Clinical Simulation Lecture: Assessment and Treatment Strategies

Overview

• It is important to assess patient's age and gender as they play significant roles in diagnosing respiratory conditions.
• Case study of Phil Brown, a 57-year-old male admitted with mild respiratory distress.
• Importance of noting initial complaints and current condition for contextual insights.
• Role of the respiratory therapist in evaluating cardiopulmonary status.

Information Gathering Strategy

First Pass: Quick, Easy, and Cheap

• Objective: Immediate assessment to determine if there's an emergency.
• Vital Signs:
  • Breath sounds
  • Vital signs (pulse, respiratory rate, heart rate, blood pressure)
  • Color of lips and nail beds
  • Chest configuration
  • Temperature
  • Smoking history
• Rationale: Rapid assessments providing immediate and significant data without high costs.

Second Pass: Relevant Data if No Emergency

• Objective: Detailed assessment after ensuring patient stability.
• Possible Assessments:
  • CBC (Complete Blood Count): WBC count for infection detection
  • Chest X-ray: Check for pneumonia
  • ABG (Arterial Blood Gas): Evaluates oxygen and carbon dioxide levels despite being non-emergent

Treatment Strategy

Initial Steps based on Gathered Info

• Common signs: cyanosis, tachycardia, febrile, barrel chest (indicative of COPD).
• Decision-making: Determine immediate treatments like increasing oxygen supply.
• Recommendations:
  • Increase nasal cannula flow or adjust FIO2 based on ABG readings

Adjust Further Based on Response

• For worsening conditions despite proper initial treatment
  • Implement BiPAP (non-invasive ventilation) if pH falls below expected level
  • Intubate & Mechanically Ventilate for severe, unresponsive conditions

Clinical Case Simulation Summary

Case of Phil Brown

• Situation changes dynamically: worsening symptoms and need for adjusting treatment strategies
• Emphasis on correct initial decision-making using quick, easy, and cheap information gathering
• Sequential adjustment based on response to previous treatments
• Highlights the proper vetting and validation of therapeutic steps to reflect real-life clinical situations

Case of Renee Sanders (Guillain-Barre Suspect)

• Presents neuromuscular baseline values and progressive symptoms
• Importance of neuro-muscular disease indicators such as recent viral events
• Correct diagnostic strategy for Guillain-Barre (cerebrospinal fluid analysis)
• Proper interpretation of pulmonary mechanics in clinical simulations
• Decision-making process influenced by new data points: airway compromise, deteriorating MPIs, etc.
• Successful mechanical ventilation management after non-invasive ventilation trial fails

Post-Treatment Considerations

• Determining long-term respiratory care and discharge planning
• Ensuring patient safety post-intubation or extubation
• Ongoing evaluations: CBC, ABG, and chest x-rays to confirm no underlying infections or complications
• Recommendations for home care: bronchodilators, oxygen concentrators, smoking cessation programs, etc.

Exam Strategy Insights

• Sequential step-wise approach in simulations for optimal decision-making
• Practice components reflecting theoretical learning in simulations
• Key takeaways: patient stability first followed by relevant data collection
• Reinforce importance of re-evaluation and dynamic adjustment in clinical practice

Final Points

• Practical decision-making based on rational step-wise assessments ideal for clinical simulations and real-world practice
• Emphasis on being pragmatic and not necessarily perfect in clinical trials aiming at competency over perfection