Dados do Resumo

Título

REALISTIC SIMULATION OF ASCENDING COLON CANCER IN A HEALTHY PILOT:AN EVIDENCE BASED PRACTICE ADDRESSING THE PATIENT AS A WHOLE.

Introdução

Training with realistic simulation is a method for medical students without exposing patients to potential risks at beginning of their internship. Ascending colon cancer in early stages must be reminded in low levels of ferritin with normal hemoglobin (Hb) even in female patients.

Objetivo

To apply realistic simulation (RS) in the practical teaching of gastrointestinal surgical pathology and integrate medical students to aerospace medicine.

Métodos

RS activities were carried out in the RS Laboratory of university.SimMan® (Laerdal, Inc.), a manikin of high fidelity was used.
Scenario (Sc)1.Female patient,43 y.o.,pilot looked for check up.Fatigue was the main chief complaint. She had heavy and prolonged menstrual bleeding.Her bowel habit was soft stools,3 times/day,sometimes abdominal cramps,when eating bread,pasta,pizza.She walked 30 min daily and anaerobic exercises 3 tpw. H 1.70 m,W 72 kg.SimMan® was programmed as follows:BP:120/80 mmgHg,HR:80 bpm.Flat abdomen,tympanic,normal bowel movements.
Sc2.Low Ferritin level with normal Hb and Ht.Low levels of 25OH vitamin D (25OHD) and vitamin B12 (vit B12).Tumor markers and Abdominal Ultrasonography:normal.Upper Digestive Endoscopy (UDE):Duodenitis with Marsch 2.Gynaecology prescribed levonogerstrel intrauterine device.
Sc3.Small intestinal transit:normal. Colonoscopy showed a 1.5 cm polyp in ascending colon.Histhopathologic study:Moderated differentiated adenocarcinoma.After activities,students had to prepare a report discussing treatment.In debriefing,tutors held discussions about scenarios and asked about the impressions and feelings.

Resultados

Sc1.Students had to perform physical examination suggesting diagnosis of abdominal distension and had to request complimentary exams,including UDE Next,they should give dietary orientations.They should send to Gynaecology.
Sc2.Students made the diagnosis of Celiac Disease. They prescribed vitD,vit B12,gluten free diet.They asked imaging exams,Colonoscopy.
Sc 3.They should ask for preoperatory exams and staging.They should send her to Surgery.
Fatigue is an usual chief complaint in aircrew even though they maintain a good quality of life through physical exercises and good quality of sleep.Heavy and prolonged menstrual bleeding may be a cause of low ferritin level.Celiac Disease maybe be a cause.However,right colon cancer should be investigated,even though colonoscoy is recommended from 45 y.o.In aircrew personnel, cosmic radiation and night shift work may increase the risks.
Students stated that this case was very interesting with many details to be observed.They discussed about the next steps.They stated that they were looking forward to the follow up,mainly to learn about temporary abscence from work in Aeroespace Medicine.

Conclusões

Realist Simulation using SimMan® as a teaching and training tool in Aeroespace Medicine in Gastrointestinal pathologies leads student to experience clinical practice integrating teaching to clinical experience by a person-centred approach to holistic assessment.

Palavras Chave

Colon Cancer; Screening; Educação médica