SIMULATION CASEBOOK - MyCourses

Gilbert Program in Medical Simulation
Simulation Casebook
Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12
NEURO:
Increasingly unresponsive, moving all extremities, not following commands but does
withdraw to pain
LABS: See Appendix A
Amylase/Lipase Level Comprehensive Metabolic Panel X
Arterial Blood Gas
Hepatic Panel
Basic Metabolic Panel
Lactate/Cortisol Level
Cardiac Markers
Thyroid Panel
Coagulation Profile Toxicology Screen X
Complete Blood Count (CBC) Urinalysis X
CBC with differential X Urine HCG
IMAGES: See Appendix B
Additional Labs: per facilitator’s discretion, fingerstick
Angiogram ECG X
CT Scan, with contrast
MRI
CT Scan, without contrast X X-Ray X
Echocardiogram
Ultrasound
CONSULTS:
Additional Images: none
***Lab technician: can call for critical value of glucose to prompt treatment (either after or before to
guide away from intubation depending on timing needs.)
CLINICAL PROGRESSION:
Patient history can only be elicited after normalization with glucose. Physical examination is difficult to
complete, patient will not accept non-rebreather mask but can gain IV access and hook up to monitor.
If participants give glucose as a bolus (not just glucose added to IV fluids), patient normalizes and can
give history.
If participants fail to give glucose in first 5-10 minutes of case—or they only give glucose as D5 in a liter
of fluids, patient has worsening mental status to the point of unresponsiveness with decreased respiratory
rate and an O 2 saturation possibly requiring intubation*:
HR BP Temperature ( o C) O 2 Sats (RA) RR
120 110/70 37.0 o 93%, decreasing 7
*To avoid intubation, see consult above or notes below
Possible addition to case: hypoglycemic seizure – if participants have already thought about glucose and
can promptly treat patient.
79