SIMULATION CASEBOOK - MyCourses
SIMULATION CASEBOOK - MyCourses
SIMULATION CASEBOOK - MyCourses
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Gilbert Program in Medical Simulation<br />
Simulation Casebook<br />
Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12<br />
CV:<br />
ABD:<br />
RECTAL:<br />
EXT:<br />
Tachycardic but regular, no murmurs/gallops<br />
Soft, mild mid-epigastric TTP, no masses/organomegaly<br />
Guaiac positive black stool<br />
No c/c/e<br />
LABS: See Appendix A<br />
Amylase/Lipase Level<br />
Comprehensive Metabolic Panel<br />
Arterial Blood Gas<br />
Hepatic Panel<br />
Basic Metabolic Panel X Lactate/Cortisol Level<br />
Cardiac Markers X Thyroid Panel<br />
Coagulation Profile X Toxicology Screen X<br />
Complete Blood Count (CBC) X Urinalysis X<br />
CBC with differential<br />
Urine HCG<br />
IMAGES: See Appendix B<br />
Angiogram ECG X<br />
CT Scan, with contrast<br />
MRI<br />
CT Scan, without contrast X-Ray X<br />
Echocardiogram<br />
Ultrasound<br />
CONSULTS:<br />
Gastroenterologist – Dr. Cole: recommends endoscopy, IV PPI, NG lavage<br />
Additional Labs: none<br />
Additional Images: Esophagogastroduodenoscopy<br />
CLINICAL PROGRESSION:<br />
History and physical, adequate IV access, IV fluids, and monitor. Students are expected to recognize GI<br />
bleeding, consider NG lavage (if they do lavage, coffee grounds are present, no gross blood), order<br />
appropriate laboratory studies, consult GI and determine need for blood products. Students may<br />
administer acid suppressors (proton pump inhibitors). Once students consult GI and discuss future<br />
management, case will end. Patients can require more aggressive fluid resuscitation, and scenario may<br />
include increasing emesis with intubation for airway protection if time allows.<br />
***If the students give 1-2 liters of fluid or blood products within the first 10 minutes of the case:<br />
HR BP Temperature ( o C) O 2 Sats (RA) RR<br />
110 145/90 37.0 o 99% 16<br />
***Failure to give fluids within 10 minutes of the start of the case OR failure to consider GI bleeding as<br />
part of differential diagnosis, vitals will worsen with blood pressure gradually dropping and a slight<br />
increase in heart rate. If deemed necessary, GI or Primary care provider will call for guidance.<br />
HR BP Temperature ( o C) O 2 Sats (RA) RR<br />
150 70/40, 37.0 o 99% 16<br />
110