Medical Student Simulation: Caring for the Unstable Acutely Ill Patient
- The rapid assessment of a patient’s airway, breathing and circulatory status is critical to treating a wide variety of patients and clinical conditions. The initial assessment of a patient’s ability to oxygenate, ventilate and protect their airway is a critical step in treating a patient in extremis.
- Early aggressive intervention in many situations limits the overall decompensation of the patient and allows for a better overall outcome. The early involvement of support staff, such as a rapid response and code teams cannot be understated. If you identify a patient an unstable patient, the FIRST thing you should do is call for help.
- Once help is on their way, do not stand around with your hands in your pockets. Remember you are the first line, and you are medically trained! You are good enough, smart enough, and gosh darnit people like you! INTERVENE! You may not know the etiology of the patient’s clinical decline, but you know that they are not stable and their airway is not protected. Use your ABC’s and help will be there shortly. If you don’t do something, the patient may be in full arrest by the time your reinforcements arrive.
- The training scenarios are designed to demonstrate the key aspects in identifying and intervening in a number of clincal conditions. They use a common decision analysis and skill set that if you master, will be an excellent basis for your ability to treat severly ill patients.
Required Reading – Knowledge Based Objectives
- General Care
- Airway Management
- Fundamentals of Critical Care Support: Chapter 2 - Airway Management *Note you are not responsible for information regarding LMA or combitubes
- Advanced Trauma Life Support: Chapter 2 - Airway and Ventilatory Management *Note you are not responsible for information regarding LMA or combitubes
- Fundamentals of Critical Care Support: Chapter 7 - Shock *Note you are not responsible for information regarding:Vasopressor and Inotropic agents (Section V)Oliguria (Section VII)Management of Acute Renal Insufficiency (Section VIII)
Required Reading – Skills Based Objectives
- Airway Management
- Central Venous Access
- Tube Thoracostomy
Supplemental (Recommended) Materials
- BMJ 2003 Hind
- NEJM 2003 McGee
- NEJM 2006 Thomsen
- NEJM 2007 Braner
- NEJM 2007 Dev
- NEJM 2007 Graham
- NEJM 2007 Kabrhel
- NEJM 2007 Ortega
- NEJM 2008 Hsiao
- NEJM 2008 Tsui
The New England Journal of Medicine has a website with readings and videos, visible online or downloadable to a PDA or iPod. They are short and VERY helpful.