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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 dont 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