#sim lab

Today I did an interprofessional team immersion where a bunch of students from the COM, dental, PA, nursing, social work, pharmacy, and occupational therapy schools got together and treated a fake patient.

Everything went well, and since we didn't have a pharmacy student on our team, I became the person in charge of that. This is hilarious if you know me and how much I struggle with pharm, but even though my pharm knowledge is about average for a medical student, it was interesting that it was more than anyone else had acquired so far.

Anyway, I was talking to the patient about her meds, how she's taking them ect. ect. And then as the social work student was talking to the patient, she said something along the lines of "and that's why the doctor is concerned about your medications" and at first I was like there isn't a doctor here?? And the I was like oh... she means me!

My “patient” was a 72 y.o. M who was found by his daughter on the floor of his home. Admitting dx of rhabdomyolysis exacerbated by heat exhaustion and electrolyte imbalances. He also has a stage II pressure ulcer on his coccyx. He is dehydrated and has a foley in place with dark amber urine.

He’s confused, oriented only to self, and is very anxious. He c/o 6/10 pain and nausea, but no vomiting.

H&H is a little low, but nothing significant.

Potassium is 6.8

Sodium is 155

All other electrolytes were WNL.

Temperature 104.2

Heart Rate 118

Blood Pressure 80/60

Respirations 22

Oxygen 96% on room air

I walk into the room and my patient is still in his street clothes. Immediately my LPN and I turn down the lights, room temperature and start changing him into a hospital gown.

I auscultate his lungs (clear) and start and grab the aforementioned vitals. That’s when he starts “vomiting” coffee ground emesis (thanks to my lovely classmate armed with a large syringe 😂).

I administer PRN IV phenergan and “call” the doctor who I give my SBAR report to and receive verbal orders for IV meds and fluids including 1/2 NS with bicarbonate to infuse @ 300ml/hr.

Eventually a two hours pass and potassium is down to 5.9 and sodium is down to 142. Blood pressure is starting to go up, and heart rate and temperature are going down.

I can’t remember all the details of what we did, but eventually my patient stabilized and their hypovolemia and electrolyte imbalances started to resolve.

All in all it was a chaotic experience, but I loved it. 🤣

This morning I had another SIM lab to practice treating a patient without consequences. It was fun as always and I got to practice explaining complex diagnosis and treatments to the patient in simple language, which I think I did pretty well. It really just made me excited for third year and actually getting to talk to people about their conditions and trying to make sure that they're involved and informed about their own health.