Beruflich Dokumente
Kultur Dokumente
SCENARIO 2:
Injuries - care and treatment
The scenario presents a patient after an injury of the hip additionally
with persistent atrial fibrillation. The student has to exclude fractures
and apply appropriate analgesic therapy. Proper conduction includes
collecting medical history and physical examination of the patient,
ordering and interpretation of diagnostic imaging studies, injury
management and to formulate a course of treatment.
List of medications to prepare by students prior to the lab:
Acenocumarol/warfarin according to INR
Bisoprolol fumarate
Enalapril maleate
potassium chloride
Dipyron hydrate, Methapyrone, Metamizol
Tramadol [Ultram, Ralivia flashtab, Ralivia ER, Tramal]
Ketoprofen [Orudis, Profenid, Actron, Oruvail]
Paracetamol [Tylenol, APAP, Datril, Acetaminofen]
500 ml r-r Ringers or Multi electrolyte fluid (Isolyte)
Patient: slippery sidewalk, 86 year old woman slipped and fell on right hip on
curb, wound on R. hip, little bit elevated HR, feels pain on r. hip and brought
to ER
1. stop bleeding and check vitals
1. HR = very high >160
2. BP high
due to pain
2. give painkillers; always assess id successful or not by asking pt. grade 1 10 before & after the medication (remember to give dosage accordingly
to age)
1. normal to become sleepy after morphine; start at 2mg and then assess
and adjust dose accordingly to avoid them becoming unconscious
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SCENARIO 3:
Rating respiratory and circulatory condition of patients,
preoperative assessment
The scenario presents a patient being prepared for elective left knee
replacement surgery. The patient had myocardial infarction 5 years
ago, suffers from recurrent venous thromboembolism, takes
anticoagulation from 8 months, 9 months ago the patient was
implanted pacemaker system due to third-degree atrioventricular
block. In addition, the patient has hypertension and chronic obstructive
pulmonary disease.
SCENARIO 4:
Analgesic therapy
The scenario presents a patient who came to the Hospital Emergency
Department because of severe pain of the lower back and numbness of
the right lower limb. The student should order analgetic treatment,
diagnose the cause of acute pain, to administrate long-term analgesia
and refer the patient to the appropriate treatment. Proper conduct
includes medical history, physical examination of the patient,
administration of an appropriate analgesic treatment, order diagnostic
imaging studies, diagnosis of disc herniation of the nucleus pulposus
protrusion at the lumbar spine and referring the patient to the
Neurosurgical Clinic for treatment.
List of medications to prepare by students prior to the lab:
Ketoprofen
0,9% NaCl 500ml
Tolperisone
Tramadol
severe back pain suddenly appeared when tried to move book case
acute piercing stabbing pain radiating to back of both legs
has problem with moving legs
40 years old and is conscious
SCENARIO 5:
Intensive medical care for an elderly person
The scenario presents the unconscious patient breathing
spontaneously. The student should to protect the patient's airway, get
the stabilisation of the patient's cardiovascular parameters and direct
the patient to the appropriate ward. Proper conduct includes
monitoring of the patient, intubation, administration of drugs to lower
BP and HR, laboratory tests and diagnostic imaging studies, and
directing the patient to the Department of Neurology.
List of medications to prepare by students prior to the lab:
SCENARIO 6:
Prevention and treatment of delirium
The scenario presents alcohol abused patient, after an episode of
bleeding from the upper gastrointestinal tract. The student has to
assess the loss of blood, exclude cranio-cerebral injury, make up
deficiencies and refer the patient to the appropriate department.
Proper procedure includes taking a laboratory tests, diagnostic imaging
study of the head, adequate hydration of patients, supplementing
electrolytes, Vitamin K and RBC. Subsequently, after obtaining a
negative result for the presence of alcohol in the blood, turn
neuroleptic treatment and transfer to the Department of
Gastroenterology.
List of medications to prepare by students prior to the lab:
phospholipid essential (Essentiale Forte) 2 caps x 3
Pantoprazole (Controloc) 20 mg x 1
phytomenadione (Vitacon) 10 mg x 1
Potassium chloride x 1
1000 ml multielectrolyte solution (Isolyte)
500 ml Voluven (6% hydroxyethyl starch 130/0.4 in 0.9% sodium
chloride injection)
Ephedryne
2 j PRBCs (packed red blood cells)
Haloperidol
rescue team brings in patient b/c blood vomiting and loss of
consciousness in front of house
lack logical contact
can smell alcohol on patient
pale and sweaty skin
marks of blood clots in angles of mouth
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SCENARIO 7:
Rehabilitation after surgery
The scenario presents a patient after surgery, arthroplasty of the right
hip. The patient reported severe pain of the right hip after falling down.
The student is to conduct the medical history and physical
examination, give analgesics and perform the necessary tests. Proper
action (based on research) includes directing patient to the
Department of Orthopaedic for the operation and further rehabilitation.
List of medications to prepare by students prior to the lab:
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Metamizol
Paracetamol (acetaminophen)
brought by ambulance to ER
found injury of right hip because of fall
broken femoral neck
had surgery to fix it
one hour post-op; decide if everything is okay with patient
- has epidural anesthesia and asking why can't move legs
BP 140/90 usually
after surgery check wound and do physical examination
bandage was dry and BP was low but high HR
- treat the BP first
blood testing: CBC, Hb, hematocrit, ferritin, electrolytes
give saline solution
wait a few hours before giving anticoagulant because epidural and
wound needs coagulation
SCENARIO 8:
Anatomical and physiological processes associated with aging
The scenario presents conscious patient suffered dysarthria, paresis of
the upper and lower left limbs. The student should take care of the
patient properly, diagnose the cause of the deterioration of his
condition. Proper conduct includes: monitoring, neurological
examination, diagnostic imaging studies and adequate treatment.
List of medications to prepare by students prior to the lab:
Clopidogrel (Plavix) 75 mg
Acetylsalicylic acid (Acard/Aspirin) 150 mg
Ramipril (Vivace) 5 mg
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SCENARIO 9:
Acute abdominal pain
The scenario presents a patient with patient with acute abdominal
pain, nausea and difficulties with breathing. The student should
identify the cause of symptoms, implement the treatment. Proper
management includes collect medical history and physical examination
of the patient, order and interpret additional tests, make the diagnosis
of abdominal pain and the inclusion of appropriate treatment.
List of medications to prepare by students prior to the lab:
oxygen
acetylsalicylic acid
nitroglicerin
morphine
500 ml multielectrolyte fluid
acute abdominal pain, nausea and difficulty breathing
- started 30 min ago during physical activity
40 years old
first time in life feeling this pain
recent MI
- do lab work for CBC, troponin, CK-MB, etc.
- do physical for hernia and other abnormalities in abdomen
- elevated CK-MB
- ST elevation of monitor
do full 12 lead ECG
AvF, V5, V6 = inferior wall affected => abdominal pain
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SCENARIO 10:
Acute pain in the lumbar region
The scenario presents a patient with patient with patient with acute
pain in the lumbar region. The student should identify the cause of
symptoms, implement the treatment. Proper management includes
collect medical history and physical examination of the patient, order
and interpret additional tests, make the diagnosis of pain and the
inclusion of appropriate treatment.
List of medications to prepare by students prior to the lab:
Codeine/acetaminophen
500 ml multielectrolyte fluid
Doxazosin
Tamsulosin
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