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Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 Upper Gastrointestinal Bleed I. Target Audience: Medical Students, Residents II. Learning and Assessment Objectives Participants are expected to understand the scientific and humanistic issues underlying the disease assessment and treatment plan, and to critically consider and deploy the therapeutic options described Participants should provide a concise presentation of the patient to each physician consultant who participates in the exercise. Debriefing sessions by on-site clinical faculty is essential to discuss critical thinking and knowledge pathways, and to provide a forum for individual and team reflection on learning and practice goals. While the case descriptions are written with medical terminology, it is important that the provider and patient (i.e. the simulator) engage in authentic dialogue with lay terminology to reflect an actual patient encounter Critical Actions Checklist: DONE CRITICAL ACTION Telemetry monitoring Patient history Physical examination Make patient NPO Aggressive IV fluid resuscitation Obtain laboratory studies: cbc, chemistries, coagulation studies, lactate Consult GI for endoscopy Administer IV proton pump inhibitor III. IV. Environment A. Simulation room set up: Emergency Department B. Manikin set up: 1. High fidelity patient simulator 2. No moulage needed 3. Lines needed C. Props: 1. IV line 2. Lab values 3. Images 4. PRBC D. Distracters: none Actors A. Nurse: facilitate scenario B. Consultants(optional for higher level residents who can provide interpretation on their own) 1. Gastroenterologist, recommends treatment plan 2. Radiologist, interprets images 108
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 V. Case Narrative PATIENT: 54 year old CC: Vomiting blood HPI: Use lay terminology as the voice of the patient Patient reports multiple episodes of vomiting and mild epigastric pain beginning this morning. Emesis was initially coffee-ground, now becoming bright red with some clots. Recent burning epigastric pain, not relieved by Maalox. PMHx: Recent admission for r/o MI: Normal exercise treadmill stress EKG at that time Hypertension Hypercholesterolemia Arthritis MEDICATIONS Ibuprofen ~600 mg BID x 1 year (knee pain, bilaterally) HCTZ Simvastatin Metoprolol PSHx: Appendectomy,age 19 NKDA ALLERGIES SOCIAL Hx: EtOH: Tobacco: Illicits: Occupation: Additional: History of heavy abuse Quit 2 years ago after heavy use Denies Line cook Divorced FAMILY Hx: No h/o cardiac diseases or ulcers that the patient is aware of ROS: (+) Abdominal pain, nausea, melena, orthostasis (-) No headache, fevers/chills, constipation/diarrhea, diaphoresis, shortness of breath PHYSICAL EXAM: Those signs not demonstrable by the mannequin should be verbalized when students perform/verbalize the examination maneuver HR BP Temperature ( o C) O 2 Sats (RA) RR 140 95/60 37.0 99% 16 GENERAL: HEENT: PULM: Pale, AAOX3 Pale conjunctiva, non-icteric sclera CTAB 109
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