Introduction: Pulmonary hypertension is not often a diagnosis that is made in the emergency department, but early diagnosis of this disease can lead to earlier referral for treatment. Emergency care providers should be comfortable in performing resuscitation in any patient with shock, as patients with pump failure can present to emergency departments. Simulation is an excellent modality to train emergency care providers how to troubleshoot a case that is not frequently encountered. Methods: This resource on syncope and dyspnea is a human-patient simulation case scenario appropriate for medical students, nurses, residents, and physician assistants. In the scenario, the patient experiences a pulmonary hypertension crisis from infusion pump failure. Participants are expected to recognize the cause of shock, prioritize treatment modalities, implement the treatments collaboratively, and communicate with other team members and consultants effectively. Results: This simulation case was classroom tested in our simulation center in the presence of 15 learners, including nurse practitioners, physician assistants, medical students, emergency medicine residents, a fellow, and attendings. Feedback was collected at the conclusion of the case. The learners found the case to be realistic and relevant to emergency medicine training. The residents found it challenging to resuscitate a patient who provided very little history and yet was critically ill, but the clues given were enough to conclude that the patient had pump-dependent pulmonary arterial hypertension. Discussion: This case is significant in that it addresses a current gap in the emergency medicine and critical care curriculum. Failure to accurately diagnose and troubleshoot pump malfunction leads to significant morbidity and mortality.
- Perform a complaint-focused history and physical exam when presented with a hypotensive, hypoxic patient.
- Discriminatively identify and address the etiology of shock.
- Review pulmonary arterial hypertension, its typical presentation, and the handling of pumps.
- Demonstrate the diagnostic workup for young patients with syncope and shock.
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