Microsoft word - rescue scenarios - 1st yr.doc
a. Kenneth Bronson is a 27 yr old male ambulatory to Physician’s
office and is being seen for a “cold” and sore throat. Rapid strep screen was positive. Physician has ordered a Penicillin injection to be given IM. Pt. denies a history of allergies to medication or foods.
b. Clinical signs: alert & responsive; calmly awaiting expected
c. Pt data: male, 27 y/o wt. 163 lb. (74 kg) ht. 72 in. d. DOB: 10/5/XX e. Prior medical history: generally healthy, he works construction
outdoors with resultant tanned weathered skin. He smokes 2 packs of cig a day.
f. Recent medical history: has be c/o general symptoms of a
“cold” with a sore throat that has been getting worse over the past few days.
2. Initial state: RR 44; HR 80; BP 124/72; SpO2 98%; Temp: 100.5F 3. Breath sounds clear bilaterally, peripheral pulses strong bilaterally 4. Look up :
a. Penicillin G Benzanthine 1,200000 b. Epinephrine 1:1000, 0.5 mg IM c. Diphenhidramine 50 mg IM d. Cimetadine 300 mg po
RESCUE SCENARIO #2 Time: 1600 Jennifer Hoffman is a 33 y/o ambulatory to ED accompanied by a family member. She has a history of asthma with several emergency visits with the last year. She appears somewhat anxious, coughing and c/o some chest tightness. She states that she is not surprised because she has felt that she was coming down with a cold and her peak flow levels were decreased this morning. She has used her bronchodilator inhaler but this did not seem to help much.
Clinical signs: Alert & responsive; appears anxious, diaphoretic Pt data: Female, 33 y/o, wt 99 lb (45 kg) ht 61 inch DOB 1/31/XX Prior Medical history: history of asthma with several emergency visits within the past year. Meds used at home include Beclovent, Intal, Serevent and a Proventil inhaler. Recent Medical history: Peak flow levels decreased this am. The pt. felt lik she is coming down with a cold. Initial state: RR 30; HR 92; BP 138/84; SpO2 89%; Temp 98.8 F Breath sounds wheezing bilaterally; coughing, states “I can’t get enough air.” Look up: Beclovent, Intal, Serevent and a Proventil inhaler
RESCUE SCENARIO #3 Time: 1100 Vincent is a 67 y/o male admitted directly from Physician office for exacerbation of chronic obstructive pulmonary disease. He has been assisted into a pt. gown and in the hospital bed. He is hunched forward in apparent respiratory distress. His wife is very attentive at his side. Physician orders have been obtained. Clinical signs: Alert & responsive; appears anxious, using accessory muscles of shoulder and neck to breathe; clubbed fingers; barrel chest Pt data: male, 67 y/o, wt 154 lb (70 kg) ht 68 inch DOB 6/28/XX Prior Medical history: 50 year history of smoking 2 packs a day. He has continued to smoke despite health care provider’s recommendations to quit. During the last year he has had two exacerbations. Recent Medical history: c/o increasing fatigue with activity and inability to sleep well at night. Has also had increased sputum production and cough. Initial state: RR 28; HR 92; BP 142/84; SpO2 80%; Temp 100.2 F Breath sounds wheezing bilaterally; coughing, states “Could I get some more tissues? I am coughing up a lot of mucous.”
Albuterol 2.5 mg in 2.5 ml NS via nebulization
RESCUE SCENARIO #4 Time: 1330 Carl is a 54 y/o male who travels frequently on business. He is seeking care in the local ED with c/o dull aching chest pain and shortness of breath. He is out of state with no local physician. He smokes less than a ½ pack of cig a day and drinks alcohol occasionally. He describes his work as “stressful”. Clinical signs: Alert & responsive; anxious, short of breath, diaphoretic & pale. Pt data: male, 54 y/o, wt 242 lb (110 kg) ht 69 inch DOB 07/19/XX Prior Medical history: history of HTN. He states he takes “water pills” for his blood pressure and has been trying to exercise and lose wt. but admits that it is very hard when he travels. Recent Medical history: Has been really “pushing” himself lately and feels the “stress” is starting to get to him. He has noticed this type of chest pain before but it usually goes away when he rests. He became worried when he began sweating and became short of breath. Initial state: RR 24; HR 120; BP 158/92; SpO2 94%; Temp 98.4 F EKG sinus tachycardia Breath sounds clear bilaterally; peripheral pulses strong; states “It feels like a tight belt around my chest.” Rates pain on scale at a 7. Look up;
RESCUE SCENARIO #5 Time: 0700 Skylar is an 18 y/o male who was brought in by ambulance to the ED in diabetic ketoacidosis, three days ago. He has spent the last 3 days in the ICU receiving IV fluids and IV insulin. His IV is now a saline lock in his right forearm. Clinical signs: Alert & responsive. Pt data: male, 18 y/o, wt 154 lb (70 kg) ht 72 inch DOB 03/11/XX Prior Medical history: no significant past medical history and takes no medications. Immunizations are up to date. As far as mother is aware, he doesn’t smoke or use illicit drugs but she does admit that in the last year he has come home drunk a couple of times. Recent Medical history: Fatigue and frequent urination began 2-3 weeks ago and have become progressively worse. Initial state: RR 18; HR 78; BP 118/74; SpO2 99%; Temp 98. F Breath sounds clear bilaterally; states “Hi, how many times are you going to stick me?” Look up:
Adapted from NLN Scenarios for Sim man – written by Laerdal Medical Corporation, 2007
Available from http://www.jamesalison.co.uk/pdf/cas19.pdf Más allá de la teoría: desatando los nudos de la Redención Esta charla corresponde al capítulo 2 de On Being Liked y es el primer capítulo del tríptico de ensayos sobre la redención que se encuentra en aquel libro. Introducción De Alejandro Magno se dice que resolvió el problema del nudo gordiano con la espada1.
TRADE MARKS ACT 1994 IN THE MATTER OF APPLICATION No. 2248462 BY GLENSIDE ORGANICS LIMITED TO REGISTER THE TRADE MARK BI-AGRA IN CLASS 1 IN THE MATTER OF OPPOSITION No. 90587 BY PFIZER INC TRADE MARKS ACT 1994 IN THE MATTER OF Application No. 2248462 by Glenside Organics Limited to register the Trade Mark BI-AGRA and IN THE MATTER OF Opposition No. 90587 by Pfizer Inc