What are the hormonal interventions for managing sexual offending behaviors?

This case study presents a scenario where a small community hospital faces a surge of patients during the early stages of the SARS-COVID pandemic. The hospital, located near a cruise ship port, has limited resources, including a 10-bed emergency department (ED) and a two-bed ICU. Several patients from a cruise ship, who are all part of the same family, present with worsening respiratory symptoms, including cough, fever, and shortness of breath. As more patients arrive, the ED staff must manage the influx while facing limited ventilators and critical care equipment. The scenario challenges participants to perform emergency triage, prioritize treatment for respiratory distress, manage limited resources, and follow pandemic protocols to prevent the spread of infection. Through these events, healthcare providers must transition from conventional operations to crisis standards of care while managing an overwhelmed system, making difficult decisions regarding resource allocation and patient survival.

This chapter covers the use of simulation as a method of disaster response preparation. It addresses case creation, high-fidelity techniques, and execution of a large, live action disaster simulation. It discusses how to build out a case from planned objectives, as well as pairing debriefing points for after the case is finished. It also gives advice on how to retain optimal control over the case to help ensure it runs smoothly. It gives advice on logistics and case flow, avoiding common pitfalls in planning such drills, and proper communication between instructors during the drill. It discusses how to implement a twist into the case to further constrain resources available to the learners and how to integrate such twists into the case without disruption.

This case presents a 3–4-year-old male child in a refugee camp in northern Kenya, suffering from severe dehydration due to prolonged nonbloody diarrhea. The child presents with signs of pediatric hypovolemic shock, including pallor, tachycardia, and hypotension. The father, speaking only Swahili, reveals the child’s symptoms through an interpreter. The patient requires immediate volume resuscitation, initiated with IV fluids, and administration of appropriate antibiotics and zinc therapy for presumed infectious diarrhea. The case emphasizes the challenges of managing critical pediatric cases in resource-limited settings and the importance of clear communication with family members despite language barriers. Key interventions include securing IV access, initiating rapid fluid resuscitation, and providing antibiotic therapy. A MEDEVAC transfer is arranged for further care at a hospital equipped to manage the patient’s worsening condition. The scenario highlights the complexities of disaster medicine, particularly in displaced populations facing health crises like cholera or other diarrheal diseases.

After a tsunami, refugees are at risk of numerous causes of morbidity and mortality. Endemic diseases, such as malaria, are among the most common. This case forces participants to consider and diagnose endemic diseases in the setting of a disaster, including determining appropriate workup, both for the end diagnosis and to rule out alternatives, as well as the correct treatment of endemic disease.

This case presents a simulated scenario of a bioterrorism attack involving the deliberate release of Francisella tularensis (tularemia) in rural farming communities. The scenario challenges participants to manage an overwhelming influx of patients presenting to a rural hospital’s emergency department with varying symptoms of tularemia, including ulceroglandular disease, pneumonia, and sepsis. The hospital faces severe limitations in critical care resources, such as ventilators and ICU beds, requiring a transition from conventional to crisis-level care. Participants are tasked with diagnosing tularemia without on-site diagnostic tools, stabilizing patients, and utilizing emergency management resources, such as the hospital incident command system (HICS). The scenario also emphasizes the need for effective communication with public health agencies, the recognition of a bioterrorism event, and ethical decision-making in allocating scarce resources. Additionally, participants must navigate the complexities of national emergency preparedness and response systems to mitigate the impact of the attack on healthcare operations.

A patient on clozapine has an absolute neutrophil count (ANC) of 1200. What do the prescribing guidelines recommend as the next step?

What is the most common type of violence in forensic hospital settings?

This chapter is a quick introduction to the history of simulation, why simulation is a powerful tool in medical education, and basic tools needed to run a successful simulation.

This case 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.

Floods along with deep and rushing water often accompany hurricanes. These lead to sequelae of drowning, near drowning, trauma, and hypothermic patients. Each patient’s care should be dictated by the ABCs (airway, breathing, circulation) and reevaluations are critical for appropriate resuscitations.

The incidence of adnexal pathology diagnosed in the first trimester varies from 0.2 to 6 per cent. The majority are ovarian cysts of less than 5-6cm in diameter that will spontaneoulsy resolve. Larger masses or those with a more complex appearance are less likely to resolve spontaneously and may represent a neoplastic process. The overall risk of malignancy in adnexal masses is however low at 1-8 per cent. Adnecxal torsion can occur in pregnancy and the risk decreases as the gestation increases. During pregnancy, the same ovarian masses can be found as in the non pregnant population. Additionally a number of pregnancy-associated masses may occur.

The case features a 34-year-old male firefighter who suffers an asthma exacerbation due to inhaling volcanic ash while attempting to rescue civilians. Despite initially avoiding more severe physical injuries from pyroclastic flows or burns, he develops significant respiratory distress and requires escalating interventions, including nebulized bronchodilators and eventual intubation. Additionally, the patient presents with a head injury from debris, though imaging confirms there is no acute intracranial pathology. The case outlines key teaching objectives, emphasizing the recognition and management of inhalational injuries and asthma exacerbations, the challenges of managing a potentially difficult airway in the context of a volcanic eruption, and the specific medical interventions necessary for both respiratory support and trauma care. It also addresses the importance of effective communication and teamwork, such as the use of appropriate personal protective equipment (PPE) for responders, activation of disaster plans, use of local resources, and management of distressed family members.

This case outlines a mass casualty scenario involving a targeted automobile ramming attack (TARMAC) during a Mardi Gras parade in New Orleans. The scenario features three patients with varying injuries: a 23-year-old man struck by a truck, a 37-year-old woman with a leg fracture from falling off bleachers, and a 63-year-old man with a head injury and confusion after falling. The exercise focuses on key disaster response principles, including scene safety, airway and breathing assessment, hemorrhage control, and trauma stabilization. It emphasizes the need for quick decision-making, effective communication, crowd control, and coordination with emergency services in mass casualty situations. Critical actions include patient stabilization, C-spine precautions, airway management, and rapid transport. Through this exercise, healthcare providers practice managing multiple trauma patients in a chaotic, high-stress environment, preparing them for real-world mass casualty incidents involving blunt trauma, penetrating injuries, and complex triage scenarios.

A severe earthquake/hurricane has caused devastation to a wide area. Nearly all local infrastructure was damaged, and it will take time to restore function. Several patients arrive days into the deployment to the area. At your medical tent, a pair of patients arrive with complaints of hyperglycemia due to not being able to take their medication and use their insulin, as well as not being able to contact their primary care doctor. One patient is mildly hyperglycemic and can be treated and released. The other patient has developed DKA and must be managed. The patient with DKA is treated with insulin and transferred to a local hospital for ongoing care.