By the end of this simulation, learners will be able to (1) assess for causes of severe shortness of breath, (2) manage severe COPD exacerbation by administering appropriate medications, (3) identify worsening clinical status and initiate NIPPV, (4) assess the causes of hypoxia after establishing endotracheal intubation and, (5) identify indication for needle decompression and perform chest tube thoracostomy.
ABSTRACT: Audience: This scenario was developed to educate emergency medicine residents on the diagnosis and management of wound botulism secondary […]
The ECG does show multiple subtle abnormalities that in conjunction with his symptoms and risk factors are concerning for ischemia and/or occlusion of the coronary artery vessel. 1) ST depression in aVL. Although slight, the ST segment is below the TP segment or isoelectric point (blue circles). 2) Focal hyper QT waves. The T-waves in II, III, AVF V2, V3, and V4 are hyper acute, namely peaked and tall in relationship to the QRS. These are best displayed in leads II, III, and AVF where the T-waves are taller than the QRS amplitude (vertical blue lines). 3) Straightening off the ST segment. Multiple leads display a straight ST segment namely aVL, III, AVF, and V2 (red lines). Of note, the length of the straight ST segment is greater than 1/4 the amplitude of the QRS (purple lines). 4) Although subtle, these abnormalities are focal in nature.
The presence of soft tissue stranding about the parotid gland suggested an underlying inflammatory or infectious process of the parotid gland. Cellulitis was considered as a possible diagnosis as well, given the presence of soft tissue stranding in the dermis that is adjacent to the parotid gland. Fortunately, no enhancement was seen in local muscles, fascia, or bones to suggest a myositis, fasciitis, or osteomyelitis. By using the anatomy of the patient and understanding the changes that occur on CT when inflammation is present, the appropriate depth and location of infection can be made, allowing for appropriate treatment regimens.
Video laryngoscopy of the upper airway was performed two days after initial burn injury. The images obtained demonstrated laryngeal edema and inflammation near the epiglottis. The dot identifies the epiglottis and the asterix identifies the area of moderate thermal burns. Imaging also demonstrated adequate patency of airway and ruled out the need for intubation at that time.
Images taken of the bilateral palmar skin lesions at our institution showed multi-centimeter, well-demarcated, friable, verrucous, crusted plaques with overlying fine yellow crust. Lesions such as these are suspicious for syphilitic gummas seen with cutaneous tertiary syphilis.
At the completion of the simulation and debriefing, the learner will be able to: 1) recognize the physical exam findings and presentation of SCAPE, 2) utilize imaging and laboratory results to further aid in the diagnosis of SCAPE, 3) initiate treatments necessary for the stabilization of SCAPE, 4) demonstrate the ability to assist with the stabilization and disposition of a patient via tele-medicine as determined by the critical action checklist and assessment tool below, 5) interpret the electrocardiogram (EKG) as atrial fibrillation with rapid ventricular response (AFRVR), and 6) recognize that SCAPE is the underlying cause of AFRVR and continue to treat the former.
By the end of this simulation case, learners will be able to: 1) describe the classic clinical presentation of anticholinergic toxicity, 2) discuss common medications and substances that may lead to anticholinergic toxicity, 3) recognize the electrocardiogram (ECG) findings in anticholinergic toxicity that require specific therapy, and 4) review the management of anticholinergic toxicity.
