Escape the Trauma Room.

Traditional conference didactics may not be effectively meeting the learning needs of today's emergency medicine (EM) residents, and educators are employing various interactive approaches to engage learners. Escape Room is a popular adventure game in which participants must work together to solve a series of puzzles to escape a locked room. Our aim was to adapt this game design to teach core EM content and procedural aptitude. Upon entering the "locked" room residents were faced with a series of puzzles involving concepts such as toxicology antidotes, ventilator management, echocardiogram interpretations, airway foreign body removal, arterial line transducer setup, and using a cast cutter. Using teamwork and limited clues learners had to work together to "escape" the room. Afterward, a didactic summary was given to enhance knowledge retention. The Escape Room construct was successfully adopted as an engaging model to teach EM core content and procedure skills while simultaneously fostering team building. Feedback received was overwhelmingly positive. This unique alternative educational activity can be easily implemented at any EM residency program as an effective alternative educational tool.

Tranexamic acid for treatment of pulmonary hemorrhage after tissue plasminogen activator administration for intubated patient.

BACKGROUND: The risk of tPA in the treatment of stroke, is that approximately 5% of patients may have significant intracranial bleeding, increasing mortality to 45%. Use of tPA can also cause other forms of life-threatening bleeding, most commonly gastrointestinal bleeding. In this case review, we discuss the presentation and management of a patient with post-tPA pulmonary hemorrhage and the use of tranexamic acid (TXA) for the cessation of bleeding. CASE REPORT: A 78-year-old female reported dysarthria, left-sided facial droop, left sided weakness of 1-hour duration with an initial NIH stroke scale (NIHSS) of 7. The patient had tPA administered, had an abrupt change in mental status and was ultimately intubated for airway protection. After endotracheal intubation, the patient began to hemorrhage from the endotracheal tube and was administered nebulized TXA totaling 2 g over the course of 20 min, with subsequent cessation of bleeding. tPA administration comes with inherent risks given the known bleeding complications and no consensus for the reversal of bleeding secondary to tPA. TXA may be a viable option in the setting of tPA induced pulmonary hemorrhage.