Car Accident and Respiratory Distress: A Trauma-Based Pneumothorax Simulation Case for Medical Students.

Audience: This simulation is intended for second-year medical students who are in the pre-clinical phase of their medical school curriculum. This case is delivered as part of a longitudinal simulation-based curriculum that aligns with concurrent didactic instruction in the cardiopulmonary systems course. Introduction: Pneumothorax is a potentially life-threatening condition that requires urgent attention and intervention, particularly in the setting of trauma.1 Traumatic pneumothorax has been reported in up to one-third of patients presenting with blunt chest wall injury.2 If left unrecognized or inadequately treated, this may progress to a life-threatening tension pneumothorax, resulting in severe respiratory compromise and obstructive shock with hemodynamic instability. Early familiarity with structured trauma assessment and recognition of time-sensitive cardiopulmonary deterioration represents a foundational skill for learners entering clinical training.This case emphasizes critical actions central to emergency medicine practice, including high-flow oxygen delivery and the use of ultrasound to guide timely procedural intervention. It is also designed to introduce medical students to fundamental principles of trauma assessment and management, which are often not directly assessed in pre-clerkship curricula.3 Prior studies have demonstrated that early exposure to simulation-based trauma training improves learner confidence and clinical preparedness,4,5 supporting the use of this structured trauma scenario. Educational Objectives: By the end of this simulation, learners will be able to: 1) obtain a focused history in the setting of recent motor vehicle accident and respiratory difficulty, 2) identify abnormal respiratory findings consistent with pneumothorax on physical exam, 3) interpret chest x-ray and point-of-care ultrasound to identify the progression of a life-threatening tension pneumothorax,4) assess for potential internal bleeding and hypovolemic shock by integrating imaging findings, vital signs, mental status, and additional components of physical examination, 5) interpret imaging and clinical findings to guide appropriate management decisions, including need for urgent procedural intervention and escalation of care, and 6) deliver a concise oral presentation to an attending physician, including key findings and management plan. Educational Methods: This case is conducted using a high-fidelity simulation environment that includes a standardized nurse, vital sign monitoring, a mannequin, and video display for diagnostic imaging (chest x-ray and point-of-care ultrasound findings). The simulation case is structured around the ABCDE (airway, breathing, circulation, disability, exposure) approach to trauma assessment, encouraging learners to prioritize stabilization during an evolving clinical presentation.6 Through this scenario, learners are guided toward integrating history-taking, physical examination findings, and point-of-care diagnostics to identify and initiate management of a traumatic pneumothorax. The case also highlights core elements of acute care management including high-flow oxygen delivery, use of ultrasound, and timely coordination of procedural intervention.This simulation was developed using the principle of instructional scaffolding, in which learners progress through a structured pathway toward key clinical objectives.7 For this case, scaffolding is operationalized through facilitator cues, prompts from confederate actors, and dynamic changes in patient status (vital signs and mannequin responses) based on learner interventions. This approach was chosen because it allows learners to make independent clinical decisions within a guided framework and enhances reproducibility of the case. Research Methods: This simulation was piloted with a group of medical students participating in a simulation-based elective curriculum. Learner performance was assessed using a structured critical actions checklist developed by the authors based on relevant literature in simulation-based assessment8 and refined by an emergency medicine physician and a simulation education specialist. The checklist was designed to capture completion of key team-based clinical actions and to facilitate targeted feedback during debriefing, consistent with established best practices in simulation-based education.8The educational efficacy of the case was evaluated through structured debriefing, facilitator observation, and post-session learner feedback. Learner comments and facilitator observations were used to refine the simulation script, standardize nurse prompts, and pace the case. Results: The learner group involved in the case pilot consisted of four pre-clerkship medical students (n=4). The learner group independently completed five of seven predefined key action items, including obtaining a focused history, performing a complete physical exam, ordering point-of-care diagnostic imaging, interpreting chest radiograph findings consistent with tension pneumothorax, and delivering a concise presentation to the attending physician. Learners required prompting from confederates to escalate oxygen delivery and recognize the need for needle decompression.Learners rated the simulation highly for clinical relevance, realism, and educational value (median of 5 on 5-point Likert scale, range 4-5). Three of four learners (75%) reported increased confidence in approaching similar scenarios and all learners (100%) reported improved understanding of FAST exam interpretation, primary trauma survey, and pneumothorax management. Discussion: This case successfully integrates clinical reasoning and team communication within a high-acuity simulation. This represents a novel addition to the medical school's simulation curriculum because it is the first scenario in the pre-clerkship program to focus on the structured primary survey and acute management of a trauma patient. Learners benefitted from the scaffolded approach to airway assessment, application of point-of-care diagnostics, and emphasis on collaborative decision-making in a high-acuity setting. Topics: Pneumothorax, trauma, ultrasound, FAST exam, respiratory distress, primary survey, acute care, medical education, simulation.