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Environment:

Emergency department resuscitation room.

This scenario may begin on scene at the patient's home with EMS gathering information from family, then transition to the ED.

Mannequin:	Adult male simulator mannequin, with wig (gray hair if possible), fully dressed. Sclera should be icteric; this can be moulaged using a yellow erasable marker or removable yellow translucent film.
Props:	To be displayed on screen or given as handouts when asked for/returned from lab:

 Images (see online component for acute cholangitis, Scenario 1.2 at https://www.wiley.com/go/thoureen/simulation/workbook2e):Chest x‐ray showing no active pulmonary disease (Figure 1.6).Radiology reading of chest x‐ray (normal) (Figure 1.7).Head CT (static image 1‐cut) showing no intracranial abnormality (Figure 1.8).Radiology read CT head (normal) (Figure 1.9).Ultrasound of right upper quadrant (static image) showing biliary dilation (Figure 1.10).Radiology read showing biliary dilation concerning for choledocholithiasis (Figure 1.11).CT abdomen/pelvis with IV contrast (static image, 1‐cut) showing grossly dilated common bile duct (Figure 1.12).CT read concerning for acute cholangitis (Figure 1.13).Electrocardiogram (ECG) showing sinus tachycardia (Figure 1.14).

 Laboratory tests (see online component as above):Complete blood count (Table 1.12).Basic metabolic panel (Table 1.13).Liver function panel (Table 1.14).Lipase (Table 1.15).Lactic acid (Table 1.16).Coagulation panel (Table 1.17).Troponin (Table 1.18).Type and screen (Table 1.19).Urinalysis (Table 1.20).Urine microscopy (Table 1.21).

Available supplies:

 Adult code cart with basic airway supplies.

 Central line kit (triple lumen).

 Medications:0.9% saline, LR IV bags.Pre‐labeled IV bags.IV vasopressor infusion (norepinephrine or similar).Broad‐spectrum antibiotics.Pre‐labeled syringes:Antiemetics (ondansetron, metoclopramide).Analgesic medications (morphine, fentanyl, hydromorphone).Rapid sequence intubation medications (sedative/paralytics typical to your institution).

Distractor:none