medical case simulator 1 backup

Cocaine

Start

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

15:00

SECONDARY OBJECTIVE

PRIMARY OBJECTIVE

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

DO NO HARM

AVOID THE BREACH OF 4 HOUR TARGET

Get your students thinking! In this decision tree, you'll find a 'Choose Your Own Adventure' style question and answer itinerary that’s perfect for encouraging decision making and critical thinking.Each page includes a question and several answer options. Depending on the answer chosen, one route or another is followed. Your choice for a given question will affect the rest of the activity.In the end, they’ll make it to a final page, according to the choices they have made throughout the genially. Customizing it is easier than you think! Thanks to a simple structure and these editing tips, your decision tree will be ready in no time.

Explanation

Click PREVIEW to interact with the buttons and learn more about the structure and tips.

How is it structured?

Tips for customization

Question

Final

Option A

Option C

Option B

Option A

Option B

Option A

Option B

Option A

Option B

Map legend

Slidenumber

Option-Answer

Slide with question

Slide with recapitulation/ Final reflection

Handover from the day team40F 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

Case

discharge the patient before they breach

review test results

History and exam

Pick your next step

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.

CaseA

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

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

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

You review the results

Investigations

Admit under medics

Discharge with safety net

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

ECG

Bloods

Vitals

HR105 bp 150/90 temp 37 rr20 sats97oa

haemolysed

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

History & Exam

Safety net the patient and signpost to support for drug cessation

explore their report of upset stomach

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

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.

Go to resus area

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

open email

You are invited for a meeting with the information governance team

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

Request the patient sign the self discharge paperwork

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

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

Unexpected turn

admit the patient under medicine with surgical consult

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

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

Toxidromic

Restart

00:03

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 lavageYou reflect on the caseYou refl

PRIMARY OBJECTIVE Success!

Drug STUFFING

Restart

info

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

00:03

PRIMARY OBJECTIVESUCCESS

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 OBJECTIVEFAILED

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.

medical case simulator 1 backup

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