SIMULATION CASEBOOK - MyCourses

Gilbert Program in Medical Simulation
Simulation Casebook
Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12
CLINICAL PROGRESSION:
History and physical, IV/O2/monitor. Students are expected to recognize possible GI bleeding, consult
GI, order 2 large bore IVs, type and cross for blood transfusion. Once students consult GI and discuss
future management, case will end.
***If the students give 1-2 liters of fluid or blood products within the first 10-15 minutes of the case:
HR BP Temperature O 2 Sats (RA) RR
100 122/82 37.4 100% 16
***If fail to give fluids within 15 minutes of the start of the case, vitals will worsen with blood pressure
gradually dropping and a slight increase in heart rate. If deemed necessary, GI or Primary care provider
will call for guidance:
HR BP Temperature O 2 Sats (RA) RR
115 90/52 37.4 100% 16
VI.
VII.
Instructors Notes
A. Tips to keep scenario flowing
1. If IV fluids are not provided, instructor can verbalize need to stabilize as patient
becomes increasingly hypotensive in order to prompt supportive care.
2. If student are unsure of imaging modality to confirm diagnosis, GI consult will
recommend endoscopy
B. Scenario programming
1. Optimal management path:
O 2 /IV/monitor
History and physical examination
Aggressive fluid resuscitation WITH 2 large bore IVs
Appropriate lab workup
o Include type and cross OR type and screen depending upon
suspected blood loss
o Hct
o Coagulation panel
Transfusion
Plan for colonoscopy
Consider need for antibiotic therapy
Consult specialist for definitive care/determine need for surgical
intervention
Transfer to OR for laparotomy, if required
2. Potential complications/errors path(s):
Failure to administer fluids
Failure to recognize need for specialist/surgical intervention
3. Program debugging: N/A
Debriefing Plan
A. Method of debriefing: Group with multimedia teaching materials
B. Debriefing materials: See Appendix C
C. Potential debriefing topics
1. Team dynamics
i. Leadership
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