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Showing 30 of 30 scenarios
Ethics: Capacity Assessment and End-of-Life Care
Mr. Arthur Jenkins, an 82-year-old male with severe COPD (on 4L home O2) and CHF, is brought in by EMS for acute respiratory distress. He is alert but visibly anxious and struggling to speak full sentences. His wife states he recently discussed a desire to 'not be intubated' but never formalized a DNR.
Anaphylaxis
A 45-year-old female is brought in by EMS. She has a known severe peanut allergy and accidentally ingested a peanut butter cookie 20 minutes ago. She is anxious, speaking in short sentences, and covered in urticaria. Vitals: BP 85/50 mmHg, HR 125 bpm, RR 28 breaths/min, SpO2 90% on room air, Temp 98.6°F.
Tricyclic Antidepressant Overdose
A 35-year-old male is brought in by EMS after being found unresponsive at home with an empty bottle of amitriptyline nearby. Initial assessment shows a deeply altered mental status, dry skin, and dilated pupils. He is restless and intermittently seizing.
Opioid Overdose
A 28-year-old male is brought in by EMS after being found unresponsive in a public restroom. Paramedics report shallow, slow breathing (RR 6). He is pale and cyanotic. Initial vital signs: BP 90/60, HR 55, RR 6, Temp 36.5°C, SpO2 78% (on room air). Pupils are pinpoint.
Postpartum Hemorrhage
32-year-old G3P3 presents to the ED 2 hours after an uncomplicated spontaneous vaginal delivery (SVD) at an outside birthing center. She is pale, diaphoretic, and reports heavy vaginal bleeding since arrival. Initial vitals: BP 85/50 mmHg, HR 125 bpm, RR 22, SpO2 96% on room air. Estimated blood loss (EBL) on arrival is approximately 1500 mL. The fundus is boggy and palpable at the umbilicus.
Ectopic Pregnancy with Rupture
A 28-year-old female presents to the ED complaining of sudden onset severe, sharp lower abdominal pain radiating to her shoulder, accompanied by moderate vaginal spotting. She reports missing her last menstrual period and feeling dizzy in the triage waiting room. Vitals: BP 85/50, HR 125, RR 22, Temp 98.6°F (37.0°C), SpO2 98% on RA. She appears pale and diaphoretic.
Diabetic Ketoacidosis (DKA) in Child
A 10-year-old male is brought in by his parents with a 2-day history of increased thirst, frequent urination, vomiting, and increasing lethargy. He appears dehydrated and is breathing deeply and rapidly (Kussmaul respirations). Parents deny prior medical history.
Croup with Respiratory Distress
A 2-year-old male is brought to the Emergency Department by his parents. He has had 3 days of mild cold symptoms, but tonight developed a barking, seal-like cough and noisy breathing. He appears anxious and is retracting slightly. Initial triage vital signs: Temp 38.5°C, HR 135, RR 40, BP 90/55, SpO2 92% on room air.
Pediatric Septic Shock
A previously healthy 18-month-old male is brought in by his parents for 12 hours of fever (max 103.5°F) and increasing lethargy. He has had poor oral intake and decreased urine output (1 wet diaper in the last 8 hours). On arrival, he is irritable, moaning occasionally, and minimally responsive to voice. Vitals: HR 185, RR 48, BP 72/45 (MAP 54), Temp 102.8°F (rectal), SpO2 96% on room air. Capillary refill time is 5 seconds, and peripheral pulses are thready.
Bacterial Meningitis
A 35-year-old male presents to the ED accompanied by his wife. He reports a severe headache for 24 hours, now associated with neck stiffness and photophobia. He is lethargic and occasionally confused. Vitals: T 103.5°F (39.7°C), HR 115 bpm, BP 105/65 mmHg, RR 22, SpO2 96% on room air. Physical exam reveals nuchal rigidity and a faint petechial rash on his trunk.
Status Epilepticus
A 55-year-old male is brought in by EMS actively seizing. He has a known history of epilepsy but reportedly ran out of his medication (levetiracetam) three days ago. He has been seizing for approximately 7 minutes prior to arrival. Vitals: HR 125, BP 165/95, RR 24, SpO2 88% on room air, Temp 100.8°F (38.2°C). He is unresponsive, generalized tonic-clonic movements are continuous, and airway is noisy.
Spontaneous Pneumothorax
A 22-year-old tall, thin male smoker presents to the ED complaining of sudden onset sharp right-sided chest pain and shortness of breath that started while he was watching TV. He denies trauma. He is anxious but speaking in full sentences.
COPD Exacerbation with Respiratory Failure
A 72-year-old male with a history of severe COPD (on home oxygen) is brought in by EMS for increasing shortness of breath, productive cough, and lethargy over the last 24 hours. He appears anxious and is using accessory muscles to breathe. Initial Vitals: HR 115, BP 140/85, RR 32, Temp 99.8°F (37.7°C), SpO2 88% on 2L NC (his home setting).
Massive Pulmonary Embolism
A 65-year-old male with a history of recent knee replacement surgery presents to the ED via EMS. He reports sudden onset of severe shortness of breath and pleuritic chest pain 30 minutes ago. On arrival, he is pale, diaphoretic, and appears distressed. Vitals: BP 78/45 mmHg, HR 135 bpm, RR 32, SpO2 88% on room air, Temp 37.0°C.
Spinal Cord Injury Assessment
A 35-year-old male arrives via EMS following a motor vehicle collision (MVC). He was an unrestrained driver whose car struck a utility pole at high speed. He is complaining of neck pain and bilateral leg numbness. He is currently immobilized on a backboard with a cervical collar.
Pelvic Fracture with Massive Hemorrhage
45-year-old male restrained driver involved in a high-speed motor vehicle collision (MVC). Extrication took 30 minutes. He is pale, cool, and minimally responsive. Vitals: BP 70/40, HR 135, RR 28, SpO2 92% on room air. Primary survey reveals significant bilateral lower extremity deformity and obvious instability of the pelvis upon gentle palpation.
Penetrating Chest Trauma with Tension Pneumothorax
A 35-year-old male presents via EMS after being stabbed in the left chest. He is agitated, cyanotic, and struggling to breathe. Vitals: HR 140, BP 80/50, RR 40 (shallow), SpO2 85% (on non-rebreather). Physical exam reveals tracheal deviation to the right and severely diminished breath sounds on the left.
Multi-System Trauma with Hemorrhagic Shock
35-year-old male restrained driver in a high-speed motor vehicle collision (MVC) with significant passenger-side intrusion. Paramedics report extrication time of 20 minutes. Patient is pale, diaphoretic, and minimally responsive. Initial Vitals: BP 70/45, HR 135, RR 30, SpO2 92% (on non-rebreather), GCS 10 (E2 V3 M5). Initial FAST is positive in the RUQ and LUQ.
Aortic Dissection
A 65-year-old male with a history of poorly controlled hypertension presents to the ED complaining of sudden, severe, 'tearing' chest pain radiating to his back. The pain started 30 minutes ago. He appears anxious and diaphoretic.
Cardiac Arrest - VF/Pulseless VT
A 55-year-old male collapses suddenly in the waiting room. Security staff initiate CPR immediately. EMS arrives and reports the patient is unresponsive, apneic, and pulseless. Initial rhythm check shows coarse Ventricular Fibrillation (VF).
Acute Heart Failure and Pulmonary Edema
A 72-year-old male with a history of hypertension, CAD, and known HFrEF (LVEF 30%) presents via EMS complaining of sudden, severe shortness of breath that started 2 hours ago. He reports orthopnea and pink, frothy sputum. On arrival, he is sitting upright, visibly distressed, and using accessory muscles.
Unstable Atrial Fibrillation with RVR
A 68-year-old male presents to the ED complaining of sudden onset palpitations and shortness of breath for the last 3 hours. He has a history of hypertension and well-controlled type 2 diabetes. On arrival, he appears pale and anxious.
Acute STEMI Management
A 58-year-old male presents with crushing chest pain radiating to the left arm. ECG shows ST elevation in leads II, III, and aVF. Navigate through critical decisions for acute myocardial infarction management.
Eclampsia Management
A 32-week pregnant patient with severe headache and seizure. Recognize eclampsia, initiate magnesium sulfate, and coordinate with OB for emergent delivery.
Acute Stroke Code
A 68-year-old with sudden onset right-sided weakness and aphasia. Work through the stroke code protocol and determine tPA eligibility within the critical time window.
Acetaminophen Overdose
A 19-year-old presents 6 hours after intentional ingestion of 15g acetaminophen. Calculate the Rumack-Matthew nomogram and initiate N-acetylcysteine protocol.
Acute Asthma Exacerbation
A 28-year-old with severe asthma exacerbation not responding to initial bronchodilators. Escalate therapy appropriately and recognize impending respiratory failure.
Traumatic Brain Injury Assessment
A 35-year-old involved in a motorcycle accident with loss of consciousness. Apply the Canadian CT Head Rule and manage increased intracranial pressure.
Pediatric Febrile Seizure
A 2-year-old with first-time febrile seizure. Differentiate between simple and complex febrile seizures and manage appropriately while counseling anxious parents.
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