medical case simulator 1 backup

All cases are ficitonal and not to be used as medical advice

PRIMARY OBJECTIVE

SECONDARY OBJECTIVE

15:00

Handover Task: review and discharge this 40 year old female who attended by ambulance with Acute Behavioural Disturbance

Start

Cocaine

Pick your next step

History and exam

review test results

discharge the patient before they breach

Case

Handover from the day team 40F brought in by ambulance. Police called to pub after public heard shouting. Police attended but patient presented voluntarily with ambulance service after admitting snorting cocaine. They required rapid tranquilisation on arrival to the ED. Since then she's been sleeping and going to breach in the next 15 minutes

Before the patient leaves, you wonder whether it's worth getting a collateral history from the police

You mark the patient as left department. You return to work the next day

You call 999 to report the patients details and condition and ask to speak to a sergeant

Case A

You inform the patient that she's been monitored in the department for 3 hours and 45 mins. The results were reviewed earlier and are all clear. You safety net the patient to return if chest pain or unwell. The patient thanks you for reviewing her. She's keen to get back home but head to the bathroom first.

Vitals

Bloods

ECG

The patient reports their chest pain has resolved and now experiencing only acid reflux and upset stomach, but keen to manage these at home

Discharge with safety net

Admit under medics

Investigations

You review the results

The patient reports their chest pain has resolved and they are now experiencing only acid reflux, but keen to manage this at home

explore their report of upset stomach

Safety net the patient and signpost to support for drug cessation

History & Exam

The patient admits to snorting 2 lines of cocaine before getting into a verbal altercation. They admit to using cocaine most weekends but are planning to stop now. You remove their cannula at their request. The patient is about to breach

open email

In the meantime the patient leaves the department. You return to your shift the next day and open your emails.

Go to resus area

The operator is very busy right now but they're keen to help. You leave a message with your number, the patients identification and summary of medical condition and the operator will request a colleague call you back. In the meantime the patient leaves the department.

You explain that the patients requires observation overnight. The patient replies that they can be observed by their friend, if there's no intervention needed overnight

Request the patient sign the self discharge paperwork

You explain that due to the ecg changes they require monitoring on the ward. The patient initially agrees but then requests to self discharge.

You know that cocaine has a halflife of about an hour so make a rapid judgement

discharge the patient with detailed safety net and advise aspirin for cardioprotection

admit the patient under medicine with surgical consult

Unexpected turn

After sitting the patient down you enquire if they have any particular concerns about their stomach upset. They are initially reluctant to go into details but after careful conversation, it transpires that on seing the police, the patient swallowed 5 wraps of cocaine. Each was double sealed in clingfilm

You return to shift the next day to find the same patient is now in resus. The patient has a profound sympathomimetic toxidrome. They have received multiple doses of lorazepam IV but continue to seize. They are receiving barbiturates and bicarbonate and a catheter is being placed for cold water lavage You reflect on the case You refl

00:03

Restart

Toxidromic

00:03

The patient undergoes whole bowel irigation and is discharged after 3 days

info

Restart

Drug STUFFING

PRIMARY OBJECTIVE Success!

PRIMARY OBJECTIVE SUCCESS

Drug stuffing is an attempt to rapidly avoid detection by police. As opposed to drug packing, the packed drugs are less well prepared and contained and more likely to burst, releasing their contents, resulting in delayed presentations that may be refractory to initial management

PRIMARY OBJECTIVE FAILED

Do you want to customize your branching scenario? Here are some tips:

• Before editing the branching scenario itself, edit in the outline first. This way you’ll get an overview and know which questions and answers go on each page.
• When editing, follow the order of the pages, from the first page or question until you reach the final pages.

Take a look at the structure of this branching scenario. Each page has a number associated with it, contains a question, and leads to several answer options. If on page 4 they choose option A, they go to page 5. But if they choose option B, they go to page 6, which contains a different question. This branching scenario is set up so that if you keep the structure the way it is, there’s no need to edit the interactivity or connections between pages. But you can also modify them. For example, imagine you want to add an option C to the question on page 5, and if they choose this option, they skip to the question on page 10. You’ll just need to set up the 'Go to page' interactivity from option C so that it jumps directly to page 10. As you can see, the most important thing when creating your branching scenario will be planning it well and assigning a number to each page before beginning to edit it. This way, you’ll be able to modify the connections very easily.