Simulation and Clinical Learning Tillamook Healthcare Simulation Program Simulation Scenario Suspected MI and Unstable Ventricular Tachycardia

Transcription

1 Simulation and Clinical Learning Tillamook Healthcare Simulation Program Simulation Scenario Suspected MI and Unstable Ventricular Tachycardia Simulation Objective: Identification and Management of a patient experiencing an MI which progresses to VT. Scenario: Physiologic System Sinus Rhythm 110 BP 100/60 Respirations 12 Scenario: Skills Oxygen placement Cardiac Monitor Placement IV Line Placement Fluid initiation Medication initiation: Morphine Nitroglycerine Oxygen Aspirin Defibrillation Accucheck 12-Lead EKG Learning Objectives: Identify and manage a patient experiencing an acute MI. Identify the patient experiencing VT and provide initial management of that patient. Competencies: Cognitive: 1. State Primary Survey per AHA and TCGH protocol 2. State initial treatment of a patient experiencing ACS per AHA and TCGH protocol 3. State treatment of a patient experiencing VT per AHA and TCGH protocol Affective: 1. Reflect on past clinical experience working with a patient evolving an MI. 2. Reflect on past clinical experience caring for a patient with VT. Funded in part with Employer Workforce Training Funds administered by the Oregon Department of Community Colleges and Workforce Development. Equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities. Esta es un programa/una empresa que ofrece igualdad de oportunidades. Disponemos de ayuda auxiliar a petición de individuos con discapacidad.

2 Psychomotor: 1. Demonstrate initial care for a patient experiencing an MI per ACLS protocol and TCGH protocol 2. Demonstrate care for a patient experiencing VT per ACLS protocol and ACGH protocol Reference: ECC Guidelines 2000 TCGH Policy

3 Patient Data: Account Number: Medical Record Number: Name: Patricia O Hern Birthdate: July 15, 1955 Patient Case History (brief past medical history of present illness) Mr. O Hern is a 50 year old male admitted for increasing chest pressure over the past 2 hours. The discomfort started at about 4 am. It woke him up from a deep sleep. Additional symptoms included diaphoresis, palor and weakness. He also experienced occasional skipped beats in his chest. He called 911 and was brought into the ED. He has no history of ACS. His mother and father both have hypertension. Mr. O Hern takes Vasotec 10 mg daily to control his HTN. He has otherwise has no medical history or surgical history. No history of asthma or COPD. No history of PVD. Pt drug allergies Penicillin Lab and other information available to participant upon request

4 Scenario Flow (desired course events during scenario: changes in VS and assessments) Notice/Interpret Respond Outcomes Oxygen at 4 l/min Monitor IV 12-Lead EKG Initiate cp Protocol Brief-Targeted Assessment Lab values CMP, CBC, BP 100/80 cardiac panel, Lipid Panel HR 120 Chest x-ray RR 18 VS Give 0.4 mg SL NTG if SBP greater then 100 and repeat NTG x 2 if pain not resolved Give ASA 162 mg Sinus 110 Blood pressure 110/60 Patient C/O chest pain Pt has not oxygen on Communicate to MD: Quality of pain Other Symptoms VS with SpO2 Results of NTG EKG Interpretation Vitals unchanged Sinus Tachycardia IV patent 12-Lead shows ST elevation in Leads II, III, and AVF Vitals remain the same, pain is stated to be 8/10 crushing substernal pain radiating down the left arm. Sinus 130 Blood Pressure 100/52 Resp 18 Chest pain 6/10 Ventricular Tachycardia 180 Respirations 6 SpO2 89 B/P 80/50 Sinus Rhythm 90 with ectopy B/P 96/50 Start IV Fluids Nitro gtt at 10 mcg Nitro at 10 mcg Morphine 2 mg Unstable VT Sychronized Cardioversion 50 j (biphasic) Fluid Bolus 100cc Amiodarone 150 mg over 10 minutes and Drip Pain down to 6/10 VT Sinus Rhythm 90 B/P 100/50 Resp 18 SpO2 96 Ectopy decreases BP 106/60

5 Notice/Interpret Respond Outcomes Resp 18 SpO2 96 Or Pain at 5/10 Ectopy decreases BP 106/60 Pain at 5/10 BP 110/70 BP 120/80 Lidocaine 100 mg With 2mg / min drip B-Blocker administered Heparin started TNKase administered Pt wgt 75 kg Pain decreases to 4/10 Pain subsides How will participants be introduced to the case (Report)? Scenario takes place in ED. Emergency Room report over the ambulance radio. Patient arrival and assess what is seen. Manikin used and initial computer set-up (v.s. and assessment information for beginning of scenario: SpO2%, temperature, heart rate, blood pressure, heart, lung and bowel sounds) Adult Sim Man is used Initial set up of computer: Sinus 110 Blood pressure 100/60 Patient C/O chest pain Assessment finds lung sounds clear, heart sounds S1 S2. Patient is alert and oriented with 8/10 chest pain radiating to the left arm and jaw. Skin is pale/grey and diaphoretic.

6 Equipment and props needed: Cardiac Monitor/Crash cart IV pump Medications for ACS Morphine Oxygen NS IV Nitroglycerine Lidocaine Amiodarone Epinephrine Vasopressin Beta Blocker Oxygen set up with nasal cannula Blood Pressure Cuff IV set-up with catheters and tubing Pulse Oximetry Medications: Morphine Oxygen NS IV Nitroglycerine Lidocaine Amiodarone Epinephrine Vasopressin Beta Blocker Paperwork and documentation: TCGH ED flow sheet Cardiac Arrest Flow Sheet Ambulance Run Sheet Personnel and actors (numbers, roles, and instructions) Team of 4 with one team leader. Team leader will get report as the patient arrives in the ED (room). Team leader will instruct activities of team members. Orders (if applicable) Additional teaching tools needed