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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 Anterior Myocardial Infarction 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: cardiac biomarkers Administer immediate aspirin Administer 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 (optional for higher level residents who can provide interpretation on their own) 1. Radiologist: reads chest x-ray 2. Cardiologist: reads ECG, recommends treatment plan 6
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 Case Narrative PATIENT: 60 year old CC: Chest pain, “There is an elephant sitting on my chest.” HPI: Use lay terminology as the voice of the patient Patient complains of crushing substernal chest pain radiating to his neck and jaw on the left side. Symptoms started one hour ago during a business meeting. Patient had to excuse himself from the meeting as he became obviously diaphoretic and pale. Patient reports nausea and lightheadedness after the onset of the “crushing” chest pain. Patient denies fevers, chills, vomiting, and palpitations. Patient reports mild shortness of breath and one previous episode of chest pain that lasted about 15 minutes one week ago that resolved spontaneously while he was in Japan. PMHx: Hypertension Lisinopril MEDICATIONS Codeine Shellfish ALLERGIES PSHx: Hernia repair, age 22 SOCIAL Hx: EtOH: Tobacco: Illicits: Occupation: Additional: Occasional Denies Denies Ambassador to the U.S. Married FAMILY Hx: Father: Gastric cancer, expired age 80 ROS: (+) Chest pain with radiation to neck/jaw, mild shortness of breath, diaphoresis, nausea, lightheadedness (-) Denies palpitations, vomiting, headache, blurred vision, numbness/motor weakness, abdominal pain, urinary symptoms, or fever/chills 7
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