Archives

Small-Scale High-Fidelity Simulation for Mass Casualty Incident Readiness

Seanne Facho, MD*, Andrea Weiers, MD*, Amber Jones, MD*, Sage Wexner, MD* and Jessie Nelson, MD^

DOI: https://doi.org/10.21980/J84S8S Issue 6:4 No ratings yet.
The learners will (1) recognize state of mass casualty exercise as evidenced by verbalization or triaging by START (Simple Triage and Rapid Treatment) criteria, (2) triage several patients, including critically ill or peri-arrest acuities, according to START criteria, (3) recognize the need to limit care based on available resources, as evidenced by verbal orders or communication of priorities to team, and (4) limit emergency resuscitation, given limited resources, by only providing treatments and employing diagnostics that do not deplete limited time, staffing, and space inappropriately.
Current IssueEMSSimulation

Cardiac Arrest in an Adolescent with Pulmonary Embolism

Matthew Myers, DO* and Courtney Devlin, MD*

DOI: https://doi.org/10.21980/J8135T Issue 6:4 No ratings yet.
ABSTRACT: Audience: The target audience of this simulation is emergency medicine residents and medical students. The simulation is based on a real case of a 13-year-old female who presented with seizures and hypoxia and was ultimately diagnosed with pulmonary embolism. The case highlights diagnosis and management of an adolescent with new onset seizures, deterioration in status, and treatment options in
Cardiology/VascularCurrent IssuePediatricsSimulation

Meningococcal Meningitis with Waterhouse-Friderichsen Syndrome

Jonathan Kelley, DO* and Amrita Vempati, MD*

DOI: https://doi.org/10.21980/J8TH1K Issue 6:3 No ratings yet.
By the end of this simulation session, learners will be able to: (1) manage a patient with altered mental status (AMS) with fever while maintaining a broad differential diagnosis, (2) recognize the risk factors for meningococcal meningitis, (3) manage a patient with worsening shock and perform appropriate resuscitation, (4) develop a differential diagnosis for thrombocytopenia and elevated international normalized ratio (INR) in an altered febrile hypotensive patient with rash, (5) manage the bleeding complications from WFS, (6) discuss the complications of meningococcal meningitis including WFS, and (7) review when meningitis prophylaxis is given.
Infectious DiseaseNeurologySimulation

Eclampsia

Thomas J Yang, MD*, Rohit B Sangal, MD, MBA* and Lauren W Conlon, MD^

DOI: https://doi.org/10.21980/J8PS8R Issue 6:3 No ratings yet.
By the end of this simulation session, learners will be able to: 1) demonstrate care of a gravid patient with altered mental status; 2) demonstrate care of a gravid patient with seizures; 3) recognize care involved in assessment of fetal status; 4) execute appropriate subspecialty consultation; 5) recognize the clinical signs and symptoms of eclampsia; 6) distinguish different treatment options for eclampsia; 7) identify magnesium toxicity and reversal agent; and 8) differentiate the spectrum of preeclampsia.
Ob/GynSimulation

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.
ProceduresRespiratorySimulation

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.
NeurologySimulationToxicology

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/OncologySimulation

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.
NeurologySimulation

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.
AdministrationSimulation

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/VascularSimulation