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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 HEPATIC PANEL Reference Range Age 25-60 Age >61 Alkaline Phosphatase 285 33 – 131 IU/L 51 – 153 IU/L Aspartate Aminotransferase (AST) 35 15-50 IU/L Alanine Aminotransferase (ALT) 25 6-50 IU/L T. Bilirubin 0.3 0.1 – 1.2 mg/dL D. Bilirubin 0.1 0 – 0.3 mg/dL Total Protein 7.3 6.3 – 8.5 g/dL XII. Appendix B: Diagnostic Studies Chest X-Ray: Normal http://www.med.yale.edu/intmed/cardio/imaging/findings/normal_chest_pa2/index.html Abdominal Ultrasound: Gallstones in neck causing acoustic shadowing, with gall bladder wall thickening >4mm: http://emedicine.medscape.com/article/774352-media Abdominal CT: http://www.aic.cuhk.edu.hk/web8/Hi res/Cholecystitis.jpg 98
Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1 st edition (2011), updated 3/2/12 Lower Gastrointestinal Bleeding 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 Order laboratory studies: cbc, chemistries, coagulation studies, lactate Aggressive IV fluid resuscitation Stool guaiac Type and cross/Type and screen GI consultation III. 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: 4. IV line 5. Lab values 6. Images D. Distracters: none IV. Actors A. Nurse: facilitate scenario B. Consultants: Gastroenterologist - recommends treatment plan 99
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