SIMULATION CASEBOOK - MyCourses

Gilbert Program in Medical Simulation
Simulation Casebook
Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12
VI.
VII.
Instructor Notes
A. Tips to keep scenario flowing
1. Nurse can ask which laboratory studies to send, and prompt for a fingerstick
B. Scenario programming
1. Optimal management path:
O 2 /IV/monitor
History and physical examination
Dextrose IV
2. Program debugging: N/A
Debriefing Plan
A. Method of debriefing: Group with multimedia teaching materials
B. Debriefing materials: See Appendix C
C. Potential debriefing topics
1. Team dynamics
a. Leadership
b. Collaboration
c. Communication
d. Professionalism
2. Didactic material
a. Presentation: history includes HA, confusion, sweating, anxiety, tremor,
nausea, and somnolence.
b. Etiology: DDx includes electrolyte abnormalities (Hyper and hyponatremia,
hypercalcemia), hypoglycemia, uremia, hepatic encephalopathy, infection,
trauma, toxic ingestion, hypoxia, hypercarbia, primary neurologic process
c. Pathophysiology
d. Treatment
i. Type of glucose administration (ampule of D50 vs. D5 in fluids)
e. Complications (obtundation with respiratory compromise, seizure)
VIII.
Development and Deployment
This case was developed for a widely subscribed fourth year medical school elective (emergency
medicine/transition to internship), and variants have been used over several years as part of an
instructional module for the physiology and management of altered mental status.
IX.
Authors/Contributors
Case drafted by Tania Fatovich, M.D., with contributions and updates by the Gilbert Simulation Team.
Compiled and formatted by Elan Guterman.
Reviewed and edited with references by Jeffrey Siegelman, M.D. and Zoë Howard, M.D.
X. Appendix A: Lab Values
Labs pending during case or if prefer- can give normal laboratory studies except for glucose. [Can discuss
after the case what lab abnormalities could explain a change in MS.] FS can be available if requested.
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