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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 Community Acquired Pneumonia 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 Vital signs Patient history Physical examination Supplemental O 2 IV fluid resuscitation Obtain appropriate laboratory studies: cbc, BMP Obtain chest xray Administer antipyretics Administer antibiotics III. IV. 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 3. Images D. Distracters: none Actors A. Nurse: facilitate scenario B. Consultants (optional for higher level residents who can provide interpretation on their own) 1. Radiologist: reads chest x-ray 2. Cardiologist: reads ECG 164
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 Case Narrative PATIENT: 57 year old CC: Shortness of breath, cough HPI: Use lay terminology as the voice of the patient Patient presents with fever and dyspnea. Patient reports 3 day history of SOB, sore throat, malaise, and low-grade fever. Patient recently developed productive cough. This morning, her/his fever rose to 103 o F at which point s/he decided to drive to the hospital. Patient presents with yellow sputum, myalgias, right sided chest pain that is worse with deep breathing. PMHx: Denies MEDICATIONS Ibuprofen, as needed Tylenol, as needed PSHx: Appendectomy, age 18 NKDA ALLERGIES SOCIAL Hx: EtOH: Tobacco: Illicits: Occupation: Additional: 2 beers/night, “sometimes more on weekends” Denies Denies Furniture dealer Divorced and dating currently FAMILY Hx: Mother: Died of an MI at age 75 Father: Alive, age 86 but has colon cancer ROS: (+) Dyspnea, diaphoresis, subjective fever, myalgia (-) No nausea, vomiting, diarrhea, chills, headache, blurred vision, lightheadedness, palpitations, numbness/motor weakness, abdominal pain, urinary symptoms. No sick contacts, recent hospitalizations, nor history of similar symptoms in the past. 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 Sat (RA) RR 112 130/75 39.0 o 92% 24 GENERAL: HEENT: Nontoxic appearing, increased work of breathing, splinting with deep inspiration Pale conjunctiva, non-icteric sclera, MMM 165
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