SIMULATION CASEBOOK - MyCourses
SIMULATION CASEBOOK - MyCourses
SIMULATION CASEBOOK - MyCourses
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Gilbert Program in Medical Simulation<br />
Simulation Casebook<br />
Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12<br />
*** If IV fluids given, raise blood pressure to 110/70:<br />
HR BP Temperature ( o C) O 2 Sat (RA) RR<br />
40 110/70 37.0 o 97% 16<br />
***If Atropine given or pacing started, patient will begin to feel better and heart rate and blood pressure<br />
will increase:<br />
HR BP Temperature ( o C) O 2 Sat (RA) RR<br />
60 105/70 37.0 o 97% 18<br />
*** If Morphine and Nitroglycerin given (sublingual or IV) drop BP and patient becomes increasingly<br />
less responsive.<br />
HR BP Temperature ( o C) O 2 Sat (RA) RR<br />
40 70/40 37.0 o 97% 12<br />
***If B-blockers given, decrease the heart rate to 30 BPM, drop BP into the upper 60’s and pt becomes<br />
unresponsive.<br />
HR BP Temperature ( o C) O 2 Sat (RA) RR<br />
30 70/40 37.0 o 97% 16<br />
VI.<br />
Instructor Notes<br />
A. Tips to keep scenario flowing<br />
1. If students are unsure of pathology, instructor can prompt the students to create<br />
differential diagnosis and lead them towards imaging and laboratory studies<br />
necessary to confirm diagnosis<br />
2. If IV fluids not provided, nurse can verbalize need for supportive care as patient<br />
becomes increasingly hypotensive<br />
B. Scenario programming<br />
1. Optimal management path:<br />
O 2 /IV/monitor<br />
History and physical examination<br />
Aggressive IV fluid resuscitation with 2 large bore IV’s<br />
Immediate aspirin<br />
Appropriate lab workup: CBC, BMP, cardiac markers, coagulation<br />
profile<br />
Appropriate imaging: stat portable CXR, ECG within 10 minutes<br />
Administer pressor<br />
Administer anticoagulation medication (e.g. Heparin)<br />
Consider administering atropine<br />
Consult cardiology for further treatment<br />
2. Potential complications/errors path(s):<br />
Failure to administer IV fluids<br />
Administering large dose of Nitroglycerin, B-blocker, Morphine<br />
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