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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 Urobilinogen 0.3 0.2 – 1.0 Ehr U/L HCG 0 0 – 5 IU/L XI. Appendix B: Diagnostic Studies Chest X-Ray: Normal http://www.rctradiology.com/icons/normalchest.jpg XII. Appendix C: Interesting articles to discuss/reference a) Wrenn, KD, Slovis, CM, Minion, GE, Rutkowski, R. The syndrome of alcoholic ketoacidosis. Am J Med 1991; 91:119. b) Marinella MA. Alcoholic ketoacidosis presenting with extreme hypoglycemia. Am J Emerg Med. May 1997;15(3):280-1. c) Hojer, J. Severe metabolic acidosis in the alcoholic: differential diagnosis and management. Hum Exp Toxicol 1996; 15:482. d) Miller, PD, Heinig, RE, Waterhouse, C. Treatment of alcoholic acidosis. The role of dextrose and phosphorus. Arch Intern Med 1978; 138:67. 58
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 Diabetic Ketoacidosis: New Onset Diabetes Mellitus Type I 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 Obtain appropriate laboratory: cbc, chemistries, blood gas IV fluid resuscitation Insulin drip III. 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 IV. Actors A. Nurse: facilitate scenario B. Consultants (optional for higher level residents who can provide interpretation on their own) 1. Endocrinologist: will recommend laboratory studies and ICU consult 2. Intensivist: will recommend management and admit patient to ICU 59
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