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The anesthetist decided to extubate his patient and first needed to test the patient’s ability to breathe spontaneously. Because of a handling error, the anesthesia machine was not switched into a spontaneous breathing mode, but instead the machine continued to mechanically ventilate the patient. In the mistaken conviction that the patient was breathing on his own, the anesthetist interpreted his...
A team of paramedics is confronted with a routine call: a motor vehicle accident with two lightly injured patients and one severely injured patient. The medical treatment of the patient with clinical signs of volume depletion is routine: oxygen via face mask; the placement of several large-bore i.v. lines, and volume resuscitation. However, this emergency situation featured some noteworthy exceptions...
A physician-in-training was confronted with a ventilatory problem in an intensive care patient. He interpreted the presenting constellation of symptoms (increased airway pressure, absent breath sounds over the right lung, and slowly decreasing saturation) as signs of a tension pneumothorax. Although there were several more differential diagnoses for this symptom constellation, and although the patient...
After 1 week of night shift in an ICU, a fatigued physician was faced with an emergency. The call for help reached him in a moment when his attention was focused on another problem. Tired and still immersed in thought, he had to manage an emergency situation where he had to concentrate on mask ventilation and at the same time prepare for reintubation. When he manually wanted to give a bolus of an...
A small trauma team provides care to a seriously injured infant. The team leader is an emergency medicine resident who has no experience with pediatric trauma management. This emergency situation is a significant challenge for him, and the patient’s young age adds even more emotional strain. Both factors combined put the physician under enormous stress. The stress is further increased due to his difficulty...
A pediatrician is confronted with an emergency in which the leading symptoms can be due to variety of causes. From clinical examination alone she gets no further clues about the etiology of the clinical deterioration. What makes this situation particularly challenging is the fact that some therapeutic actions (e.g., intubation, insertion of a chest tube) might actually worsen the patient’s condition...
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