O2 SAT: 94% RA - 1-2L saline bolus - All actions complete or 5 min into case 2. Worsening T: 37oC - Tox/Abdo/G+S Bloodwork hemodynamics - B-HCG - Cap glucose - POCUS (IUP, no free fluid) - CXR/AXR 2. Worsening Breathing more Learner Actions Modifiers labored. - If not yet asked, boyfriend comes hemodynamics - Prepare for intubation Becomes to room HR → 140 - Fluid resuscitation obtunded. - If no intubation by 8 min, O2 SAT BP → 80/50 - Push dose pressors → drops 80% RR → 25 - ± Start or prepare **VBG result O2 SAT → 88% vasopressor infusion given at onset Triggers - Consider naloxone of state - Intubate 3. Persistent hypotension 3. Persistent Easy intubation. Learner Actions Modifiers - If not yet asked, boyfriend shows hypotension - Call poison control Sedated. bag of meds (1 empty bottle of HR → 110 - Start vasopressor or increase prenatal vitamins, full Prozac and BP → 80/55 dose herbal supplements) RR → 12 - Start chelation therapy - Rest of bloodwork given O2 SAT → 96% - Prepare for whole bowel - If called, Poison Control suggests irrigation (insert OG) deferoxamine at 15mg/kg/hr (may - Foley catheter lower for hypotension) and whole - Post-intubation sedation bowel irrigation - Heavy metal levels Triggers - Start chelation 4. Resolution 4. Resolution Sedated. Learner Actions Modifiers Intubated. HR → 95 - Call ICU Ventilated. Triggers BP → 105/65 - Discuss psych assessment - ICU called End of case RR → 12 O2 SAT → 96% Section VI: Scenario Progression Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results VBG: pH 7.05/PCO2 38/PO2 80/HCO3 5 CBC: Hb 90/WBC 17/Plts 65 Lytes: Na 135/K + 4/HCO3 5/Cl 100/ Cr 130/Glucose 17 Lactate: 8
O2 SAT: 94% RA T: 37oC - 1-2L saline bolus - Tox/Abdo/G+S Bloodwork - B-HCG - Cap glucose - POCUS (IUP, no free fluid) - CXR/AXR - All actions complete or 5 min into case 2. Worsening hemodynamics 2. Worsening hemodynamics HR → 140 BP → 80/50 RR → 25 O2 SAT → 88% Breathing more labored. Becomes obtunded. **VBG result given at onset of state Learner Actions - Prepare for intubation - Fluid resuscitation - Push dose pressors - ± Start or prepare vasopressor infusion - Consider naloxone Modifiers - If not yet asked, boyfriend comes to room - If no intubation by 8 min, O2 SAT drops → 80% Triggers - Intubate 3. Persistent hypotension 3. Persistent hypotension HR → 110 BP → 80/55 RR → 12 O2 SAT → 96% Easy intubation. Sedated. Learner Actions - Call poison control - Start vasopressor or increase dose - Start chelation therapy - Prepare for whole bowel irrigation (insert OG) - Foley catheter - Post-intubation sedation - Heavy metal levels Modifiers - If not yet asked, boyfriend shows bag of meds (1 empty bottle of prenatal vitamins, full Prozac and herbal supplements) - Rest of bloodwork given - If called, Poison Control suggests deferoxamine at 15mg/kg/hr (may lower for hypotension) and whole bowel irrigation Triggers - Start chelation 4. Resolution 4. Resolution HR → 95 BP → 105/65 RR → 12 O2 SAT → 96% Sedated. Intubated. Ventilated. Learner Actions - Call ICU - Discuss psych assessment Modifiers Triggers - ICU called End of case Section VI: Scenario Progression Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results VBG: pH 7.05/PCO2 38/PO2 80/HCO3 5 CBC: Hb 90/WBC 17/Plts 65 Lytes: Na 135/K + 4/HCO3 5/Cl 100/ Cr 130/Glucose 17 Lactate: 8
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