[0:12]Hello, doctor. My name. Welcome. If you have a seat right there.
[0:24]I'm Dr. Tansky, it's nice to meet you. It's nice to meet you. I'm Dr. Nice to meet you. Hello doctor. This is a prioritization case. Keep in mind that while prioritizing care, patient information and diagnostic results provided by the examiner may be very limited. Sometimes I may interrupt you to move through the case. This does not reflect your performance. In the time allotted, it's possible you may not have the opportunity to completely manage every patient on your tracking board. You'll have 15 minutes to complete the case. Before we begin, do you have any questions? Nope. The clock starts now. You are a single covered ED physician working at a community hospital. Six patients are waiting to be seen. Here is your patient tracking board. After reviewing the tracking board, let me know when you are ready to proceed. Okay, I'm ready. What one or two most important pieces of additional information from the history, physical exam, or immediately available diagnostic testing would you like to know about each patient A through F in order for you to prioritize care? Okay. Patient A, I would go ahead and find out if it's a intentional wrist laceration. I would check for arterial bleeding and then I would go ahead and um get an x-ray for foreign body. Patient B, I would know want to know their medical history. I'd want to listen for their breath sounds, and I'd uh get a chest x-ray and an EKG. Patient C, I would go ahead and find out her medical history, including if if she's on uh oral contraceptive pills. I'd go ahead and um listen for her breath sounds and get an EKG. Patient D, let's see. 72-year-old altered mental status. I need to know medical history. I need to um know pupillary exam if they have pinpoint pupils. And then I need to have someone give me an accu check. And then patient E, I need to know it's an ankle injury. I need to know if it's open, if it's dislocated, if there is a pulse distally and if there's normal sensation distally. Um, I'd also go ahead and put an e any normal uh ankle x-ray. Um, and then patient F, I would find out if this started right after they um, right after they were like eating something or had something in their mouth, or if they uh, like are vaccinated. I don't think they need any testing right now. Here is your updated patient tracking board with additional patient information. Links to additional diagnostic studies are highlighted in gray for you to view. After reviewing the tracking board, let me know when you are ready to proceed.
[3:39]Can I um take a look at the EKG stimulus? Here's your EKG. I think uh sinus rhythm. Normal access, normal intervals, our ST segments look okay. Okay, look at the chest x-ray. Chest x-ray has no obvious pneumonia. There's no pneumothorax. us midline. Based on what you know now, which patient do you want to treat first and what immediate stabilizing treatment would you provide?
[4:16]I'm going to go see patient B first. And I would put them on non-invasive positive pressure ventilation, um, since they're sad at 86% on a non-rebreather. Thank you. Are there any tasks you'd like to delegate to your care team to do while you're caring for this patient? Um, I would go ahead and get a IV put in patient D and an IV put in patient E and get that room set up for a procedural sedation. You've stabilized your first patient. Which patient would you choose to evaluate second and why? I'd go see patient D second. Um, they're lethargic with a hypoglycemic blood sugar. I would go ahead and uh evaluate them next. What immediate actions would you take? Um, I would go ahead and start 250 milliliters of D10 on that patient as a bolus, um, and assess for response. Doctor, here is your ECG for patient C. With normal access.
[5:27]Normal intervals. Normal rate, and our ST segments look okay. You've stabilized your second patient. Which patient would you choose to evaluate third and why? Um, I would go see patient E third. So they uh have an ankle injury with no pulses and a trimalar fracture, um needs to be evaluated for uh emergent reduction. Thank you. What immediate actions would you take? I would go ahead and I would push 2 mg per kilogram of uh ketamine and I would perform a reduction and a splint to reduce that uh reduce that fracture and get a pulse back. Thank you. You've stabilized your third patient. Before you can evaluate the remaining patients, two additional patients G and H arrive by EMS and have been added to your tracking board.
[6:20]Considering the remaining initial patients and the arrival of two new patients, who would you assess now and what immediate stabilizing treatments would you provide? Um, I would go see patient H next. Uh, they have facial burns and certain airway and they need to be intubated. All of your patients have been assessed and stabilized. Thank you, doctor. This concludes your case.
