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Scenario Information Case Name/Topic ex. “Pediatric Sim 8/10/15”, “ PEA Arrest”Target Audience/Learnersex. Medical Students, Residents, RNs, etc.Date of ScenarioAuthors/Points-of ContactNames, Emails, AffiliationsAuthorized to share scenarioIndicate if you give HCMC Sim Center permission to share your scenario FORMCHECKBOX Internally (HCMC) FORMCHECKBOX ExternallyOverview of Simulation ScenarioCase Summary 3-4 sentences describing the overall flow of the caseEx: A 50 y/o male presents to… Primary ObjectivesUse actionable verbs: Recognize, Perform, Demonstrate, Evaluate, Create...ExCreate an algorithmic approach to the patient with PEA arrest.12345Critical Action ChecklistList the specific actions you want to see your learners perform and how you will know they performed them (eg. “Checks vital signs”, “Explains situation to family”, “Verbalizes diagnosis of pneumothorax when seen on X-ray”)EXObtains set of vital signsNotes1.2.3.4.5.6.7.8.9.10.11.12.13.14.15.16.17.18.19.20.Actors & RolesAll necessary people and their roles on day of simulationRolePatient, family member, RN, MD, consultant, PCP, EMS, security, etc.Playing the part?SIM Mannekin, Sim Center Actor, extra RN, faculty, etc. What will they do?Patient can barely breathe, speak, or answer questions. Very anxious. Family Member is very concerned and starts to get angry with medical staff as case progresses.Sim Jockey(runs simulator)Debriefer(s)Information Available to Learners Scene Intro (given to learners prior to entering room) eg “you are in a small, rural hospital…”If learners ask for patient information, patient or confederate will tell them:Chief ComplaintTriage note, EMS or Nursing Home reportHistory of Present Illness (given by patient, family, etc.)Past Medical/Surgical HistoryMedicationsAllergiesFamily/Social HistoryScenario conditions/resources (rural hospital, small clinic, STAB room)Initial VitalsBP: HR: RR: SpO2: Temp: Physical Exam General: Neuro:HENT:Eyes:Chest/Pulm:CV:Abd:Back:Ext:Skin:Scenario Branch PointsList the “expected actions” or “triggers” such as changes in patient condition, interventions, patient’s response to treatments, etc. Write this so that someone else can look at it and understand how your scenario will flowEXAMPLE ofExpected Action:Asks for vitalsIf yes → Initial vitals show up on screenIf no → Confederate nurse thinks out loud, “I wonder if their oxygen levels are okay...”If still no → Confederate nurse asks, “Do you think you’ll want vital signs for this patient?”EXAMPLE ofTrigger:Patient seizesAppropriate→ If learner prepares O2, suction, and asks for 2mg Ativan, seizure stopsInappropriate→ If no action, nurse asks “The patient looks like he is seizing, what can I do to help?”Still Inapprop→ If still no action, nurse asks “Is there any medications we can give to stop the seizure?”If yes → If no → If still no → If yes → If no → If still no → If yes → If no → If still no → If yes → If no → If still no → If yes → If no → If still no → If yes → If no → If still no → If yes → If no → If still no → If yes → If no → If still no → If yes → If no → If still no → If yes → If no → If still no → Stimuli for Day of ScenarioLabsEKGRadiologyUltrasoundPhysical Exam PicturesMiscellaneousDebriefing PlanWatch: High-Fidelity, Case-based Simulation Debriefing VideoRead: Supplementary Debriefing Quick Reference GuideMethod Individual vs group? Time to watch video of sim scenario?MaterialsPlease attach or email supplementary didactic materials as neededReaction Phase QuestionsHow did you feel about the case?Understanding Phase QuestionsWhat was going through your mind when you first saw the patient...?Do you have an approach you use every time you see someone with…?I noticed that… what was going through your mind at that point?...……...Summary Phase QuestionsWhat main learning point can you take away from this scenario and apply to your clinical practice in the future?Assessment Tool(if applicable) Only needed if learners are being graded/assessed with the simulation. Equipment ChecklistSim Room AssignedScenario NamePatient Name/DOBIn EPIC?Setting/EnvironmentPatient Board needed? Yes or NoPlease fill out with items you would like to be on the patient white boardRoom: Phone: 612-873- Date: Name: Nurse: Nursing Assistant: MD: ScheduleDiet: Breakfast: Lunch: Dinner: Managing My PainPain Goal:My Goals: Activity: Possible Discharge Date: Patient and Family Questions and Concerns:Family Contact: MISC. EQUIPMENTMISC. EQUIPMENTMISC. EQUIPMENTAvailAvailAvailInstructor PCWOWPatient VS MonitorExtension CordDrainage bagILT Barcode SheetsCompressorBarcode ScannerTwo way mirrorMedication ScannerUSB MicrophoneHeadsets/WalkiesMouseEquipment NeededOnAvailMannequinOnAvailBody FluidsOnAvailConfederates: Sim Man 3G (2 available)SweatName badgesSim Man ClassicEmesisWardrobeSimMom? Basin ? ChuxOther ?????Junior (6-7 year old)Quality:???OnAvailMannequin StatusBaby (7 month old)Quantity ????? mL? Male ? FemaleNewbie (full-term newborn)UrinePosition: ?????Standardized Pt? Foley ? UrinalID braceletOther:Quality:?Allergy bracelet: ?????OnAvailMonitorQuantity???? mLGownEKGFecesWig: ?????Pulse ox? Bag ? ChuxHat: ?????NIBP Quality:????Glasses: TempQuantity ????? mLOther:End tidal CO2BloodOnAvailClothes:Arterial LineQuantity mL ?????OnAvailDressings:Central LineOther:OnAvail??? Moulage:??? ????????FloTrac ? PA CathOnAvailIntubation Equip.VentricETT sizes - ????? OnAvailIV Access/LinesSwanBlades - ????? NoneOther ?????HandleSaline lock OnAvailOxygen Delivery DevicesET introducer/BougieIONasal cannula@ ?SuctionPICCNRB Mask @ ?? BVMTL Central lineLocation:NebulizerOPABiPAP ?NPAUmbilicalIntubated SupraglotticArterial lineLocation:Trach ?????ETCO2 detectorAnesthesia gas machineBulb detection deviceVent: Mode: ???Rate ??PEEP ??FiO2 Vent TypeEnd Tidal CO2 cannulaOnAvailProceduresOnAvailEquipment, TubesOnAvailEquipment, TubesNeedle thoracostomyNG tubeEpidural catheterChest TubeOG tubeChest tubePericardiocentesisFoley catheterOther ?????LP-Adult or PedsRectal tubeCentral lineGastric lavageOther ?????PEG / Feeding tubePaperElectronicStimuli *Please let us know if you need help findingOnAvailEquipment, OtherStimuliSpecify what you would likeCode CartEKGUltrasoundX-rayIO Gun & Needles: Adult or PedsCTAirway CartMRIiSTATUltrasoundCervical CollarFastGlucometerHeartBackboardLungsCMACLabsEmesis basinOther:_________________Junctional Bleeding TrainerOnAvailDocumentation FormsDefibSign-out reportFlolanCode RecordContinuous NebEHRMRN#UnitSyringe PumpBair HuggerOnAvailMisc. Environment PropsHCA CartInpatient furniture: Chair, bedside and overbed table, telephone, call lightTOCO monitor & BeltsAlsiusWalkerBedside CommodeMedications NeededRoutes: IVP, IVPB, IM, PO, PR, SL, Intra-nasalOnAvailIV FluidsAvailRouteCardiovascularAvailRouteNarcotic/AnalgesicsStandby Pump(s):Anti-arrhythmicFentanyl 50 mcg/mLIVF: ?Rate ????? mL/hr ???? Adenosine 3 mg/mL*Morphine 1 mg/mLAmiodarone 30 mg/mL*Dilaudid (Hydromorphone)IVF: ?Rate ????? mL/hr ???? Atropine 0.4 mg/mL*Other:????Digoxin 0.25 mg/mLAvailRouteSedative/HypnoticIVF: ?Rate ????? mL/hr ???? Lidocaine 1 mg/mL *Diazepam 2 mg/mLProcainamide 500 mg/mLLorazepam (Ativan) 1mg/mLIVF: ?Rate ????? mL/hr ???? AvailRouteBeta-blockerMidazolam (Versed) 1 mg/mLEsmolol 10 mg/mLAvailRouteIntubation InductionIVF:Rate ????? mL/hr ???? Labetalol 5 mg/mLEtomidate 2 mg/mLMetoprolol 1 mg/mLKetamine 50 mg/mLIVF ?Rate ????? mL/hrPropranolol 1 mg/mLMidazolam 1 mg/mLAvailRouteACE InhibitorPentobarbital 25 mg/mLCADD:Rate ????? mL/hrCaptoprilPropofol 10 mg/mLEnalaprilat Thiopental 25 mg/mLLevel One Infuser & tubingLisinoprilOther:AvailUnitsBlood products:??AvailRouteCalcium channel blockerAvailRouteParalyticRed Blood Cells:Diltiazem 5 mg/mLAtracurium 10 mg/mLFresh Frozen PlasmaNicardipineCisatracurium 2 mg/mLPlateletsNifedipinePancuronium 1 mg/mLCryoprecipitateNimodipineRocuronium 10 mg/mLOther:Verapamil 2.5 mg/mLSuccinylcholine 20 mg/mLMTP CoolerAvailRouteAnti-emeticVecuronium 1 mg/mLAvailRouteReversal AgentsDroperidol 2.5 mg/mLOther_______________Edrophonium 10 mg/mLProchlorperazine (Compazine)AvailRouteAnti-hypertensiveFlumazenil 0.1 mg/mLOndansetron (Zofran)Nitroglycerin*GlycopyrrolateAvailRouteProton Pump InhibitorNitroprusside Naloxone (Narcan) 1 mg/mL Protonix (Pantoprazole)Neostigmine 1 mg/mLAvailRouteMiscellaneousAvailRouteInotrope/PressorAvailRouteMedication PropsAlbuterolEphedrinePill bottleAspirin (ASA)Epinephrine*Insulin PensBendaryl (Diphenhydramine)IsoproterenolPatient GlucometerCalcium chloride 10 mg/mL*NorepinephineEpi PenTall skinny pen/Small box penCalcium gluconate*PhenylephrineDigibindDopamineD50*Dobutamine?????D25AvailRouteAntibioticsAvailRouteOB SpecificD10AmoxicillinCytotec?(Misoprosto)DuoNebAmpicillinHemabateFurosemide(Lasix) 10mg/mLAncef (Cefazolin)Methergine (Methylergonovine)Magnesium sulfate*Azithromycin (Zithromax)Oxytocin (Pitocin)?????MannitolCefepimeTerbutalineNa bicarbonate (Sodium Bicarb)1 mEq/mL*Ceftriaxone (Rocephin)Racemic Epi NebCimetidineAvail*Insulin:Solu-Cortef (Solumedrol) 125 mg/mLCiprofloxacinRegular InsulinTamifluClindamycinLantusZantac (Ranitidine)DoxycyclineNovolog (Aspart)Glucagon/Glucose*Imipenum70/30tPA (Alteplase)LevetiracetamLispro (Humalog)LevofloxacinVancomycinZosynOther: ................
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