Adult
You can use one of these already created Google Slides "Rooms" to run your virtual simulation.
ASA Overdose
The learner will be presented with an altered febrile patient, requiring an initial broad work-up and management plan. The learner will receive a critical VBG report of severe acidosis, hypoglycemia and hypokalemia, requiring management. Following this, the rest of the blood work and investigations will come back, giving the diagnosis of salicylate overdose. The patient’s mental status will continue to decline and learners should proceed to intubate the patient, anticipating issues given the acid-base status. The learner should also initiate urinary alkalinization and make arrangements for urgent dialysis.
Google Slide Room (view only)
Case By: EMSimCases. Room by Dr. Sarah Foohey.
Anaphylaxis
A 45 year old man eating in the hospital cafeteria feels lightheaded and then collapses. He is found to be having an anaphylactic reaction with wheezing, stridor, tongue swelling, and hives. The learners should recognize this as an upper airway emergency and review the steps involved in upper airway management while treating the anaphylaxis.
Google Slide Room (view only)
Case By: Dr. Sarah Foohey, modified from case provided by Clerkship Airway Seminar, Undergraduate Medical Program, University of Toronto
Atrial Fibrillation
62 year old woman presents with lightheadedness. Is found to be in atrial fibrillation. Is initially stable, giving learners the opportunity to do complete history and physical. Patient then becomes unstable, requiring the learners to proceed with cardioversion. A discussion about appropriate discussion for sedation for a hypotensive patient will likely be generated. The cardioversion is successful.
Google Slide Room (view only)
Case By: Victoria Forcina (MD Candidate 2022) and Shauna Jose (MD Candidate 2022). Reviewed by Dr. Sarah Foohey.
Bradycardia
72 year old female with a 4 day history of feeling unwell, decreased oral intake. Had syncopal episode earlier today and feels weak. Found to be bradycardic and unstable, requiring pacing. As the case progresses, initial labs will show an AKI and hyperkalemia. Based on how the learners progress, the case can end upon stabilization of the patient with pacing or progress to a PEA arrest.
Google Slide Room (view only)
Case By: Dr. Garvin Leung & Dr. Debbie Brace
Cardiac Arrest: PEA & UGIB
The patient is a 59 year old who called EMS after having multiple episodes of frank hematemesis. He is hypotensive but conscious with EMS, but en route to the ED his LOC declines. Shortly after arrival in the resus room, he loses his pulse. Learners must manage his PEA arrest. After Epi is given twice, they are again able to palpate a pulse. The learners must then manage his hypotension in the context of blood loss and presumed UGIB.
Google Slide Room (view only)
Case By: Dr. Sarah Foohey. Modified from case written by Dr. Shelton and Dr. DeSousa from the Sunnybrook Canadian Simulation Centre.
Cardiac Arrest: Hypothermia
50 year old man is brought to your community ED. He was found by the police in a wet sleeping bag with no winter coat, surrounded by beer bottles in the winter. Initially he is altered and unstable, and the team should begin rewarming. Regardless of their actions, he will progress to a VF arrest. ECMO is not available because of resource limitations, but the team recommends active rewarming until target 30-32d is reached. Various rewarming strategies can be attempted depending on team’s experience and environment.
Google Slide Room (view only)
Case By: Dr. Sarah Foohey. For the 2023 EM Cases Sim Summit.
CHF & Pneumothorax
A 74 year old woman presents with several days of SOB. The learners can use POCUS images to identify and diagnose CHF. They will start medications and a trial of BiPAP. The patient then develops chest pain, becomes unstable, and is found to have a new diagnosis of PTX on POCUS. The learners can work through their steps of doing a finger decompression with procedure slides.
Google Slide Room (view only)
Case By: Dr. Melissa Snyder
Eclampsia
A 30 year old woman who is 32 weeks pregnant presents with headache, vision changes, and vomiting with a blood presure of 165/115. She begins seizing and ultimately requires intubation.
Google Slide Room (view only)
Case By: Dr. Julia Wystma and Dr. Eileen Cheung, modified from a case written by Dr. Kyla Caners from EMSimCases. Room by Dr. Julia Wystma.
House Fire & Cric
Steven is a 25-year old man who is brought in by ambulance to ED. He was extricated from a burning house and is unresponsive. He has singed eyebrows, soot on his face and in his nares. He also has burns to his entire chest, abdomen, front of his right arm and right leg. Case includes: burn management, difficult airway (with a cric procedural slide), recognition and treatment of cyanide toxicity.
Google Slide Room (view only)
Case By: Dr. Lauren Self, modified from a case written by Dr. Kyla Caners from EMSimCases. Room by Dr. Sarah Foohey.
Hyperkalemia
A 65 year old man who is a dialysis patient presents after a witnessed collapse. His initial ECG shows a wide complex QRS. Learners should manage empirically as hyperkalemia. If promptly treated as hyperK, the rhythm will change to sinus. If hyperK is not addressed, the patient will proceed to have an asystolic arrest.
Google Slide Room (view only)
Case By: Dr. Chelsea Hall.
Hyponatremia
A 56 year old woman presents to the ED after having a generalized seizure. While in the ED, she has another seizure. She is found to have a sodium of 110 and requires management with 3% NS. The purpose of this case is to discuss simultaneous seizure management with concurrent consideration of status DDx.
Google Slide Room (view only)
Case By: Dr. Chelsea Hall.
Multisystem Blunt Trauma (MVC)
A 71 year old man presents after a high speed MVC. He is tachycardic and hypoxic on arrival. He is found to have a pneumothorax that requires urgent management. His FAST is initially negative but becomes positive on repeat. Learners should consider the concurrent diagnosis of neurogenic shock. The case has a full series of ultrasound images so learners can complete the FAST, a specific trauma tray, and a series of procedural slides for them to complete the finger decompression and thorocostomy.
Google Slide Room (view only)
Case By: Dr. Andrew Petrosoniak. Room by Dr. Sarah Foohey.
Multisystem Penetrating Trauma
An adult male presents after multiple gunshot wounds, to the chest and to the leg. He requires a chest tube and recognition of acute ischemic limb.
Google Slide Room (view only)
Case By: Modified from EM Sim Cases for the 2023 EM Cases Sim Summit.
Opioid Overdose
A 35 year old male presents to the ED with ALC, and is found to be bradypneic and hypothermic secondary to opioid overdose. Participants will learn how to identify and manage patients with opioid overdose and respiratory distress.
Google Slide Room (view only)
Case By: Victoria Forcina (MD Candidate 2022) and Shauna Jose (MD Candidate 2022). Reviewed by Dr. Sarah Foohey.
Resuscitative Hysterotomy
The patient is a 22-year-old G1P0 woman at 38 weeks GA age who has been endorsing chest pain and progressive dyspnea for the last 24 hours. She presents to your community hospital with severe chest pain, 2-word dyspnea, and abnormal vitals. The team will be given 3 minutes to prepare as EMS patches in notification of the case. She will arrest soon after arrival to the resuscitation room. Resuscitative hysterotomy will need to be performed. The diagnosis of massive PE can be made using history, physical exam, and using provided ultrasound findings. After the perimortem hysterotomy and thrombolysis is complete, the patient will see a pulse visible on ultrasound of her femoral artery, giving the group the opportunity to discuss pseudo PEA vs. PEA.
The team can use the C/S slides to walk through the steps involved in the perimortem hysterotomy, ending with a third slide that shows a video of the baby being delivered. This case could be used in sequence with the NRP case.
Google Slide Room (view only)
Case By: Dr. Mike Saccone and Dr. Sarah Foohey. Room by Dr. Sarah Foohey.
Subarachnoid Hemorrhage
A 45-year-old male who suffered an aneurysmal subarachnoid hemorrhage while weightlifting presents to the emergency department requiring intubation for airway protection and develops Cushing’s response requiring ICP lowering maneuvers before definitive surgical management.
Google Slide Room (view only)
Case By: Dr. Martin Kuuskne from McGill University, from EM Sim Cases.
Sepsis: Pneumonia
case summarycough. She is found to be septic and hypoxic. She requires resuscitation with fluids, antibiotics, and pressors. She will have escalating oxygen requirements and ultimately require intubation.
Google Slide Room (view only)
Case By: Case from SimSinai collection. Updated for EM Cases Course Feb 2021 by Dr. Sara Gray, Dr. Yasmin Mawji, and Dr. Nick Clarridge.
Sepsis: Pyelonephritis
This is a case of a 64-year-old male with a history of recurrent urinary tract infections. He presents to the ED with signs and symptoms of pyelonephritis. He was started on iv ceftriaxone and admitted to CTU 3 days ago. Overnight he becomes lethargic, disoriented, and hypotensive. He will have increasing SOB He will require transfer to the ICU as vasopressors will be needed. His blood cultures and urine culture grow E. coli and susceptibility indicates extended-spectrum beta-lactamase (ESBL) susceptible only to carbapenems, ciprofloxacin, and nitrofurantoin. This case covers the pathophysiology and management of sepsis. It also emphasizes the importance of antibiotic resistance, recognizing the risk factors for resistance and appropriate empiric antibiotic therapy.
Google Slide Room (view only)
Case By: Case and Virtual Room created by Dr. Kevin Shi, UBC
Shock NYD: Pulmonary Embolism
A 60 year old woman presents to the ED after a syncopal episode. She has a history of breast cancer. She is tachycardic and hypotensive. Learners are expected to work through their DDx for shock. This case is designed to allow learners to practice using the RUSH protocol for undifferentiated shock, and has a selection of ultrasound images. Learners can make the diagnosis of PE using these US findings. She becomes progressively unstable and ultimately arrests, requiring lysis.
Google Slide Room (view only)
Case By: Case from Sim Sinai. Updated by Dr. Rob Simard and Dr. Sarah Foohey Feb 2021.
Status Epilepticus
A 25 year old mpatientan presents to the emergency department after having a tonic-clonic seizure. While in your ED, patient has another seizure that persists, requiring status management and intubation.
Google Slide Room - FEMALE PATIENT (view only)
Google Slide Room - MALE PATIENT (view only)
Case By: Dr. Justin Hsu. Reviewed by: Dr. Marlee Klaiman, Dr. Sarah Foohey, Dr. Alex Alferis.
STEMI comp. by Bradycardia
85F with inferior STEMI, presenting in cardiogenic shock with hypotension and bradycardia. Needs to be stabilized before going to the cath lab.
Google Slide Room (view only)
Case By: Dr. Sarah Foohey
STEMI comp. by CHF
The case begins with a resident on call receiving a page from the floor. A patient is experiencing chest pain. The patient will be diaphoretic and have signs of CHF. His ECG will initially show new TWI and then evolve to an anterior STEMI. Residents will have to activate the cath lab and initiate management of his ACS and CHF.
Google Slide Room (view only)
Case By: Dr. Kyla Caners, case from EMSimCases. Room by Dr. Sarah Foohey.
STEMI comp. by VTach
A 65 year old man presenting with SOB is found to have a STEMI on ECG. While the learners are managing his STEMI, he will develop stable and then unstable ventricular tachycardia. The case resolves after the patient has been cardioverted and STEMI medications are given.
Google Slide Room (view only)
Case By: Dr. Sarah Foohey & Alexandra Aliferis (CC3, McMaster Medical School)
Supraventricular Tachycardia (SVT)
A 23 year old woman presents with “heart racing” and is found to be in SVT. She is initially stable and learners can trial vagal maneuvers and medications. She then becomes hypotensive and learners should proceed with cardioversion. When they complete the cardioversion, they can “use” the machine.
Google Slide Room (view only)
Case By: Dr. Sarah Foohey.
Sympathomimetic Toxidrome
26 year old male who presents with paranoia. He is found to be tachycardic, hypertensive, and hyperthermic. His presentation is secondary to acute methamphetamine intoxication. Learners will aim to de-escalate the ED encounter, discuss appropriate chemical/physical restraint use for this patient, encounter one of the medical complications of the sympathomimetic toxidrome, and safely provide informed discharge for the patient with IVDU.
Google Slide Room (view only)
Case By: Victoria Forcina (MD Candidate 2022). Reviewed by Dr. Sarah Foohey.
Tricyclic Antidepressant Overdose (TCA)
A 25 year old man presents with a seizure after an Amitriptyline overdose. He requires management of the seizure and ultimately will need to be intubated. He also has a wide complex QRS on ECG which, depending on the level and management of your learners, may progress to VT.
Google Slide Room (view only)
Case By: Dr Luke Hays, Osler Sim Lead.
Vertigo & Cerebellar Stroke
66 year old man with “dizziness”. Found to have symptoms and signs concerning for cerebellar stroke, after learners complete a thorough assessment including HINTS exam. After a time lapse, the patient’s clinical status deteriorates. He becomes obtunded secondary to posterior fossa edema.
Google Slide Room (view only)
Case By: Dr. Sarah Foohey
Ventricular Tachycardia (VTach)
A 65 year old man presents to the ED with “fast heart beat”. He rhythm is found to be ventricular tachycardia. He is initially stable. He then becomes hypotensive and develops chest pain. As the learners are preparing to cardiovert, he loses his pulse. The learners will review the tenants of good quality CPR before defibrillating the patient. After defibrillation, he will regain his pulse.
Google Slide Room (view only)
Case By: Dr. Sarah Foohey, modified from a case from EMSimCases.
