ESIM
| |[Insert program/department name here] |Last updated: |
| |[Insert scenario name here] |[insert date here] |
| | |[pic] |
|Learning Objectives: |
|By the end of the debriefing the participants should be able to: |
| |
|Competencies (Knowledge, Skills, Attitudes, and Judgment): |
|Remember SMART |
|eg. |
|Recognize abnormal rhythm and hemodynamic instability |
|Demonstrate effective cardioversion |
| |
|Crisis Resource Management: |
|Remember SMART |
|eg. |
|Communicate effectively using SBAR and closed loop communication |
|Demonstrate clear role allocation and distribution of tasks |
|Required personnel: |Who are my learners? |
|Who needs to be involved to make this sim happen, from a facilitator or confederate lens? |Disciplines |
|eg. |# of learners – can be a range |
|Facilitator |eg. |
|Confederate – role: outgoing RN |1-2 ICU or CCU residents |
|Sim Tech |2-3 ICU or CCU RNs |
| |1-2 RTs |
|Required Equipment (including Manikin & Monitors): |References, Resources, Protocols, Algorithms, or Evidence Informed Practice Guidelines: |
|List required equipment and adjuncts here |Insert any guidelines, protocols, algorithms, etc. that this session should make use of, |
|Include e-copies of adjuncts required, i.e. vital sign print-outs for low tech scenarios, vital|eg. |
|sign record, past medical history, etc. |2015 ACLS guidelines for unstable tachycardia: |
|eg. | |
|CVC connected to drainage bag – R IJ | |
|ART line – Rt radial | |
|IV pumps – 4 channels needed | |
|Running NS TKVO through distal port | |
|Yanker and suction | |
|Foley Catheter | |
|Ventilator – as per manikin allowance | |
|ACLS cart outside room – stocked as per cart list | |
|Additional notes regarding pre-brief: |Case Briefing: |
|List any specifics of pre-brief unique to this case |Insert case briefing / intro to scenario here |
|eg. |eg. |
|Use all equipment as if it were real – open meds, push/hook up to CVC |It’s 0730 on a Monday morning, at the change of shift. Jim is a 26 year old male who was admitted |
|Zoll adapter |half an hour ago for hypoxic respiratory failure from the ED. He had extreme nausea and vomiting x |
|Use real energy |2 weeks and was dehydrated, along with signs of sepsis. He received 6L of fluid and went into |
|Ventilator settings are not properly displayed |respiratory distress, requiring intubation. |
| |He was diagnosed with Leukemia one month ago, and started chemotherapy last week. He’s otherwise |
| |previously healthy. |
| |The case will start with handover from the outgoing RN to the primary RN. Everyone else will be |
| |where they normally would be at change of shift. |
| | |
| |[review flowsheet / vital signs with primary RN] |
|Vital Signs / |Patient Status |Effective Management |Modifiers / Triggers |
|Scenario Transitions | | | |
|Phase 1: Phase descriptor here, if applicable |
|HR: |CNS: |List expected actions here |Modifiers |
|BP: |RESP: |Eg. |List anything which might modify the |
|RR: |CVS: |Nurse assesses patient LOC, pulse, and NIBP |scenario |
|SpO2: |ABDO: |Prints a monitor ECG strip ( confederate |eg. -If FiO2 ( to >60% ( SpO2 ( 94% |
|Temp (C): |GU: |Calls for help from another RN | |
| |SKIN: |Team paged |Triggers |
| | |ACLS cart brought to bedside |Include anything which would warrant |
| | |RT notified if RT hasn’t noticed |a different branching of scenario |
| | |Requests BW ( confederate |(see below for example) |
| | |Requests 12 Lead ECG ( confederate | |
|Insert instructions for when to move | |RT calls for assist | |
|to next phase | |Communicates patient baseline and current status to team | |
|eg. Proceed to Phase 2 when Resident | |Levophed infusion initiated ( no change to BP | |
|arrives at bedside | |FiO2 increase ( Modifer | |
|Phase 2: Phase descriptor here, if applicable |
|HR: |CNS: |List expected actions here |Modifiers |
|BP: |RESP: |Eg. |List anything which might modify the |
|RR: |CVS: |Residents may do Valsalva maneuvers i.e. carotid massage, suction, cough etc. ( no |scenario |
|SpO2: |ABDO: |change |eg. If Adenosine given ( HR pause for|
|Temp (C): |GU: |Ask for 12 lead if not done yet |3 seconds, then HR ( 132 for 5 sec, |
| |SKIN: |Ask for BW if not done yet ( confederate |then ( back to previous (167 or 180) |
| | |Medication management: | |
| | |Amiodarone ( Modifier |-If Amiodarone or Metoprolol given ( |
| | |Metoprolol ( Modifier |HR ( 132 for 5 sec, then ( back to |
| | |Adenosine ( Modifier |previous (167 or 180) |
|Insert instructions for when to move | |RT may bag as needed | |
|to next phase | |Residents should make the decision to cardiovert patient due to narrow complex |-If cardioversion occurs in 8 |
| | |# of Joules verbalized |minutes ( proceed to Phase 3 |
| | |Cardioversion |regardless of Joules |
| | |Safety of « I’m clear… » | |
| | |RT should be clear if bagging | |
| | |Synched |Trigger |
| | |Delivery verbalized |Include anything which would warrant |
| | | |a different branching of scenario |
| | | |eg. If defibrillation occurs (not |
| | | |synched) instead of cardioversion ( |
| | | |proceed to Phase 4 (V. Fib) |
| | | | |
|Phase 3: Phase descriptor here, if applicable |
|HR: |CNS: |List expected actions here |Modifiers |
|BP: |RESP: | |List anything which might modify the |
|RR: |CVS: | |scenario |
|SpO2: |ABDO: | | |
|Temp (C): |GU: | |Trigger |
| |SKIN: | |Include anything which would warrant |
| | | |a different branching of scenario |
| | | | |
| | | | |
| | | | |
|Insert instructions for when to end | | | |
|case | | | |
|eg. Case ends after summary of case | | | |
|and « next steps » verbalized | | | |
|Phase 4: Phase descriptor here, if applicable - may be the “trigger” phase |
|HR: |CNS: |List expected actions here |Modifiers |
|BP: |RESP: | |List anything which might modify the |
|RR: |CVS: | |scenario |
|SpO2: |ABDO: | | |
|Temp (C): |GU: | |Trigger |
| |SKIN: | |Include anything which would warrant |
| | | |a different branching of scenario |
| | | | |
|Insert instructions for when to end | | | |
|case, or when to return back “on | | | |
|track” | | | |
|Eg. Move to Phase 3 once patient | | | |
|defibrillated | | | |
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