SIMULATION CASEBOOK - MyCourses

More documents

Recommendations

Info

Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 EXT: NEURO: No edema or rashes WNL, MAE X 4, grossly intact LABS: See Appendix A Amylase/Lipase Level Comprehensive Metabolic Panel Arterial Blood Gas Hepatic Panel Basic Metabolic Panel X Lactate/Cortisol Level Cardiac Markers Thyroid Panel Coagulation Profile Toxicology Screen Complete Blood Count (CBC) Urinalysis CBC with differential X Urine HCG IMAGES: See Appendix B 152 Additional Labs: none Angiogram ECG X CT Scan, with contrast MRI CT Scan, without contrast X-Ray X Echocardiogram Ultrasound CONSULTS: Cardiology – Dr. Jones: ECG, if obtained, is read as normal sinus tachycardia. Radiology – Dr. Smith: CXR is normal. Additional Images: none CLINICAL PROGRESSION: History and physical, IV access, and monitor. Patient has decreasing O 2 saturation, increasing fatigue, and increasingly short of breath until nebulized albuterol administered and supplemental O 2 provided. Participants are expected to recognize and treat low O 2 saturation, build a thorough differential diagnosis, order appropriate laboratory studies/images, and determine need for admission. Once participants administer O 2 , bronchodilators, and steroidal medication, case will end. Alternatively, can progress to increased dyspnea with expectation that advanced interventions such as magnesium, heliox, and intubation will be employed. ***If inhaler is used to provide medication, patient cannot take in a dose before needing to take a breath and does not improve. ***Failure to give supplemental O 2 and nebulized medication within the first 10 minutes of the case will result in increasing tachycardia and decreased O 2 saturation, the vitals will read: HR BP Temperature ( o C) O 2 Sats (RA) RR 130 130/75 37.0 o 88% 32 ***If single dose of nebulized β-agonist (albuterol) and/or antimuscarinic (ipratropium) administered alongside supplemental O 2 , shortness of breath and wheezing improve:
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 HR BP Temperature ( o C) O 2 Sats (NRB) RR 120 130/90 37.5 o 98% 18 ***If continual nebulized albuterol, antimuscarinic medication (ipratropium), and steroids (prednisone) administered, blood pressure and respiratory rate normalize. Shortness of breath and wheezing are completely resolved. VI. VII. Instructor Notes A. Tips to keep scenario flowing 1. If students are unsure of pathology, prompting can come in form of a primary care physician calling to check in on his patient. 2. If supplemental O2 is not provided, nurse can verbalize need for supportive care as patient becomes increasingly dyspneic B. Scenario programming 1. Optimal management path: O2/IV/monitor History and physical examination Appropriate lab workup (none needed): CBC, BMP Appropriate imaging (none needed): CXR, ECG Stacked nebulized β-agonist and antimuscarinic Administer corticosteroid (prednisone) 2. Potential complications/errors path(s): Failure to administer O2 Failure to administer medications via nebulizer 3. Program debugging: N/A Debriefing Plan A. Method of debriefing: Group with multimedia teaching materials B. Debriefing materials C. Potential debriefing topics 1. Team dynamics a. Leadership b. Collaboration c. Communication d. Professionalism 2. Didactic material a. Presentation i. A decreased respiratory rate does not always mean the patient is improving b. Pathophysiology c. Etiology i. Exacerbation triggers ii. Differential diagnosis: pneumothorax, CHF exacerbation, pneumonia, pleural effusion, foreign body d. Treatment i. Treatment strategies: short-acting vs. long-acting medications ii. Factors determining whether to admit patient to hospital iii. Chest xray useful in first time wheeze, or apparent infectious symptoms 153
Page 1 and 2:
THE G. S. BECKWITH GILBERT AND KATH
Page 3 and 4:
Gilbert Program in Medical Simulati
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102: Gilbert Program in Medical Simulati
Page 151: Gilbert Program in Medical Simulati
Page 177: Gilbert Program in Medical Simulati
show all

SIMULATION CASEBOOK - MyCourses

Create successful ePaper yourself

Delete template?

Save as template?