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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 XIII. Appendix B: Diagnostic Studies Chest X-Ray: Normal or mild Congestive Heart Failure http://www.heartfailurematters.org/PublishingImages/chest_xray.jpg ECG (Part I): Left Ventricular Hypertrophy http://www.heartandmetabolism.org/images/HM9/hm9ccfig1.gif ECG (Part II): Rapid AF http://www.ecglibrary.com/af_fast.html XIV. Appendix C: Interesting articles to discuss/reference a) Zile, MR, Gaasch WH. Heart failure in aortic stenosis - improving diagnosis and treatment. N Engl J Med 2003; 348:1735. b) Julius, BK, Spillman, M, Vassalli, et al. Angina pectoris in patients with aortic stenosis and normal coronary arteries. Mechanisms and pathophysiologic concepts. Circulation 1997; 95:892. c) Vincentelli, A, Susen, S, Le Tourneau, T, et al. Acquired von Willebrand syndrome in aortic stenosis. N Engl J Med 2003; 349:343 24
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 Cardiogenic Shock 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 Telemetry monitoring Patient history Physical examination Supplemental O 2 IV Access Immediate ECG and portable CXR (within 10 minutes of start of case) Obtain appropriate laboratory studies: troponin, cbc, chemistry Administer immediate aspirin Increase cardiac output with pressor agent Administer anticoagulation medication Consult cardiology for further treatment 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 (see Appendix A) 3. Images (see Appendix B) D. Distracters: none Actors A. Nurse: facilitate scenario B. Consultants: Cardiology for EKG interpretation and management, Primary care provider if the students need prompting in general (optional for higher level residents who can provide interpretation on their own) 25
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