Genial Escape Room

Escape the Exacerbation

CHF or COPD?

start

Introduction

Teams will "escape" the virtual room by correctly diagnosing the patient with COPD exacerbation, CHF exacerbation, or both, and deciding on appropriate management steps. The goal is to solve puzzles in the shortest time possible.

Scenario

“John is a 65-year-old male who presents with shortness of breath for two days, worsening at rest, and bilateral leg swelling. He has a history of smoking 40 pack-years, hypertension, and ischemic heart disease.”

Test 1

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Test 4

Test 5

Final Test

Tests

Complete each test to beat the game: there is no other way to escape!

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1

Determine which elements of his history suggest COPD, CHF, or both

Past Medical History:

• COPD: Diagnosed 10 years ago.
• Ischemic Heart Disease: History of MI 5 years ago. On beta-blockers and statins.
• Hypertension: Diagnosed 15 years ago; on ACEi
• Hyperlipidemia: On statin therapy.
• Type 2 Diabetes Mellitus: managed with metformin.
• Obesity: BMI of 31.

• CABG 5 years ago.

• Smoking: 40 pack-year history; quit after MI
• Alcohol: Drinks occasionally, 1-2 beers per week.
• Illicit Drug Use: Denies use.
• Occupation: Retired construction worker.
• Living Situation: Lives at home with his wife.

Onset: Two days agoDuration: ConstantCourse: Gradually worsening

• Shortness of breath, worse when lying flat
• Experiences paroxysmal nocturnal dyspnea
• BLE swelling that started 3 days ago; worse at night
• Productive cough with white sputum
• Reports mild chest “tightness,” non-radiating, no relation to exertion
• Aggravating Factors: Lying flat, physical exertion.
• Relieving Factors: Sitting up or resting
• Fatigue and decreased exercise tolerance for a week
• Mild weight gain (3 pounds) over the past week
• No fever, chills, or night sweats
• No recent upper respiratory infection symptoms

Test 1

Productive cough (COPD)Paroxysmal nocturnal dyspnea (CHF)Dyspnea on exertion (both)Smoking (COPD)LE swelling (CHF)Hx MI (CHF)HTN (both)Tachycardia (both)

1

Test 1

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Test 5

Final test

Tests

Complete each test to beat the game: there is no other way to escape!

Lorem ipsum dolor sit amet consectetur adipiscing elit, mauris suspendisse praesent nascetur massa molestie est magna, luctus lacinia nunc ridiculus netus nostra. Dictum accumsan sollicitudin praesent morbi sem mollis quis neque volutpat.

2

John’s physical exam findings: HR 110 bpm, S3, BP 140/90 mmHg, RR 28 breaths/min, O2 sat 88% on room air, bilateral crackles, wheezes, JVD, cyanosis.

Match his physical exam findings with either CHF, COPD, or both

Test 2

2

Crackles (CHF)JVD (CHF)Wheezes (COPD) Low O2 saturation (both) Tachycardia(both)Cyanosis (both)

Test 2

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Test 5

Final Test

Tests

Complete each test to beat the game: there is no other way to escape!

Lorem ipsum dolor sit amet consectetur adipiscing elit, mauris suspendisse praesent nascetur massa molestie est magna, luctus lacinia nunc ridiculus netus nostra. Dictum accumsan sollicitudin praesent morbi sem mollis quis neque volutpat.

Take a good look at this ABG:Interpret ABG values to determine the primary condition.

3

Test 3

ABG Results

3

Respiratory acidosis with elevated pCO2 (suggestive of COPD).Compensatory metabolic alkalosis with elevated HCO3 (indicates chronic respiratory acidosis)."COPD" is primarily suggested by the ABG findings.

Test 3

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Test 5

Final Test

Tests

Complete each test to beat the game: there is no other way to escape!

Lorem ipsum dolor sit amet consectetur adipiscing elit, mauris suspendisse praesent nascetur massa molestie est magna, luctus lacinia nunc ridiculus netus nostra. Dictum accumsan sollicitudin praesent morbi sem mollis quis neque volutpat.

XR findings

4

continue

Test 4

4

Drag common XR findings for COPD vs. CHF

CHF

COPD

1. Flattened diaphragm

2. Cardiomegaly

3. Hyperinflation of lungs

4. Kerly B lines

5. Bullae/Bleb

6. Pulmonary venous congestion

Test 4

4

Drag common XR findings for COPD vs. CHF

CHF

COPD

1. Flattened diaphragm

2. Cardiomegaly

3. Hyperinflation of lungs

4. Kerly B lines

5. Bullae/Bleb

6. Pulmonary venous congestion

Test 4

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Test 5

Final Test

Tests

Complete each test to beat the game: there is no other way to escape!

Lorem ipsum dolor sit amet consectetur adipiscing elit, mauris suspendisse praesent nascetur massa molestie est magna, luctus lacinia nunc ridiculus netus nostra. Dictum accumsan sollicitudin praesent morbi sem mollis quis neque volutpat.

5

Review John's EKG

Test 5

5

Sinus rhythm Rate: ~125Sinus tachycardia Normal AxisNormal PR, QRS, QT intervals LVH

Test 5

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Test 5

Final Test

Tests

Complete each test to beat the game: there is no other way to escape!

Lorem ipsum dolor sit amet consectetur adipiscing elit, mauris suspendisse praesent nascetur massa molestie est magna, luctus lacinia nunc ridiculus netus nostra. Dictum accumsan sollicitudin praesent morbi sem mollis quis neque volutpat.

John's diagnosis?Treatment plan?

6

Test 6