This resource is a simulation case using a high-fidelity human patient simulator. The case involves a patient who presents to the emergency department in status asthmaticus and does not respond to appropriate treatment. The patient requires intubation and subsequently stabilizes with continued treatment. After a brief period of stabilization and improvement, the patient starts to acutely deteriorate as he develops a pneumothorax from positive pressure ventilation. This rapidly develops into a tension pneumothorax, which requires needle decompression followed by tube thoracostomy in order for the patient to be resuscitated. The case is designed to provide an assessment of the resident’s ability to clinically reassess a patient who deteriorates following initial resuscitation.
By the end of this simulation case, participants will be able to:
- Demonstrate rapid primary survey assessment to detect a patient’s respiratory distress with initiation of emergent interventions, including supplemental oxygen, pharmacotherapy, and assuring the patient’s airway is protected.
- Know the indications and contraindications for rapid sequence intubation of an emergent patient with respiratory failure.
- Recognize the clinical findings that should arouse suspicion of tension pneumothorax in the clinical course of managing an intubated patient with respiratory failure.
- Perform a successful needle decompression of a tension pneumothorax.
- Demonstrate successful placement of a chest tube following needle decompression (with confirmation of appropriate placement).
- Demonstrate a focused history and physical exam to assess the nature and severity of respiratory distress and factors influencing the optimal approach to airway control.
- Demonstrate the ability to recognize clinical features of respiratory failure requiring definitive airway control and to interpret accompanying ancillary studies.
- Know the appropriate agents for rapid-sequence intubation based on the patient’s underlying condition.
- Demonstrate appropriate intubation technique, including the avoidance of prolonged (more than 30 seconds) attempts if difficulty is experienced.
- Demonstrate appropriate use of a consultant to provide a definitive airway if a definitive emergent airway cannot be secured.
- Understand the risk factors and the basic mechanism for tension pneumothorax.
- Demonstrate a concise, focused verbal report and produce a comprehensive, focused written emergency department record.
© 2008 Ten Eyck.
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Ten Eyck R. Status asthmaticus with development of tension pneumothorax post-intubation. MedEdPORTAL. 2008;4:787. https:/
doi. org/ 10. 15766/ mep_ 2374- 8265. 787