 5) demonstrate additional critical actions in the management of a patient with a TIAF, including early consultation with otolaryngology and cardiothoracic surgery as well as emergent blood transfusion and activation of a massive transfusion protocol.

Botulism

John Thompson, MD^*, Zane Horowitz, MD^* and Adam Blumenberg, MD^{*^}

DOI: https://doi.org/10.21980/J8FD0R Issue 6:1 No ratings yet.

By the end of this simulation learners will be able to: 1) develop a differential for descending paralysis and recognize the signs and symptoms of botulism; 2) understand the importance of consulting public health authorities to obtain botulinum antitoxin in a timely fashion; 3) recognize that botulism will progress during the time period antitoxin is obtained. Early indications of respiratory compromise are expected to worsen during this time window. Secondary learning objectives include: 4) employ advanced evaluation for neurogenic respiratory failure such as physical examination, negative inspiratory force (NIF), forced vital capacity (FVC), and partial pressure of carbon dioxide (pCO2), 5) discuss and review the pathophysiology of botulism, 6) discuss the epidemiology of botulism.

Toxicology Neurology Simulation

HIT-Heparin Induced Thrombocytopenia Simulation Case

Shaza Aouthmany, MD^*, Alyssa Siano, BS^*, De ante’ Russ, MD^*, and Mark Bustillo, DO^*

DOI: https://doi.org/10.21980/J89Q0M Issue 6:1 No ratings yet.

After completing this simulated case, participants will be able to: 1) Obtain a detailed history that includes recent medications, medical, surgical, and social history to evaluate for HIT risk factors, 2) perform an adequate neurovascular exam including evaluation of motor function, sensation, skin color, pulses, and capillary refill, 3) order appropriate laboratory testing and imaging for diagnosis of thrombocytopenia and arterial occlusion, including bed side doppler or ultrasound, 4) discuss and recognize the symptoms of HIT and the contraindications of platelet and heparin administration in the emergency department, 5) avoid administration of heparin in the emergency department setting and recognize that platelets may worsen thrombus formation and lead to limb amputation, 6) select appropriate medications for treatment and determine appropriate disposition for a patient presenting with HIT, 7) demonstrate interpersonal communication with patient and family, 8) recognize that HIT with thrombosis is a potential complication in hospitalized patients and outpatient settings and is associated with high mortality rates.

Hematology/Oncology Simulation

Posterior Reversible Encephalopathy Syndrome (PRES)

William Ciozda, MD^* and Adeola Adekunbi Kosoko, MD^*

DOI: https://doi.org/10.21980/J85W6C Issue 6:1 No ratings yet.

By the end of the simulation, the learner will be able to: 1) manage an acute seizure 2) discuss imaging modalities to diagnose PRES 3) discuss medical management of PRES.

Neurology Simulation

What do you do if your relief comes to work intoxicated: An Impaired Provider Scenario

David A Gay, MD^*, Anthony F Steratore, MD^*, Adam Hoffman, CHSE^{^}, Jessica M Neidhardt, MD^*, Courtney A Cundiff, MD^*, Erica B Shaver, MD^*, Autumn Starn Kiefer MD^† and Christopher Stephen Kiefer, MD^*

DOI: https://doi.org/10.21980/J8DM0H Issue 5:4 No ratings yet.

By the end of this simulation, learners will be able to: 1) Identify potential impairment in the form of alcohol intoxication in a physician colleague; 2) demonstrate the ability to communicate effectively with the colleague and remove them from the patient care environment; 3) discuss the appropriate next steps in identifying long-term wellness resources for the impaired colleague; and 4) demonstrate understanding of the need to continue to provide care for the patients by moving the case forward.

Administration Current Issue Simulation

Extracorporeal Membrane Oxygenation (ECMO) for Refractory Cardiac Arrest

Kevin Hanneken, MD^*, David Gaieski, MD,^*Amrita Vempati, MD^*and Ronald Hall, MD^*

DOI: https://doi.org/10.21980/J88W69 Issue 5:4 No ratings yet.

ABSTRACT: Audience: Our target audience includes emergency medicine residents/physicians. Introduction: Treating cardiac arrest is a common theme during simulated emergency medicine training; however, less time is focused on treating refractory cases of cardiac arrest. There are varying definitions of refractory cardiac arrest, but it is most commonly defined as the inability to obtain return of spontaneous circulation (ROSC) after 10-30

Cardiology/Vascular Current Issue Simulation

Agitated Psychiatric Patient

Brooke M Pabst, MD^*, Cynthia Leung, MD, PhD^*, Jennifer A Frey, PhD^*and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J85352 Issue 5:4 No ratings yet.

At the conclusion of the simulation session, learners will be able to: 1) Obtain a relevant focused history and physical examination on the agitated psychiatric patient. 2) Develop a differential for the agitated psychiatric patient, including primary psychiatric conditions and other organic pathologies. 3) Discuss the management of the agitated psychiatric patient, including the different options available for chemical sedation. 4) Prioritize safety of self and staff when caring for an agitated psychiatric patient.

Psychiatry Current Issue Simulation

Cardiac Tamponade

Alan Chu MD^*and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J81D1D Issue 5:4 No ratings yet.

By the end of this simulation session, the learner will be able to: (1) describe a diagnostic differential for dizziness (2) describe the pathophysiology of cardiac tamponade (3) describe the acute management of cardiac tamponade, including fluid bolus and pericardiocentesis (4) describe the electrocardiogram (ECG) findings of pericardial effusion (5) describe the ultrasound findings of cardiac tamponade (6) describe the indications for emergent bedside pericardiocentesis versus medical stabilization and delayed pericardiocentesis for cardiac tamponade (7) describe the procedural steps for pericardiocentesis, and (8) describe your state’s laws regarding disclosure for sentinel events.

Cardiology/Vascular Current Issue Simulation

Owning the Trauma Bay: Teaching Trauma Resuscitation to Emergency Medicine Residents and Nurses through In-situ Simulation

Andrew Bellino, MD^*, Alexandra June Gordon, MD^{^}, Al’ai Alvarez, MD^*and Kimberly Schertzer, MD^*

DOI: https://doi.org/10.21980/J8WK9X Issue 5:4 No ratings yet.

ABSTRACT: Audience: The following two cases were designed to address learning objectives specific to interns, junior residents, and senior residents in emergency medicine, as well as trauma-certified emergency nurses. Introduction: Traumatic and unintentional injuries account for 5.8 million deaths across the globe each year, with a high proportion of those deaths occurring within the initial hour from the time of

Current Issue Simulation Trauma

Hemoptysis Due to Diffuse Alveolar Hemorrhage

Zoltan Buchwald, MD^* and Amrita Vempati, MD^*

DOI: https://doi.org/10.21980/J8ZP86 Issue 5:3 No ratings yet.

By the end of this simulation session, learners will be able to: (1) recognize worsening respiratory status of a patient with hemoptysis and intervene appropriately, (2) manage a patient with severe hemoptysis and perform appropriate ventilator management, (3) manage sinus tachycardia with QT prolongation on the ECG caused by cocaine and hypomagnesemia, (4) address various etiologies of hemoptysis, (5) discuss the causes of massive hemoptysis and management options, and (6) review ventilation strategies in an intubated hypoxic patient.

Respiratory Simulation