Читать книгу Emergency Medicine Simulation Workbook - Группа авторов - Страница 35

A 60‐year‐old man is brought in by EMS from home. Patient is moaning due to abdominal pain, complaining of feeling sick.

Vital signs:	Temp 102.5°F (39.2°C), HR 125, RR 22, BP 80/60, SpO2 99% on room air.
Head:	Atraumatic, normocephalic.
Eyes:	Icteric sclerae; pupils 4 mm bilaterally and reactive to light; extraocular movement intact without nystagmus.
Ears/nose/mouth:	Dry mucous membranes, with subungual icterus (if asked).
Neck:	Supple, full range of movement, no meningeal signs.
Heart:	Tachycardic, regular, no murmurs/rubs/gallops.
Lungs:	Clear to auscultation bilaterally (patient reports worsening belly pain when taking deep breaths).
Abdomen:	Distended, with hypoactive bowel sounds. Tender to palpation in the upper abdomen, most significant in the right upper quadrant and epigastric region. No rebound. Voluntary guarding in all quadrants.
Extremities:	No edema, cyanosis, or clubbing.
Skin:	Warm to the touch.
Neurologic:	Alert and oriented to person and place, but not to time. Answers most questions appropriately but seems confused and takes a while to respond to simple questions. No focal deficits. Cranial nerves intact. No asterixis.

Physical exam findings that are not available on your mannequin may be offered verbally to learners if they ask (e.g. if unable to simulate icteric sclera, can verbally report the scleral exam to the learners if they specifically ask for this information).

See flow diagram (Figure 1.15) for scenario changes based on learner actions.