SIMULATION CASEBOOK - MyCourses

More documents

Recommendations

Info

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 102
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 ii. Collaboration iii. Communication iv. Professionalism 2. Didactic material a. Appropriate differential diagnosis of lower GIB i. Broad differential diagnosis: anatomic (diverticulosis); vascular (angiodysplasia, ischemic, radiation-induced); inflammatory (infectious, idiopathic); neoplastic b. Pathophysiology of diverticular bleed c. Workup/Treatment options i. Discuss why endoscopy and colonoscopy are both warranted when searching for source of GIB ii. Discuss definitive way to determine origin of GIB iii. Other studies (radionuclide imaging, angiography) iv. Appropriate disposition – ICU vs floor, Surgical consultation (Hemodynamic instability, active bleeding..) d. Colon cancer i. Familial history ii. Surveillance VIII. Development and Deployment This case was developed as part of an elective GI pathophysiology module for second year medical students; the module combines cognitive and procedural (GI endoscopy) simulation, and has been deployed as a recurrent offering. IX. Authors/Contributors Case drafted by Steven Kappler, M.D. with Emily Hayden, M.D. and Helen Shields, M.D.; additional contributions and updates by the Gilbert Simulation Team. Compiled and formatted by Elan Guterman. Reviewed and edited with references by Jeffrey Siegelman, M.D. and Zoë Howard, M.D. 103
Page 1 and 2:
THE G. S. BECKWITH GILBERT AND KATH
Page 3 and 4:
Gilbert Program in Medical Simulati
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52: Gilbert Program in Medical Simulati
Page 101: Gilbert Program in Medical Simulati
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177:
show all

SIMULATION CASEBOOK - MyCourses

Create successful ePaper yourself

Delete template?

Save as template?