Calum A. MacRae, MD, PhD
Explain to clinicians who are requesting blood and blood products the requirements and time frames needed when ordering product gastritis flu like symptoms generic rabeprazole 20 mg. Clinicians often turn to laboratory staff for advice when ordering blood and blood Collaborate products gastritis diet ñåêñè order rabeprazole in india. You should help raise awareness around patient blood management (refer to tip 10 below) and appropriate use by Good relationships with referring clinicians to local policies as well as those outside your facility national guidelines found at If you order for gastritis diet ðáê order 10 mg rabeprazole visa, or from gastritis symptoms throat 10 mg rabeprazole for sale, another health provider you should ensure they understand inventory management best practice. Hospitals of time with a lower likelihood of being used, for example should have a policy that reserve emergency stock in a remote location within your describes the limited facility, it may be better to choose fresher product but clinical situations where rotate it more regularly back into general inventory, to use of the oldest blood enable it to be used before expiry. Product should have first may not be adequate shelf life left before expiry when moved from appropriate. You should have documented arrangements for ensuring this occurs on a regular basis. Options to consider if product is getting close to expiry might include transferring to another hospital or laboratory, rotating segregated inventories where possible and highlighting to others that product is soon to expire. One example may be to make up a sign for the fridge that clearly identifies stock with short expiry, enabling it to be the first selected for issue. Each time blood and blood products are reserved for a patient, this Where possible your laboratory should consider product is effectively removed from Electronic Crossmatching ?available? inventory. These an artificial shortage and can cause procedures work well with Group and Screen policies, unnecessary replacement orders. Where blood and blood products have been reserved for specific patients, consider short reservation periods to enable product to be moved back to general inventory if not used. Any remote refrigerators such as those at remote sites, emergency areas and other associated off-site facilities should also be maintained appropriately. Discarding product due to equipment failure can be avoided by following proper maintenance schedules and being prepared for unforeseen failures. You should develop local policies concerning the You should communicate shortages in supply to management of contingency events. In times of more widespread shortage, your state or territory health department will have a contingency plan that you can adapt to fit your setting, and this should involve identifying key personnel to be responsible for communicating any shortages to those affected. You should also be familiar with the National Blood Supply Contingency Plan8 found at National The available from the Apple program is a way to link clinical areas across a health App Store. Tools to help implement better practice inventory management are being developed by the National Blood Authority and will be found at Additionally it offers tools that health providers can use to comply with relevant standards and accreditation. Introduc tion Under the National Blood Agreement all Governments are committed to providing an adequate, safe, secure and affordable supply of blood products, services and promoting high quality management of blood products. This module for Blood and Blood Product Transfers aims to assist health providers in meeting the requirement of the Statement on National Stewardship Expectations for the Supply of Blood and Blood Products. The intention is for this guideline to: Help identify transfer options for blood and blood products between health providers, including between public and private. Implementing a blood and blood product transfer agreement can assist laboratories to: enhance the availability of blood and blood product manage a limited resource reduce unnecessary wastage by transferring blood and blood product to a health provider where it is more likely to be used appropriately. This could include the following: health providers you currently have informal arrangements with; health providers located in your local area that you can approach to set up a transfer arrangement; health providers within your organisation located in other suburbs or health networks. You could consider reducing your usual order depending on the amount of product you are aware will be transferred in. This will allow you to manage your own inventory and that of smaller regional facilities with a low turnover. In turn, smaller sites can operate with a lower inventory and still maximise blood use before expiry. Data loggers are currently recommended for all shipments beyond the Blood Service validated transport times when using their shippers. A number of local health networks have transfer or hub and spoke arrangements between a large metropolitan laboratory and smaller regional and remote sites. BloodMove in South Australia is an example where there is a formal arrangement to transfer blood and blood product between public and private health providers. Any issues that may arise with these (or any other proposed options) should be considered, agreed and documented by all parties. This should provide assurance to receiving health providers that any transferred blood and blood products they receive have been stored appropriately. If not, investigate courier or taxi options and discuss with management to determine the division of costs. When taking transport into consideration a cost benefit analysis can be undertaken to understand the workload and financial cost of transferring blood and blood products in and out versus the financial cost and loss of a valuable resource. If the cost of transport outweighs the cost of the blood product/s then it may not be feasible to develop regular transfer arrangements in exceptional circumstances. Examples of transport options include: using an existing health provider courier service; engaging hire cars, buses or taxis; investigating a courier service that specialises in cold product transfer. You may consider entering into a Service Level Agreement with your chosen courier company. Review existing shipping configuration for the transfer of blood and blood products In accordance with the National Pathology Accreditation Advisory Council blood and blood products must be transported in validated shipping containers. More information on packing and transport shippers can be found under Packing Requirements, section below. See Appendix 1: Transfer arrangement checklist for a summary of items to consider when setting up formal transfer arrangements. See Appendix 2: Example Validation Process for an outline of a possible shipper configuration and validation process. For example an existing validated blood and blood product packing configuration and transport times is detailed in Australian Red Cross Blood Service Receipt and Use of Blood Service Shippers by External Institutions to Transport Blood and Blood Products10 and Transportation of blood components and fractionated products13. The Blood Service recommend the use of data loggers outside their validated transport times14 with specific packing configurations. Principles and guidelines on validation can be found in the National Association of Testing Authorities Guidelines for the validation and verification of quantitative and qualitative test methods. Consideration of the ambient temperature is important when transporting blood and blood products. It is important to consider all temperature conditions and length of time that may be experienced by the blood or blood product you are packing and transporting. Think about where your blood or blood product is being transferred to and all the environments the shipper may experience. The validation process must be repeated for all possible temperatures the blood and blood product may be exposed to during its transport. Some examples of items to consider when transferring blood and blood product include: If the product is going by plane: the cargo hold might not be heated resulting in very low temperatures the items might be held in air conditioned storage before or after the flight the items might be left on the tarmac for some time in extreme hot or cold temperatures. Consider conducting initial and ongoing seasonal courier temperature audits and ad hoc quality assurance audits as required. If you are transporting blood or blood product outside of a validated timeframe or condition you must ensure manufacturers? temperature specifications are met. Blood Component Information, circular of information17 It is recommended that a temperature data logger, or other temperature monitoring device, is utilised in the transport of all blood and blood products. The recommendations below are given to ensure the receiving site has the highest likelihood to use the product before expiry; 7 14 days before expiry for red blood cells, >5 days before expiry of supplier irradiated blood cells, 24 hours, or as short as agreed to with the receiving site, before expiry for platelets, 1 3 months before expiry for manufactured products. You may wish to introduce a system to improve utilisation of short expiry products. For example, the sending laboratory should phone the receiving laboratory to see if they can use the product prior to expiry. This notification will allow sufficient time for receiving facilities to adjust their own inventory orders from the supplier. Details of blood and blood product transfers should be recorded in BloodNet prior to transport for facilities with access to BloodNet. The BloodNet transfer receipt form, or equivalent, should then be printed and added to the shipper for transportation with packing date, time and signature of packer. Health providers without access to BloodNet should complete the transfer form in Appendix 6 to accompany their shipment. A checklist to check blood and blood products is available for receiving sites in Appendix 6. A record of the storage temperature of the products must be available on request at the facility that shipped the product.
Pick up a glass gastritis diet ÷èòàòü cheap rabeprazole express, bottle or can 5 rink from a cu p orm u g 6 ru s you rteet 7 T u ck in you rs irt 8 gastritis diet ìàéë order 10 mg rabeprazole with visa. For each of the activities listed diet with gastritis recipes purchase rabeprazole 20 mg mastercard, please indicate (circle): 3 the amount of difficulty that you (or your carer) experience in doing the task gastritis diet 9000 discount 20 mg rabeprazole with amex, based on your activity over the last 7 days. Section C asks what general symptoms and difficulties you are having related to your leg which impact on your life. For these questions you will need to score the extent to which each item impacts on you in your life based on the last 7 days. If you are unable to complete the questionnaire independently, you may: receive assistance from a carer or professional to act as scribe receive assistance from a carer or professional to help you understand and complete questions for the passive function sub-scale, a carer may complete the questionnaire on your behalf based on difficulty in carrying out the tasks. If the activity is never done, but this has nothing to do with your leg or is never done with your affected leg, Score 0 = No difficulty Section A: Caring for the affected leg (not using it in tasks or activities) No Mild Moderate Severe Unable difficulty difficulty difficulty difficulty to do activity 1. Putting your leg(s) through a trouser leg(s) 0 1 2 3 4 (If never done, circle 0) 5. Transfer using a hoist, including positioning 0 1 2 3 4 sling (If never done, circle 0) 6. Positioning your leg(s) in bed using a 0 1 2 3 4 positioning aid or pillow (If never done, circle 0) 8. Putting on your footwear 0 1 2 3 4 Section B: Independently completing activities using your affected leg No Mild Moderate Severe Unable difficulty difficulty difficulty difficulty to do activity 1. To what extent have you experienced pain or 0 1 2 3 4 discomfort in your affected leg(s) or foot? To what extent have you experienced 0 1 2 3 4 involuntary movements or leg spasms in your affected leg(s) (ie movements or abnormal limb postures that you can?t control)? To what extent have you experienced 0 1 2 3 4 involuntary movements or leg spasms impacting on your comfort or sleep? To what extent have you experienced 0 1 2 3 4 restricted range of movement (due to shortening of muscles or stiffness in joints) in your affected leg(s)? To what extent is it difficult for you (or your 0 1 2 3 4 carer) to care for your affected leg(s) (eg positioning your leg, putting on underwear or pads, or washing between your legs)? To what extent has your affected leg(s) limited 0 1 2 3 4 your daily activities (eg sitting, transferring, walking or doing stairs)? To what extent have involuntary movements 0 1 2 3 4 or tightness of your leg(s) or foot interfered with your mobility or balance? To what extent has your affected leg(s) 0 1 2 3 4 limited your normal activities with family, friends, neighbours or groups (eg social activities)? To what extent has your affected leg limited 0 1 2 3 4 your work or other regular activities (eg hobbies)? Total score Section A Section B Totalling section A, B and C separately produces a total score for each sub-scale of the measure. The resulting stiffness and tightness of muscles may affect your ability to move one or more of your limbs. Sometimes spasticity is so severe that it gets in the way of daily activities, sleep patterns, and caregiving. Common unwanted effects of spasticity are: pain spasms or involuntary movements contracture and deformity decreased functional abilities difficulties with care, hygiene, dressing etc reduced mobility. Spasticity-related pain/discomfort: Spasticity may cause pain arising from stiffness or a cramp-like sensation in the muscles, the joints being pulled into uncomfortable positions, or the fingernails digging into the palm. When severe, pain may interfere with activities or cause sleep disturbance at night. For example when walking or moving, the spastic arm may pull into a tight fist or bend at the elbow. When severe, these involuntary movements or spasms can effectively limit normal activities. Restriction of movement Spasticity may restrict the range of movement in joints causing abnormal posture in the affected limb(s). When severe, it can lead to contractures (permanent shortening of the muscles and tendons) and deformity of the bones and joints. Caring for the affected limb Spasticity may result in difficulty caring for the affected limb. For example, keeping the palm or armpit clean, cutting the finger-nails or dressing the limb (eg getting the arm through a sleeve or the hand in a glove). Using the affected limb in functional tasks Spasticity may affect the ability to use the limb. When severe, it may limit ability to reach out for, grasp, hold and release objects. Mobility Spasticity (even in the upper limb) may limit mobility, affecting ability to walk at normal speed or for long distances; or interfering with balance producing a tendency to fall. But on the other hand, if all baseline scores are recorded at ?2, this does not allow for worsening. Partially achieved No No change Got worse * For more information see the website: Staff will discuss everything in this leaflet with you, but if you have any questions, please speak to a member of the clinic team. Botulinum toxin is a substance produced by a type of bacterium and it has been developed into a treatment for spasticity. The toxin is diluted in order to inject it into a muscle, where it blocks the communication between nerves and the muscle. The injection of spastic muscles with botulinum toxin is only done when the muscle overactivity is actually causing a significant problem or risk to the individual. After damage to the brain or spinal cord, muscles can become overactive and stiff (this is known as spasticity). When this happens to a single muscle or a small group of muscles, rather than throughout the body, it is called focal (localised) spasticity. Sometimes this stiffness in a muscle can help a person to do something, such as standing when leg muscles are very weak. However, it can sometimes lead to problems, such as difficulties with daily tasks or pain. Botulinum toxin injections are used for a number of different reasons: to optimise the effect of treatments aimed at maintaining or increasing a range of movement to improve/enable tasks (such as being able to open your hand for washing) to improve or enable active functional activity (such as relaxing the calf muscles to enable the foot to be flat on the ground when standing) to decrease pain to improve posture. Botulinum toxin injections are used to help staff carry out physical treatments, such as putting a splint on. These interventions can be undertaken without the injection, but may not be as effective. Alternatively or additionally, tablet medications for spasticity can be tried on certain patients. The effects of botulinum toxin injections come on gradually and usually peak at approximately 2 weeks. Serious complications following botulinum toxin injections are rare, however the following have been known to occur: pain where the injection is given bruising where the injection is given flu-like symptoms excessive muscle weakness and temporary swallowing problems rarely, there is potential for anaphylaxis, which is a severe allergic reaction to the medication and requires urgent medical attention. If you believe you have had a serious reaction to an injection please seek urgent medical attention at the nearest Accident and Emergency Department. If you are pregnant or think you may become pregnant, please inform the clinic team. If you have concerns about the injection or associated treatments, or you would like to discuss the issues raised in this leaflet, please speak to the clinic team. Please note that this service does not provide clinical advice so please contact the relevant department directly to discuss any concerns or queries about your upcoming test, examination or operation. Key definitions Administration is defined as the giving of a medicine by either introduction into the body (for example, orally or by injection) or external application. Prescribing is defined as the process of issuing a written or electronic prescription for a medicine for a single individual by an appropriate practitioner. Off-label use only applies to medicines that are already licensed ie hold a valid marketing authorisation. Equally, the use of botulinum toxin to treat muscle groups not covered by the licence is also off-label. Independent prescribing Independent prescribers are specified health professionals defined in law as being able to prescribe medicines independently. The current professions with independent prescribing rights are: doctors dentists nurses pharmacists optometrists physiotherapists podiatrists If the professional is not a doctor or dentist, in order to be an independent prescriber, a member of one of the listed professions must also be: 1 Listed on the relevant regulatory register 2 Annotated on that register as an independent prescriber, having completed an approved training programme. Generic rabeprazole 10mg without prescription. How To Cure Gastritis Naturally | Get Rid of Gastritis Fast.
Lymphovenous oedema A condition commonly occurring in obese chronic gastritis rheumatoid arthritis cheap rabeprazole 20mg without a prescription, immobile people with an underlying pathology of venous insuffciency gastritis and duodenitis definition generic rabeprazole 20mg online. Often coexists with and complicates lymphoedema and can cause skin weeping and ulceration gastritis erosive symptoms cheap 20 mg rabeprazole overnight delivery. Primary lymphoedema Lymphoedema without an inciting factor gastritis diet ëåíòà buy 20 mg rabeprazole visa, termed primary lymphoedema, is generally due to a congenital or inherited condition associated with pathologic development of the lymphatic vessels. It often presents in childhood, but later presentations into early and later adulthood also occur. Secondary lymphoedema Lymphoedema that occurs as the result of other conditions or treatments, such as cancer treatment, infection, infammatory disorders, obesity, and chronic forms of lymphatic overload. A positive result occurs when a thickened fold of skin at the base of the second toe or second fnger cannot be gently pinched and lifted. The presence of this sign is most often an early diagnostic indication of primary lymphoedema; however, it can also develop later in secondary lymphoedema. Toe web intertrigo An infammation due to bacterial, fungal or viral infection occurring in opposing skin surfaces, in this case between toes. Pain and discomfort are frequent symptoms, and people with lymphoedema have increased susceptibility to acute cellulitis, requiring hospitalisation and antibiotic therapy. Accurate assessment should be accompanied by individualised care plans with appropriate, evidence-based treatments. Developing comprehensive integrated lymphoedema services that identify people at risk will enhance timely and responsive treatment. This will enable people to remain active, self-manage their condition and reduce the likelihood of complications. This may be particularly valuable for those who are lymphoedema services were not consistently available in all new to this specialist area of practice, or those seeking to districts. A broad reference group was established which included people living the principles of care outlined in this guide are not intended with lymphoedema, medical, nursing and allied health to replace informed clinical judgment, nor prescribe how professionals from both regional and metropolitan settings, a healthcare service should meet these principles. The representatives from non-government organisations, and approach different services, and the clinicians working within academics. Wide consultations and review processes further them, take to meet these principles should be customised, in refned the document. Lymphoedema: A guide for clinical services is supported, where available, by current evidence. Where evidence is Scope unavailable or conficting, recommendations for best practice the guide aims to cover the care for people with a are based on consensus from experts in the reference group. This includes: primary lymphoedema (including lymphoedema in paediatric clients), secondary Aims lymphoedema, and lymphoedema in palliative care settings. For example, lymphoedema is almost 100 times more prevalent in people with spina bifda than in the general By clearly describing best-practice principles of care, it is 2 patient population. Another example is lymphovenous hoped that: oedema, which commonly occurs in the legs of people unwarranted variations can be reduced with obesity who are immobile and deconditioned. While the principles outlined in this framework are applicable to clinical practice will increasingly align with these groups, there are likely to be additional needs and research evidence considerations that are outside the scope of this document. Style note Paediatric considerations are indicated by -blue text and happy child bullets or -a box with a blue-background heading and a child icon. Lymphoedema occurs when there is an Lymphoedema can cause pain, and decreased limb imbalance in the transportation and/or production of fuid movement and mobility. It can cause problems with dressing in the interstitial tissues, resulting in the accumulation of 6 and other activities of daily living. It may be a congenital malformation of the lymphatic system (primary lymphoedema) and/or due to footwear, needed to accommodate a swollen limb or damage, trauma or interference with the lymphatic vessels body part, present fall risks and signifcant diffculties in or nodes, for example after cancer treatment (secondary mobilisation. Left untreated, patients with lymphoedema are change in tissue composition is also known as staging, with twice as likely to develop cellulitis requiring hospitalisation and intravenous antibiotic therapy. The greater the severity them at higher risk of developing cellulitis, an infection of of lymphoedema, the higher the impact on the individual. There is of children with lymphoedema include: altered evidence that lymphoedema is under-reported and the actual relationships between parents and children with numbers may be higher. There is no specifc data on the prevalence of lymphoedema Effective partnerships will allow health service providers the in Aboriginal people. However, barriers Aboriginal Health Workers in developing clinical skills and such as poor access to services and therefore the ability to protocols in the management of lymphoedema. Clinicians should poor levels of health literacy within communities utilise interpreter services when required and resources poor adherence to treatments such as using compression should refect languages other than English. People who garments in hot climates have different cultures, languages and religions, who live with or are at risk of lymphoedema, must be treated a lack of identifcation with public health services by with respect and recognition of their linguistic, cultural Aboriginal clients. It should also be noted that there One manager reported ?the progression from early signs can be signifcant diversity among individuals within their to a chronic condition is more common and long-term communities. Their treatment often the importance of encouraging, supporting and requires hospitalisation for management of cellulitis or, in developing rural services to improve access for people in some cases, sepsis. Aboriginal Health Workers are key strategies for improving service access and engagement. She attended radiotherapy at a metropolitan cancer service and during this time her leg swelling commenced. However, as she was not a local resident, she was ineligible to receive treatment. This of lymphoedema relies on awareness of the causes of includes people who have undergone removal of lymph lymphoedema, associated risk factors, implementation of nodes or radiation therapy for cancer treatment. An underlying predisposition to developing lymphoedema may be a contributing factor. Education on lymphoedema risk factors Applying the principle in practice and development Monitoring for the early detection of lymphoedema Education for people at risk of lymphoedema should be occurs in those with elevated risk. Education should be ongoing and Those identifed and educated about their risk should reinforced along the treatment continuum to ensure that also be informed of their local lymphoedema services. The individual, carers and health professionals be assessed, including: should be aware that there may be a considerable delay from 6? The postoperative risk of lymphoedema was discussed and arm measurements were taken using both tape measure and bioimpedance. Postoperatively in hospital, Maria was reviewed by the physiotherapist, who commenced arm exercises and provided further information about lymphoedema, including using the arm normally, encouraging weight management and exercise. During her chemotherapy, and taping was implemented with a new, stronger Maria developed early arm swelling confrmed by compression sleeve prescribed. In most patients, the diagnosis of lymphoedema can be readily determined from the clinical Lymphoedema can present with multiple contributing history and physical examination. In some cases, for assessment of the person possibly developing lymphoedema example following cancer treatment where vulnerability to should be holistic in its approach and encompass the the development of lymphoedema is known or anticipated, physical, functional or psychosocial issues that a person it can present in a range of ways. A complete initial assessment should heaviness, tightness, swelling or aching in the at-risk limb. The objective presentations, such as primary lymphoedema, can appear measurement of the region with lymphoedema is an unexpectedly at any stage in life. See Figure 2 on ?At age 58 I was diagnosed with page 11 for a diagnosis algorithm. My physiotherapist A patient with swelling should be encouraged to seek diagnosed my condition and has been clinical assessment and treatment as soon as possible. Skin changes such as thickening, hyper pigmentation, increased skin folds, Measurement of the limb or region with swelling: fat deposits and warty overgrowths circumference, volume and/or bioimpedance spectroscopy develop. The surgeon did explain that surgery could result in lymphoedema and at each check-up Marilyn was examined for evidence of lymphoedema. Six months after surgery and following an extended car trip, Marilyn experienced swelling in her legs. Clinical diagnosis by an appropriately trained health professional Most cases of lymphoedema are diagnosed based on medical history and physical examination. If alternative diagnosis of swelling is suspected, involvement of appropriate medical professionals may be needed to facilitate the required investigations. The choice of investigations used to determine the cause of the swelling will depend on the history, presentation and examination of the patient. The differentials shown below need to be taken into consideration and investigations ordered as appropriate. Implementation these include: Protocols and policies are in place to ensure that people Lymphoscintigraphy a nuclear medicine procedure with lymphoedema are identifed within three months of used to demonstrate lymphatic morphology, particularly lymphoedema indicators.
If participants are unsure of medication names but request to lower heart rate with an ?anti sympathetic? drug gastritis muscle pain purchase rabeprazole with paypal, follow the benzodiazepine response and leave discussions of complications due to B-block for debrief 2 gastritis vs ulcer order 10mg rabeprazole mastercard. If participants are unsure of pathology gastritis tylenol buy 20mg rabeprazole with mastercard, instructor can prompt a cardiology consultation to lead participants in direction of care B gastritis diet õîðîñêîï discount 20mg rabeprazole mastercard. Discuss increase in blood pressure due to unopposed alpha and b2 antagonism 127 Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1st edition (2011), updated 3/2/12 ii. Development and Deployment this case was developed for a widely subscribed fourth year medical school elective (emergency medicine/transition to internship), and has been used in this course over several years as part of an instructional toxicology module. It has also been adapted for use as part of a graduate-level science course (college, PhD students). Cocaethylene: a current understanding of the active metabolite of cocaine and ethanol. Validation of a Brief Observation Period for Patients with Cocaine-Associated Chest Pain. Distracters: Friend of patient may be used as source of background distraction during scenario. Level of distraction at the discretion of instructor (less distractions for novice learners). Friend: distracts participants from patient care, able to provide initial history 132 Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1st edition (2011), updated 3/2/12 V. Will recommend monitoring sodium level and continuously evaluating effect of management plan. Appropriate differential diagnosis, including various illicit intoxication: Cocaine, Amphetamine, Crystal meth, Anticholinergics. Development and Deployment this case was developed and deployed for independent study sessions among first and second year medical students. Hyponatremia associated with 3,4 methylenedioxymethylamphetamine ("Ecstasy") abuse. Consultants (optional for higher level residents who can provide interpretation on their own) 3. Friend reports patient has no known drug allergies or significant past medical history. Patient not following commands, occasionally yells ?Get me outta here? or ?leave me alone. As desired, can introduce more complex scenarios: polysubstance use, body packing, etc. If participants are unsure of treatment, nurse can suggest contacting poison control for assistance which should be tailored to participant knowledge level. Failure to administer Narcan 140 Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1st edition (2011), updated 3/2/12 3. Appropriate differential diagnosis of altered mental status: Electrolytes (hyper/hypo: Na, glucose, Ca), uremia, hepatic encephalopathy, infection (central and otherwise), head trauma, illicit substances, hypoxia/ hypercarbia, primary neurologic process b. Development and Deployment this case was developed for a widely subscribed fourth year medical school elective (emergency medicine/transition to internship), and has been used over several years as part of an instructional module for altered mental status/toxicology. Poison control / Toxicologist: recommends treatment plan 144 Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1st edition (2011), updated 3/2/12 V. Patient is confused and having trouble breathing as s/he relates that the symptoms began while at work on a landscaping job. The worker was alone in one area of the yard spraying for bugs when coworkers noticed patient to be vomiting and confused. Students should recognize strong likelihood of organophosphate poisoning, take decontaminating actions, order laboratory studies and imaging studies. Please stop the vomiting and diarrhea? and ask for something to make her/him feel better. Labs will be pending throughout the case so students are expected to take action with suspected diagnosis of organophosphate overdose based on clinical presentation alone. If students are unsure of pathology, instructor can prompt the students to create differential diagnosis by calling in as a consultant 2. If airway management, oxygen therapy and atropine not initiated, nurse can verbalize need for supportive care B. Atropine, atropine, atropine (and more atropine until respiratory secretions decrease) ii. Development and Deployment this case was developed as part of a graduate-level science course (college, PhD students), and has been deployed as a standard course offering. Variants have also been used to teach medical students as part of an instructional pharmacology module. As the patient was out running past a construction site, s/he started having difficulty breathing. Patient slowed down the pace but still became increasingly short of breath and anxious. Patient has decreasing O2 saturation, increasing fatigue, and increasingly short of breath until nebulized albuterol administered and supplemental O2 provided. Participants are expected to recognize and treat low O2 saturation, build a thorough differential diagnosis, order appropriate laboratory studies/images, and determine need for admission. Once participants administer O2, bronchodilators, and steroidal medication, case will end. Alternatively, can progress to increased dyspnea with expectation that advanced interventions such as magnesium, heliox, and intubation will be employed. If students are unsure of pathology, prompting can come in form of a primary care physician calling to check in on his patient. If supplemental O2 is not provided, nurse can verbalize need for supportive care as patient becomes increasingly dyspneic B. Chest xray useful in first time wheeze, or apparent infectious symptoms 153 Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1st edition (2011), updated 3/2/12 iv. Development and Deployment this case, along with it precursors (reference Gordon, below) and variants have been used over several years for a wide range of students, including high school, college, masters/PhD candidates, medical students (preclinical and clinical) and resident trainees. Authors/Contributors Case drafted by the Gilbert Simulation Team with group updates and contributions. While the case descriptions are written with medical terminology, it is important that the provider and patient. Radiologist: reads chest x-ray 157 Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1st edition (2011), updated 3/2/12 2. Cough was initially non-productive, then gradually began bringing up non-bloody, yellowish phlegm. Patient was hospitalized for ?breathing issues? last year but has no history of intubations. Patient has decreasing O2 saturation, increasing fatigue, and is increasingly short of breath until nebulized albuterol is administered and supplemental O2 provided. Students are expected to recognize and treat low O2 saturation, build a thorough differential diagnosis, order appropriate laboratory studies/images, and determine need for admission. Once students administer O2, bronchodilators, and steroidal medication, case will end. If students are unsure of pathology, prompting can come in form of a primary care physician calling to check in on their patient. It is commonly used as part of a ?train the trainer? curriculum for faculty development in the use of simulation. Authors and their affiliations Case drafted by the Gilbert Simulation Team with group updates and contributions. Appendix B: Diagnostic Studies Chest X-Ray: Hyperinflated, no opacities radiopaedia. Noninvasive Ventilation for Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Outpatient Oral Prednisone after Emergency Treatment of Chronic Obstructive Pulmonary Disease. Harvard Medical School, Boston: President and Fellows of Harvard College, 2002 163 Gilbert Program in Medical Simulation Simulation Casebook Harvard Medical School Draft of the 1st edition (2011), updated 3/2/12 Community Acquired Pneumonia I. 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. This morning, her/his fever rose to 103 F at which point s/he decided to drive to the hospital. Patient presents with yellow sputum, myalgias, right sided chest pain that is worse with deep breathing. |
