SIMULATION CASEBOOK - MyCourses

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.
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