Below you will find a weekly series of educational resources and a case bank that can be used on shift during times of boarding.

Clinical Setting: 50 y M with CAD s/p CABG, COPD, cirrhosis who presents from his primary care doctor with an abnormal EKG, palpitations.

HR - 160
BP - 125/66
RR - 20
SpO2 - 93% on RA Temp - 97.8 F

In the times of paper charting, new patients would show up in a file box in A/B/C pod - “Hitting the Box” is our colloquial saying for picking up new patients.

Click here for Link to Case Files

Instructions - These cases are meant to be presented to the learner over a longer period of time. The objective of the case administration is to force the learner to task switch and to essentially add an extra virtual patient to their list of active patients.

Start by allowing the resident to collect a history and physical and order some labs. Allow some time to pass and then provide them with the lab results (can time this such that it forces them to task switch). Discuss additional diagnostics and therapeutics and then allow the case to unfold until they ultimately disposition the patient. You can debrief on the content at an opportune time when the resident has time to digest the learning points.

The Archives - Previous weeks resources

Link to One Drive - Boarding Educational Resources

Procedures

Week 1: EJ Placement

Week 2: Peripheral IJ

Week 3: Subclavian Line

Week 4: Supraclavicular Line

Week 5: Femoral Line

Week 6: IJ Central Line

Week 7: Hemodialysis Catheter placement

Week 8: Abscess I&D Loop Drainage

Week 9: NailBed Laceration Repair

Week 10: Bartholin Gland Abscess Drainage

Week 11: Lateral Canthotomy

Literature

Week 1:Casey, J. D. et al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. New Engl J Med 380, 811–821 (2019).

Week 2: Burton, J. H., Harrah, J. D., Germann, C. A. & Dillon, D. C. Does End‐tidal Carbon Dioxide Monitoring Detect Respiratory Events Prior to Current Sedation Monitoring Practices? Acad Emerg Med 13, 500–504 (2006).

Week 3: Driver, B. E. et al. Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation. Jama 326, 2488–2497 (2021).

Week 4: Kheterpal S, Han, Richard, Tremper, Kevin K., et al. Incidence and Predictors of Difficult and Impossible Mask Ventilation. Surv Anesthesiol 2007;51(6):290. 10.1097/sa.0b013e31815c0fdb

Week 5: Driver BE, Klein LR, Carlson K, Harrington J, Reardon RF, Prekker ME. Preoxygenation With Flush Rate Oxygen: Comparing the Nonrebreather Mask With the Bag-Valve Mask. Ann Emerg Med 2018;71(3):381–6. 10.1016/j.annemergmed.2017.09.017

Week 6: Neumann JT, Twerenbold R, Ojeda F, et al. Application of High-Sensitivity Troponin in Suspected Myocardial Infarction. New Engl J Med 2019;380(26):2529–40. 10.1056/nejmoa1803377

Week 7: Baldi E, Schnaubelt S, Caputo ML, et al. Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest. Jama Netw Open 2021;4(1):e2032875. 10.1001/jamanetworkopen.2020.32875

Week 8: Lemkes JS, Janssens GN, Hoeven NW van der, et al. Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. New Engl J Med 2019;380(15):1397–407. 10.1056/nejmoa1816897

Week 9: Smith SW, Dodd KW, Henry TD, Dvorak DM, Pearce LA. Diagnosis of ST-Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block With the ST-Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. Ann Emerg Med 2012;60(6):766–76. 10.1016/j.annemergmed.2012.07.119

Week 10: Aslanger EK, Yıldırımtürk Ö, Şimşek B, et al. DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction (DIFOCCULT Study). Ijc Hear Vasc 2020;30:100603. 10.1016/j.ijcha.2020.100603

Week 11: Thiruganasambandamoorthy V, Sivilotti MLA, Sage NL, et al. Multicenter Emergency Department Validation of the Canadian Syncope Risk Score. Jama Intern Med 2020;180(5):737–44. 10.1001/jamainternmed.2020.0288

EKGs

Week 1 - Clinical Setting: 78 y F with history of a-fib, CHF, CAD presenting with sudden onset of generalized weakness and dyspnea. HR - 180, BP - 90/53, RR - 16, SpO2 - 94%, Temp - 99 F

Week 2: Clinical Setting: 48 y M with schizophrenia found collapsed in stairwell of hospital garage, now complaining of “can’t breathe.” HR -138; BP -90/44; SPo2 -not picking up; RR -28 Temp -100.1 F

Week 3: Clinical Setting: 92 y F with HTN, remote breast cancer, Parkinson’s presents with generalized weakness and bilateral leg swelling.

Week 4: Clinical Setting: 68 y F who presents with agitation, with a reported intentional benzodiazepine overdose. HR - 70
BP - 175/110 RR - 20 SpO2 - 97% Temp - 99.2 F

Week 5: Clinical Setting: 44 y M with a history of alcohol use disorder presents with confusion. HR - 78, BP - 155/64 RR - 14 SpO2 - 97% Temp - 98.5

Week 6: Clinical Setting: 55 y M with CHF (EF 30-35%), HTN, schizophrenia who presents after he had a pre-syncopal episode.HR - 78, BP - 148/96, RR - 16, SpO2 - 95% RA Temp - 98.4 F

Week 7: Clinical Setting: 77 y F with HTN, Parkinson’s, DMII who presents with shortness of breath for 2 days, worsening today. HR - 95, BP - 165/87, RR - 18, SpO2 - 93%, Temp - 99.1 F

Week 8: Clinical Setting: 64 y M with history of CAD, HTN, mild aortic stenosis who presents with lightheadedness.

Week 9: Clinical Setting: Clinical Setting: 74 y F with HTN, HLD, DMII, COPD who presents with chest pain.

Week 10: Clinical Setting: 71 y M with history of heavy smoking, but otherwise does not see a doctor or have any known medical problems, presents with tachycardia, and a month of fatigue with exertional dyspnea.

HR - 136
BP - 158/95
RR - 22
SpO2 - 93% on AR Temp - 99.1 F

Week 11: Clinical Setting: 70 y M with VF arrest, s/p ROSC in the field. Unresponsive.

HR - 62
BP - 98/55
RR - 22
SpO2 - 98% on NRB Temp - 96.9 F