Читать книгу Emergency Medicine Simulation Workbook - Группа авторов - Страница 36

For all learners, the case should begin with obtaining a complete history as well as performing a thorough physical exam. The nurse can help the learners to set the patient up on the monitor to obtain vital signs. This should also include obtaining a fingerstick glucose, in light of the patient's slightly altered mental state.

Learners should order initial labs, imaging, IV fluids and medications.

If there is inadequate fluid resuscitation, the patient's hypotension will worsen. Continued failure to appropriately fluid resuscitate will lead to PEA, requiring CPR.

For novice learners, administration of an appropriate fluid bolus (30 cc/kg) will cause the patient's blood pressure to increase to a mean arterial pressure greater than 65 mmHg and his heart rate will slowly lower. With these improvements, the patient's mental status will also improve. Laboratory tests and imaging will then be available for review and appropriate consultation should be made with general surgery/GI, as well as an admitting physician. The case will end after appropriate disposition and consultation have occurred.

For advanced learners, despite initiation of IV fluids and broad‐spectrum antibiotics, the patient will continue to be hypotensive and altered, requiring initiation of vasopressors and intubation. Failure to do so will result in PEA arrest. Once intubation is performed and vasopressors are initiated, the patient will stabilize. Consultation with general surgery/GI and the intensive care admitting physician should then occur. The case will end after appropriate disposition and consultation have occurred.