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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 Narcotic Overdose 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 Physical examination Supplemental O 2 IV fluids Empiric Narcan and glucose Obtain appropriate laboratory studies: CBC, BMP, fingerstick, toxicology screen Obtain appropriate images: CXR, ECG Airway management III. 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. Code blue cart 2. Lab values (see Appendix A) 3. Images (see Appendix B) D. Distracters: none IV. Actors A. Nurse: facilitate scenario B. Consultants (optional for higher level residents who can provide interpretation on their own) 3. Radiologist: reads chest x-ray 4. Cardiologist: reads ECG 138
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: 31 year old CC: Altered mental status HPI: Use lay terminology as the voice of the patient ***Per EMS: Friend called EMS after he found patient on apartment couch and was not acting himself. Friend reports patient has no known drug allergies or significant past medical history. No further history possible secondary to decreased mental status. Patient not following commands, occasionally yells “Get me outta here” or “leave me alone.” Vitals on scene: HR BP Temperature ( o C) O 2 Sats (RA) RR 70 120/84 37.0 o 98% 8 PMHx: ***Per friend: Non-contributory Unknown MEDICATIONS NKDA ALLERGIES PSHx/SOCIAL Hx/FAMILY Hx/ROS: Unknown 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 78 110/84 37.0 o 98% 6 GENERAL: HEENT: NECK: PULM: CV: ABD: EXT: NEURO: Confused Atraumatic, 1mm pupils Supple, no JVD CTAB, decreased RR RRR, no murmurs/rubs/gallops, 2+ pulses Soft, NT/ND, +BS No trauma, no c/c/e Pinpoint pupils, MAE x 4, grossly intact, exam limited due to poor cooperation LABS: See Appendix A ***Pending until patient given Narcan empirically: Amylase/Lipase Level Comprehensive Metabolic Panel X Arterial Blood Gas Hepatic Panel Basic Metabolic Panel X Lactate/Cortisol Level Cardiac Markers Thyroid Panel Coagulation Profile Toxicology Screen (Urine, Serum) X 139
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