MedEdPORTAL (Jun 2015)
Typhoid Fever Presenting as Heat Stroke
Abstract
Abstract Introduction As travel into and out of our country continues to become more common, the U.S. emergency physician must be familiar with the presentation and management of travel-related illnesses. To that end, here we provide a comprehensive typhoid fever simulation case guide intended to support the simulation-based training of emergency medicine residents and medical students. It may also be used in a simulation based evaluation of resuscitation in the content areas of heat related illness and travel medicine. Methods This case is fairly straightforward and can be run either with or without sophisticated simulation equipment. However, a mannequin is preferred over a human volunteer so that if the participants decide to, they may initiate CPR, intubate, etc. One adolescent sized mannequin is sufficient for a group of 3-5 participants. The case is designed to take approximately 20-25 minutes to complete. Results A survey was sent to all learners following the case asking the learners to rate the quality of the presentation and the value of the content on a scale from 1 to 5 and providing a space for open comments. Feedback was overall positive. On the 1-5 scale, on average learners rated the activity a 4.0 for the value of the content, and a 4.36 for the quality of the presentation. Specific positive comments included: “Good review of stuff we don't see often.” and “Good review of how to handle foreign travel illnesses.” Discussion This case grew out of an actual patient encounter during a hot summer in southeast US, where heat illness is common but where typhoid fever is very rare. This simulation case was created to highlight both the resuscitative core competencies involved in stabilizing a patient presenting clinically with heat stroke and the importance of maintaining a broad differential diagnosis and taking a thorough history, in particular a travel history. As we have recently seen with Ebola in West Africa and its spread throughout other parts of the world (as just one prominent example), a keen awareness of possible infectious etiologies and the habit of obtaining a good travel history are critical skills for the emergency physician to aid in putting these diagnostic puzzles together.
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