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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 PULM: CV: ABD: SKIN: EXT: Right (or left if L-sided pneumonia) chest with crackles, decreased breath sounds S1, S2, tachycardic, regular, no M/R/G Soft, NT/ND, +BS No rash, warm to touch, cap refill
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 ***Failure to give supplemental O 2 and antipyretic 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 128 130/75 39.0 o 90% 28 V. Instructor Notes A. Tips to keep scenario flowing B. If students are unsure of pathology, prompting can come in form of a primary care physician calling to check in on their patient. 1. laboratory studiesIf supplemental O 2 is not provided, nurse can verbalize need for supportive care as patient becomes increasingly dyspneic C. Scenario programming 1. Optimal management path: O 2 /IV/monitor History and physical examination Appropriate lab workup: CBC, CMP, and consider ABG, blood culture, sputum culture Appropriate imaging: CXR, ECG Administer antipyretics Administer antibiotics Determine need for hospital admission 2. Potential complications/errors path(s): Failure to administer O 2 Failure to recognize need for antibiotics and possible hospital admission 3. Program debugging: N/A VI. Debriefing Plan A. Method of debriefing: Group with multimedia teaching materials B. Debriefing materials: See Appendix C C. Potential debriefing topics 1. Team dynamics a. Leadership b. Collaboration c. Communication d. Professionalism 2. Didactic material a. Presentation i. Appropriate differential diagnosis ii. Based on the chest x-ray, discuss what would be expected on physical examination of the chest b. Pathophysiology i. Likely cause of acute febrile illness ii. Host defense mechanisms that are overcome for organism to cause pneumonia c. Etiology i. Understand differences between community acquired, nosocomial, and healthcare associated pneumonia 167
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