SIMULATION CASEBOOK - MyCourses

Gilbert Program in Medical Simulation
Simulation Casebook
Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12
Aortic Stenosis: Angina Followed by Atrial Fibrillation
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
PART I
Telemetry monitoring
Patient history
Physical examination
Supplemental O 2
Immediate ECG and CXR
Provide IV fluids
Obtain appropriate laboratory studies: cardiac biomarkers
Admit patient for stress test
PART II
Obtain additional history
Repeat physical examination and immediate ECG
Electrical or chemical cardioversion
Initiate anticoagulant therapy
Consider beginning longer acting rate/rhythm control agents after
successful cardioversion
III.
Environment
A. Simulation room set up: PART I in emergency department, PART II in either emergency
department or on medical floor
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
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