SIM MAN

DO NOT MISS SIM MAN You will have two sim man stations in which you should do management 1- acute asthma 2- acute limb ischemia I have seen many doctors have struggled in these two stations so I would like to talk about these two stations

Shortness of breath in sim man

To begin with, as you know shortness of breath in sim man has two stations: One of these is acute asthma, which involves taking history, examination and management. The other is infective exacerbation of COPD, which involves taking history and examination, NOT management. This means before starting the station you can be sure if there is management in the task, the station is acute asthma. COMMON MISTAKES in acute asthma station

1-Many doctors forget to fasten the mask properly, maybe they are thinking about choosing a right mask at the beginning of the station. There is usually only one mask, Hudson with reservoir, which is the right one. Therefore, it should not distract you. Please fasten the mask properly when you start your treatment in very early stage of station. Don't expect to pass if you don't fasten it properly. It is a good idea when you are putting the mask tell the examiner '' I'm giving my patient oxygen and let the examiner ask you about percentage (high flow 100%), and rate (15 L/ min). The examiner will ask you, however, if he did not so you can talk about them. 2-Many doctors could not reach to auscultation .To tackle this problem you should aim to auscultate the chest at least 90 sec before the station finishes because in this station the most important finding is on Auscultation. The best way to manage your time is you must keep looking at the monitor and as soon as oxygen saturation drops below 90%, then should start your next treatment step, so you can save time and don't let sim man to waist your time. For example, during taking history, you have to give oxygen when you come to know he has asthma. During the examination, when you see oxygen saturation drop below 90% immediately talk about nebulized salbutamol 5 mg every 15 minute. The simman may deteriorate once more, so you keep tracking the monitor and this time please talk about IV hydrocortisone 5 mg every 4-6 hours .By doing this, you don't let sim man to start showing you his shortness of breath in which you have to ask him “what is happening?” and he can't talk due to shortness of breath you have to wait and ask it again and …. This approach not only save your time but also gives a good impression to the examiner as you keep looking at the monitor. 3-Many doctors at the end of the station when the examiner asks them a question they

answer something else! When you finish auscultation please talk about your finding, which is wheeze and the diagnosis, which is acute asthma. If the examiner asks you ''what are you going to do now?'' please do not talk about other steps of treatment because when you finish the station the sim man is usually stable. The examiner doesn't look for other steps of treatment. Here you should talk about the investigation, which is ABG, X-ray and ECG.As you know after using steroid (either hydrocortisone IV 100 mg or prednisone PO 40-50 mg) if the patient deteriorates you should inform ITU and your senior so the stage after steroid should not be the examiner's concern. However if he asks '' what are you doing if your patient deteriorates again ?” please tell the examiner “I informing my  seniors and ITU team and they may consider magnesium sulphate and intubation ” To summaries,

Please don't waist your time by thinking whether maybe there are some other findings apart wheeze or maybe there is no finding in this station! You must count every seconds now so please don’t let anyone to confuse you  by giving false information. Please concentrate on practicing common station .Do not forget your job is to pass the exam, not convincing those who have PLAB2 hallucination and delusion so please do not argue with them and work hard for passing the exam. I am sure reviewing such mistakes will enable you to pass this station pass with an excellent mar All the best, Hamed I try my best to post some information about other sim man station, involving management, which is acute limb ischemia