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, O 2 /IV/monitor. Students must treat pain and determine future management of
patient. Case will end when students release patient, educating patient about possible triggers, how to
recognize signs of aura, and need for abortive medication.
***If NSAID, anti-emetic (prochlorperazine, metoclopramide), or triptan given (oral, IM, IV), headache
improves, pain gradually reaches rating of 5 (1-10 scale)
VI.
Instructor Notes
A. Tips to keep scenario flowing
1. Patients asks “Doc, aren’t you going to give me something for my head?”
2. Nurse suggests analgesics, as necessary.
B. Scenario programming
1. Optimal management path:
O 2 /IV/monitor
History and physical examination
Analgesia
2. Potential complications/errors path(s): N/A
3. Program debugging: N/A
VII.
Debriefing Plan
A. Method of debriefing: Group with multimedia teaching materials
B. Debriefing materials: See Appendix C
C. Potential Debriefing topics
1. Team dynamics
a. Leadership
b. Collaboration
c. Communication
d. Professionalism
2. Didactic material
i. Aura vs. no aura
ii. Systemic manifestations (nausea, vomiting, scotoma, paresthesias,
photophobia)
iii. Historical factors suggesting a more serious underlying cause of
headache
iv. Indications for imaging: unexplained neurological finding, atypical
features, additional risk factor (e.g. HIV), sudden severe headache
v. Migraine types: basilar type, menstrual, familial hemiplegic, etc.
vi. Differential diagnosis: migraine, ruptured aneurysm, meningitis,
“hangover,” brain tumor, opportunistic infection, drug-induced
cerebral vasospasm, stroke
b. Etiology
i. Triggers: list of foods, environmental, etc.
c. Pathophysiology
d. Treatment
i. Mechanism of Toradol
ii. Mechanism of Triptan
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