Following the dynamic scenario will be a static version of the same incident. Participants will learn about the recognition, treatment, and management of obstetric emergencies including hypertension, post-partum hemorrhage, and cardiomyopathy. A mark sheet is included to facilitate structured feedback Scenario 1 Post Cardiac Arrest 1 (Right Bronchus Intubation & Post-Resus Care) Scenario 58 year old male witnessed collapse whilst in pub. If you think you may have a medical emergency, call your doctor or 911 immediately. 4 0 obj The laceration is complex and will be closed by the maxillofacial team. A simulation exercises is a fully simulated, interactive exercise that tests the capability of an organization or other entity to respond to a simulated emergency, disaster or crisis situation. Instructor BriefingNo mannekin or airway equipment requiredWhiteboard and pens or similar for candidate to useBrief role players. The candidate is expected to address the parental concerns and obtain informed consent for wound closure under ketamine sedation. AACS Role PlayerYou are an ACCS ST1 in Emergency Medicine. "�Թ�ū���"l Clinical Knowledge 60%Teaching Skills 40%, Scenario 4Airway Assessment prior to Sedation (Teaching), Overall                                                                                                  PASS                     FAIL, This page was last updated November 12th 2014 (6 years ago), © copyright Health Education England 2021 | Crafted by Carbon Crayon, Management of Chest Pain and Shortness of Breath, Inotropic support 1 in 100.000 adrenaline cautiously to improve BP, Paralysis: suitable long acting paralysis, Ventilation, suitable ventilation profile 7ml/kg, Cautious sedation, aliquots of midazolam or propofol infusion at low rate, Cooling; cold 0.9%saline bolus, consider magnesium (VF and cooling), ETCO2 is essential as clinical examination can be unreliable. Learning & Debrief PointsRole of ketamine in paediatric sedation.Increase in recreational ketamine abuse can cause issues with patient acceptance. This . They are designed to be run by someone with appropriate training in simulation and debrief. You intend to sedate the patient with propofol and fentanyl.The ST1 who has no anaesthetic training asks you to teach them how you assess an airway prior to sedation.You are expected to teach the ST1 a structured approach to airway assessment. Candidate ExpectationsEarly connection of ETCO2.Recognition of oesophageal intubationRemoval of ETT and institute adequate oxygenationAttempt re-intubation having established plan and prepared equipment.Only maximum 3 attempts at re-intubation, each must have a change of technique instituted.Recognition of potential difficult intubation due to body habitus.Call early for senior airway support.Adequate resuscitation if arrest occursSenior airway support will not arrive until end of scenario; aim is for candidate to maintain adequate oxygenation by appropriate route until this arrives.Ensure debrief, informing consultant and critical incident report. Emergency Scenarios with Case Review Fire (Manageable and Unmanageable) This emergency scenario is about patient-visitor disruption, and is set up for role-play and case review with your staff. You have no caps, crowns or loose teeth. He has sustained a facial laceration by falling into barbed wire. Simulation Scenarios This material is made available as part of the professional education programs of the American Academy of Pediatrics and the American College of Emergency Physicians. The nurse feels you are required as the patient is gagging on the ETT and she is concerned the ST2 is “out of their depth”.You have an ST2 ACCS Anaesthetics and nurse is in attendance. ��v^�Yt�����bjk�ָ���߹w��8��»+����i���ur���%���7����δ��v��z3/�`��k��5&6��IT9Ƒ��y+��B� A�8Lm~Hs�E�sv,�����|Ȇl��[W�g6}F�]!��8Y����u�tƹ���o�A��mkx�{��~� #��_AU�������(ֺ�h�&xz��hx� �H �#6a�"nM�M"�"�@��~�)0l �h�f��1�e#�����>�S�#E� 0vpjp��tA�d�G�M"�Y�\l!F�8�������}��%݀�� �|O�e@6hk�;��Z@P��P͕�@�K`����3:m�I�"6m�~���ٚ���B&Т�;������Y��&*�K G�>����l�eЦ@qZ���R���L���3J�5��8s�X(g�i�B&aztȼM����$�9=1��2'�t!��6j 'd�Wcul�Q-{D��d�[�H/&�3������z[uoZ�a�:�vE�f(���c�.���cL�|�s�[�~p�8S�����k�,J[�ukN���U,���]}��C�t��$���t%'�A4P`�Y����D�e9]mAC��8���ךd&��-p Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Reuben Addison , Tate Skinner , Felix Zhou , Michael Parsons 1. Reinforce role of BMV as important in short acting sedation techniques. Candidate ExpectationsDemonstrate and teach a structured approach to airway assessment.Focus on, Factors relevant to predicting difficulty in BMVThis should be considered contra-indication to sedation in this circumstance.Five independent predictors of difficult BMV, Adequate BMV can be difficult due to following factors1.Difficult mask seal, 2. Introduction. Current Trainees / 1) The person facilitating scenarios can print out the pages below. You are on no medication and have no allergies. BLS commenced by family.Found by crew in VF with agonal gasps, shocked x3 with transient PEA, 1mg adrenaline and intubated.Now RoSC with spontaneous breathing and gagging on ETT.ST2 ACCS gives 10mg vecuronium IV as candidate enters room.There is unrecognised oesophageal intubation as no ETCO2 or Easicap is attached. Human Kinetics and Recreation, Memorial University of Newfoundland 2. You have been busy in the Obs Unit and are informed by the senior nurse that an obese 60-year-old male post VF cardiac arrest is in resus. • Respiratory Therapy Code Pink Simulation • Simulation of Pediatric Diabetic Patient • Placenta Previa - Remediation • Pre-scenario Worksheet and List of 14 Scenarios • Skills Check-off Scenario • Basic Medical / Surgical Nursing • Intermediate / Complex - 2 Medical / Surgical Scenarios 2 Sessions Each ����Rc�� r�����ܢ�Lg��L�J���!bax��)E�xk�6���2�ޕ""�zf�,E. However a full airway assessment including predicted difficulty with BMV, laryngoscopy, intubation, SAD insertion and surgical airway is acceptable. The department has received a pre-alert from ambulance control. Post Cardiac Arrest 2Unrecognised oesophageal intubation & failed intubationClinical knowledge, technical skills and team work, 3. 2) Undertake a role-play as if this were actually occurring in your clinic. Paediatric SedationGain parental consent for ketamine sedation to facilitate wound closure.Communication and clinical knowledge, 4. Airway Scenarios, 1. Each scenario should run for 15 minutes followed by 10 minute debrief. Purpose A simulation is a way to test a company’s emergency response plan. Laerdal patient simulators are designed specifically to support the practice of critical thinking, clinical diagnosis and interprofessional team training for emergency care and trauma. The actio… Tragus of ear in line with sternal notch.External laryngeal manipulation BURPLaryngoscope blade, consider McCoy and gum elastic bougie.Discuss techniques of using bougieNeed senior airway practitioner as soon as possible, call early. Peer-reviewed simulation cases for Emergency Medicine programs available in FOAMed spirit. Dangers of long acting paralysis until tube position confirmedDifficult airway and failed intubation drillsOxygenation is paramount. Scenarios OR Scenario 71 Appropriate for: OR Setting: Hospital Three C-Arm machines are dedicated to the Operating Room (OR). The unique features and responsive physiology of each patient simulator below enable training simulations which are as close to reality as possible. Enhanced laryngeal reflexes, bronchospasm, Increased sympathetic tone >HR, >BP. A. Frequency of training Candidate BriefingYou are the ED shop floor senior. Emergency Scenarios with Case Review Seizure This emergency scenario is about a patient with seizure, and is set up for role-play and case review with your staff. The Royal College of Emergency Medicine established a simulation specialist group in 2008 to explore the development of simulation training in delivering the RCEM curriculum. RR 28, ETCO2 3.7C; Pulse 72, no radial, BP 85/40D: Extensor posturing biting on tube, ABG, pH 7.10, pO2 9.0 kPa, pCO2 7.8 kPa, BE –10, lactate 8.4, glucose 23.4, K+ 5.8, OptionsConsider run of VT requiring DC cardioversion and amiodarone loading in view protracted VF.If aggressive sedation hypotensive episode progressing to profound low output state, PEA with low ETCO2, Candidate ExpectationsPrepare team, allocating tasks.Prepare equipment including ETCO2Take adequate handover, Recognition of right main stem bronchus intubation, reposition under direct vision. Candidate ExpectationsIntroduce self and establish relationship of parent.Explain rationale for procedural sedationEmphasise need for appropriate wound closure in timely mannerRetain empathy and rapport with parent.Listen and address all concernsRisk benefit of ketamineSafety profile of ketamineNo risk of long-term sequelaeDiscuss potential side effects and what can be achieved to mitigate these.Emergence phenomena, nystagmus, ataxia, drooling, nausea and vomiting etcDiscuss other options; GA, alternative sedationPost sedation care requiredPost wound closure careGain informed consent to proceed with sedation. ���ۿtκ�(:Su�q��k�����0 =�^�'�K[��\ݚ���\�a�]f`�-��kO� Free Nursing Simulation Scenarios, Free Emergency Medicine Scenarios, and Free Healthcare Simulation scenarios: I have previously shared the following articles on where to get free clinical simulation scenarios: “And, Scene!” – Places to get Simulation Scenarios (even FREE) Free Emergency Medicine Sim Case Library Free Nursing Simulation Scenarios Additional Free Nursing Simulation … Difficult to maintain open airway (without ETT or SAD), Should utilise mnemonic to aid learningHAV NOT or MOANS, HAV NOTH History of previous anaesthetic or airway problemsA Anatomy; facial features, mouth, dentitionV Visual clues; age, facial hair, obesity, postureN Neck mobility, range or movement, pre-existing neck pathology, MILSO Opening of mouth. 1) The person facilitating scenarios can print out the pages below. The scenario takes place in real-time, and requires a variety of resources to operate – both human and material. SimEx’s are exercises for practical operations in which the participants’ actions are evaluated. DoseIV 0.25-0.5 mg/kg can be repeatedIM 2-4mg/kg, CautionThree strengths available 10mg/ml, 50mg/ml, 100mg/mlEnsure correct vial. The incident commander explains how he would manage the incident. << /Length 5 0 R /Filter /FlateDecode >> Throughout this scenario, participants will be tasked with identifying opportunities to apply effective communication and efficient teamwork skills, such as the ones recommended by TeamSTEPPS. Candidate BriefingYou are the ED shop floor senior on in a DGH. If attached there will be no CO2.Auscultation is equivocal over chest but confirms oesophageal intubation over stomach. You are about to supervise an ST1 reduce an anterior shoulder dislocation in a young, fit, healthy adult patient. ���2�3HS�٭ Ww8e��K�^w&�+?��j�����ƈT���C�˂j_�B�q�c�#h�6��9srsr�I�߇�� m����'��-�iR� �T�=RLA.E�s�����M�����-�c8��>\�l]���5�[k��i��m�O&�g�!Wᆵ��SS�!�� �:s��p�һK� �ocq���同˜� �9���P���P]nV18��&g*En¼KT�]����t ��m���f��u�̊(S�]�����]��?i�ȅK$���;�8w��T���kQ[R��� More common in high doses, Factors relevant to procedural sedation with propofol and fentanyl. It immerses users in a realistic 3D environment in which almost any scenario … Cardiac arrest, BLS undertaken.On arrival ambulance,VF shocked x3 then PEAAdrenaline 1mgIntubatedRoSC after 15 minutes.Now spontaneously breathing, Instructor BriefingHigh fidelity mannekinA: Mannekin intubated 8.0 ETT to 26cm,B: right main stem bronchus intubation with no expansion, air entry on left. They have RoSC and are intubated and have IV access. Less relevant in children, Nausea & vomiting. Parental Role Player BriefingYou are the single parent of a 3-year-old boy. However to achieve a good cosmetic result is proposed that sedation is used. ScenarioMorbidly obese 60 year old male patient witnessed collapsed. Post Resuscitation CareRole and requirements for paralysis and sedation after accurate GCSAdequate oxygenation and ventilationUse of ETCO2 as marker of cardiac output in steady ventilatory stateCoolingGlycaemic controlPCI, Scenario 1Post Cardiac Arrest 1 (Right Bronchus Intubation & Post-Resus Care), Recognise right main stem bronchus intubation, Confirm correct placement, clinical & radiological, Overall                                                                                             PASS                            FAIL. D�+G����pz��1�e���,%6 You have examined the patients cardiovascular and respiratory system and found no abnormality. The parent has concerns regarding the safety and acceptability of this drug as they have seen several recent news items regarding abuse of ketamine.These involveIs it safe?Street drug, will it harm child, make them mad or addictIt’s a horse tranquiliserThey go mad after it’s givenCauses abdominal pain and urinary problems. However, scenario design is an under-appreciated area in the field of health simulation. Two are being used for orthopedic cases, and one for a cholecystectomy with an intraoperative cholangiogram. Focus on anatomical considerations required to assess an airway prior to a short sedation. Correction under direct vision, Discuss length at incisors 20-21cm. Supraglottic device will achieve adequate oxygenation. Brief parental role player. This 68 y/o patient with a history of hypertension develops a sudden onset of slurred speech while watching television in her home. B���#���O���*w0w�>���e�����#���} �lh"y�#��� ��3l40���U��),�p�~{}�#S��sa������0h�b��›���I?���a����Zx�O��#�o(�[0�o��� ����U��a˖�3P�HbA��֪�M_7F Learning & Debrief PointsRecognition of right main stem bronchus intubation. Clinical Knowledge 50%Technical Skills 20%Team Work 30%.
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