SIMULATION CASEBOOK - MyCourses

Gilbert Program in Medical Simulation
Simulation Casebook
Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12
patient. Cardiology consult will recommend admitting patient for further evaluation including stress test
with imaging, echo, possible cath.
***If nitroglycerin administered (with or without IV fluids), patient will complain of worsening
symptoms and lightheadedness as blood pressure decreases:
HR BP Temperature ( o C) O 2 Sats (RA) RR
92 120/90 37.0 o 93% 20
***If IV fluids provided, pain and shortness of breath will moderately resolve:
HR BP Temperature ( o C) O 2 Sats (RA) RR
90 150/100 37.0 o 96% 16
**Debriefing of first case can occur now (guide for debriefing found after PART II of case)
VI.
Case Narrative: Part II
***Patient name, past medical history, social and family history as above.
CC: Chest pain, shortness of breath
HPI: Use lay terminology as the voice of the patient
Patient (above) was admitted to the inpatient unit and back to baseline vitals, more or less, but is having a
second episode of chest pain and dyspnea, this time with lightheadedness. Atrial fibrillation with rapid
ventricular response is displayed on the monitor. ROS: Initially as above
PHYSICAL EXAM (Atrial Fibrillation): Those signs not demonstrable by the mannequin should be
verbalized when students perform/verbalize the examination maneuver
HR BP Temperature ( o C) O 2 Sats (RA) RR
156 80/40 37.0 o 95% 20
GENERAL:
HEENT:
NECK:
PULM:
CV:
ABD:
EXT:
NEURO:
A&Ox3, anxious, diaphoretic
Unremarkable
Slighty elevated JVD
Rales scattered (nonspecific)
Irregularly irregular tachycardia
Soft, NT/ND, + BS
No C/C/E, palpable pulses all extremities
MAE X 4, grossly intact
LABS: See Appendix A
Amylase/Lipase Level
Arterial Blood Gas
Basic Metabolic Panel
Comprehensive Metabolic Panel
Hepatic Panel
Lactate/Cortisol Level
17