Septic shock, Cardiogenic shock, Acute CHF, Pneumonia, Vasopressor.

Elderly patient with a complex medical history significant for coronary artery disease burden presented to ED with SOB and ALOC. Initial clinical picture was suspicious for CHF. With further investigations, patient was found to have community acquired pneumonia.

Case occurred in a rural community (Dawson Creek) where the hospital was staffed by one resident and two nurses in house. Lab and X-ray were available on a call-in basis. The staff physician is at home, 10 mins away.

A RTVS (RUDI) physician was called to support the case virtually.

Goals and Objectives

Educational Goal:

1. Use RTVS support in the management of undifferentiated, medically complex elderly patient in resource limited setting.
2. Approach to undifferentiated Altered LOC and SOB.

Objectives (Medical and CRM):

1. In a limited resources setting with limited initial information, communicate effectively with team members in the care of a complex, critically ill patient.
2. Prioritize orders, medication administration, and airway management among team members appropriately

EPAs Assessed:

1. Recognize, diagnose and appropriately manage shock.
2. Communicate and coordinate urgent consultation while managing complex patient.
3. Coordinating transfer to higher level of care.