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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 HEENT: NECK: CV: PULM: ABD: SKIN: EXT: NEURO: No abnormalities Supple, JVP not elevated Tachycardia. Regular rhythm. No m/r/g. CTAB, with good bilateral air entry Non-distended, soft, tender to palpation in RUQ. positive Murphy’s sign, normal bowel sounds, no organomegaly or masses. Rectal: guaiac negative brown stool, non-tender. No rashes, warm to touch, cap refill
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 ***If pain managed appropriately, heart rate and blood pressure improve to normal ranges: HR BP Temperature O 2 Sats (RA) RR 92 130/80 37.0 99% 12 VI. Instructor Notes A. Tips to keep scenario flowing 1. Patient will continue asking for pain medication if not administered. 2. If students are unsure what to do, nurse will prompt surgery consult who will ask for presentation of patient and will recommend abdominal ultrasound. B. Scenario programming 1. Optimal management path: O 2 /IV/monitor History and physical examination Appropriate lab work-up: BMP, CBC, hepatic panel, amylase/lipase Appropriate imaging: CXR, abdominal U/S IV fluid resuscitation Manage pain (analgesic) Initiate antibiotic therapy Recommend for cholecystectomy 2. Potential complications/errors path(s): failure to administer antibiotics or appropriate consultation 3. Program debugging: N/A VII. Debriefing Plan A. Method of debriefing: Group with multimedia teaching materials B. Debriefing materials: See Appendix C C. Potential debriefing topics 1. Team dynamics i. Leadership ii. Collaboration iii. Communication iv. Professionalism 2. Didactic material i. Presentation 1. Murphy sign 2. Systemic symptoms (fever) ii. Etiology and Pathophysiology iii. Treatment 1. Decision about antibiotic selection 2. Decision to admit patient for surgery: biliary colic v. cholecystitis iv. Complications 1. Perforation/rupture 2. Ascending cholangitis 3. Surgery complications: bile leak, wound infection, bleeding, etc. 95
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