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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 X. Appendix A: Lab Values ARTERIAL BLOOD GAS Reference Range pH 7.32 7.35-7.45 pCO 2 50 35-45 mmHg pO 2 80 60-100 mmHg HCO 3 26 24-28 mmol/L Sa O 2 91 97-100% FiO 2 .21 .21 BASIC METABOLIC PANEL Reference Range Sodium 136 135-147 mmol/L Potassium 3.5 3.5-5.2 mmol/L Chloride 100 95-107 mmol/L CO 2 28 22-30 mmol/L Urea Nitrogen (BUN) 20 7-20 mg/dL Creatinine 1.2 0.5-1.2 mg/dL Glucose 100 60-110 mg/dL COMPLETE BLOOD COUNT Reference Range WITH DIFFERENTIAL Male Female White Blood Cell (WBC) 8,500 4,500 - 10,000 K/uL Neutrophils (%) 57 54 – 62% Band forms (%) 8 3 - 5 (>8% indicates L shift) Basophils (%) 0.75 0 – 1% 0 - 0.75% Eosinophils (%) 2 0 – 3% 1 – 3% Lymphocytes (%) 32 24 – 44% 25 – 33% Monocytes (%) 4 3 – 6% 3 – 7% 162
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 Hemoglobin (HGB) 13.0 13.5 - 16.5 g/dL 12.0 - 15.0 g/dL Hematocrit (HCT) 39.2 41 – 50% 36 – 44% Red blood cell (RBC) 4.8 4.5 - 5.5 M/uL 4.0 - 4.9 M/uL RBC Distribution Width 10.0 < 14.5% MCV 90 80 – 100 fL MCH 32 26 – 34 pg MCHC 33 31 – 37 g/dL Platelet 200,000 100,000 - 450,000 K/uL XI. Appendix B: Diagnostic Studies Chest X-Ray: Hyperinflated, no opacities http://radiopaedia.org/images/266487 ECG: Sinus tachycardia http://www.emedu.org/ecg/images/st_1a.jpg XII. Appendix C: Teaching Materials Diseased vs Healthy lungs: http://www.simplescience.org/Lessons/Medicine/Breath/Lesson0.htm Anatomy of diseased alveoli: http://myhealth.ucsd.edu/library/healthguide/enus/support/topic.asp?hwid=zm2394 XIII. Appendix D: References a) Brochard L, et al. Noninvasive Ventilation for Acute Exacerbations of Chronic Obstructive Pulmonary Disease. NEJM 1995; 333(13): 817-22. b) Skorodin MS, Tenholder MF, Yetter B, Owen KA, Waller RF, Khandelwahl S, et al. Magnesium sulfate in exacerbations of chronic obstructive pulmonary disease. Arch Intern Med. Mar 13 1995;155(5):496-500. c) Saint S, et al. Antibiotics in Chronic Obstructive Pulmonary Disease Exacerbations. A Meta- Analysis. JAMA Mar 22 – 29 1995; 273 (12): 957 – 960. d) Aaron SD, et al. Outpatient Oral Prednisone after Emergency Treatment of Chronic Obstructive Pulmonary Disease. NEJM 2003; 348 (26):2618-25. e) Gordon, JA. Macy Cases for Realistic Patient Simulation in Critical Care and Emergency Medicine. Harvard Medical School, Boston: President and Fellows of Harvard College, 2002 163
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