A severe earthquake has affected an area surrounded by oil refineries. During the initial response, an accident at a nearby location results in several patients becoming contaminated with oil. All patients are brought to the field hospital and require decontamination. Most patients are only mildly injured, but one suffers airway damage from oil and other hydrocarbons. The patient undergoes advanced airway management and is evacuated to a local hospital. The other patients are treated and released.

This scenario is based on the Whakaari/White Island volcanic eruption that occurred on December 9, 2019, in New Zealand. The eruption, classified as a Stage III burn disaster, overwhelmed local and regional medical systems, necessitating a national and international response. The scenario focuses on the initial receiving hospital’s experience and the on-shift medical staff’s challenges. It aims to provide a realistic training module for healthcare professionals in volcanic regions, emphasizing the importance of preparedness and skill practice. The scenario includes a fictional patient case with severe burns and other injuries, requiring comprehensive emergency care, including decontamination, airway management, fluid resuscitation, and wound care. The scenario also highlights the critical role of teamwork, communication, and resource management in handling mass casualty incidents. By reflecting on the Whakaari disaster, this scenario serves as a tribute to the victims, their families, and the responders, offering valuable insights for future emergency preparedness and response efforts.

This scenario outlines the management of a 61-year-old female patient who suffered multiple traumatic injuries after being caught in an EF4 tornado outside Birmingham, Alabama. The patient, who has a history of diabetes, hypertension, and obesity, was helmeted and riding her bike when the tornado struck, causing her to be thrown into a field. Her injuries include a closed fracture of the right femur, multiple contaminated lacerations and impalements to her hands, and a suspected globe rupture of the left eye. The scenario emphasizes the importance of a structured approach to trauma care, including a thorough primary and secondary survey, pain management, and the need for rapid stabilization and consultation with specialists. The patient requires immediate initiation of broad-spectrum antibiotics and antifungal therapy due to the high risk of infection from soil-contaminated wounds. Essential actions include immobilization of the femur fracture, detailed ocular examination, and prompt ophthalmologic and orthopedic consultations. This case highlights the complexities of managing multiple trauma in the aftermath of a natural disaster, emphasizing the need for coordinated care, communication, and reassessment to prevent complications and optimize patient outcomes.

This article presents a detailed medical scenario involving a chemical attack at a country fair, where an unknown substance is sprayed into the crowd, leading to multiple cases of organophosphate poisoning. The scenario revolves around the arrival of a 31-year-old male at a community emergency department, suffering from respiratory distress, vomiting, and symptoms consistent with cholinergic toxidrome. The patient and several others were exposed to a toxic substance at the fair, requiring immediate decontamination and treatment with Pralidoxime and Atropine. Key teaching objectives include recognizing the signs of organophosphate poisoning, performing patient decontamination, and addressing whether critical treatment can be initiated prior to decontamination in life-threatening cases. The scenario also emphasizes coordination with EMS to assess HazMat risks, airway management, and the recognition of cholinergic toxidrome, along with the potential for an Atropine shortage if multiple patients are involved.

Ultrasound is widely used in the monitoring of patients under going expectant and medical management of both miscarriage and ectopic pregnancy. It is also used intra-operatively during the surgical management of miscarriage where it can help guide cervical dilatation, reduce the risk of uterine perforation and help ensure complete evacuation of the uterus. It is similarly used to guide the surgical management of uterine ectopic pregnancies. It is alos a valuable tool in the management of post-intervention complications.

Uterine ectopic pregnancies are relatively rare and account for less than 5% of all ectopic pregnancies. They can implant either partially or completely within the cervix, the site of a previous caesarean section scar or in the myometrium. Ultrasound diagnostic criteria now exist for all these pregnancies. A pregnancy can also implant in the rudimentary horn of a unicornuate uterus.

This case study focuses on managing a 70-year-old male patient trapped in a flooded home for over 24 hours. The patient, with a history of peripheral vascular disease, diabetes, and bipolar disorder, is found wading in three feet of freshwater, suffering from hypothermia, trench foot, and a potential soft tissue infection. The scenario emphasizes key principles of emergency management, including the assessment of hypothermia, careful rewarming to avoid cardiac arrhythmias, and the identification and treatment of nonfreezing cold injuries such as trench foot. The case highlights the importance of clear communication and teamwork in a disaster setting, particularly in coordinating care with EMS and other healthcare providers. The scenario also stresses the need for appropriate wound care, infection management, and pain control. Key learning objectives include understanding the pathophysiology of cold exposure injuries, managing environmental health emergencies, and ensuring effective communication in crisis situations. The case is designed for emergency medical training, simulating real-life conditions to enhance clinical skills in managing patients affected by flooding and hypothermia, ensuring comprehensive preparedness for similar disaster scenarios.

Which evidence-based treatment of schizophrenia could potentially increase OCD symptoms?

What is the first-line treatment for a patient with comorbid treatment-resistant schizophrenia and obsessive–compulsive disorder (OCD) (schizo-obsessive disorder)?