Practical ACLS Megacode Testing and Training Scenario Set for SimPad. Consolidated Instructor Manual. Frances Wickham Lee, DBA

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1 Practical ACLS Megacode Testing and Training Scenario Set for SimPad Consolidated Instructor Manual Frances Wickham Lee, DBA Scenario Authors: Frances Wickham Lee, DBA John Walker, BHS John Schaefer, MD Matthew McEvoy, MD Sheila Scarbrough, RN Rev. 1/13/2013

2 Table of Contents Curricular Information 3 Faculty Information-General Instructions (Training) 4 Faculty Information-Specific Instructions (Training) 5 Faculty Information-Specific Instructions (Testing) 12 Setup and Equipment 18 Case Information 19 Debriefing Information 25 2

3 Curricular Information ACLS Training is a set of fifteen scenarios based on the 2010 American Heart Association ACLS guidelines and written for use with the existing ACLS curriculum. The ACLS Training set includes the following: 1. Asystole In-Hospital 1 2. Asystole In-Hospital 2 3. Bradycardia In-Hospital 1 4. Bradycardia In-Hospital 2 5. PEA In-Hospital 1 6. PEA In-Hospital 2 7. PEA In-Hospital 3 (Bradycardia) 8. Stable Tachycardia In-Hospital 1 9. Stable Tachycardia In-Hospital Unstable Tachycardia In-Hospital Unstable Tachycardia In-Hospital Ventricular Fibrillation/Pulseless Ventricular Tachycardia In-Hospital Ventricular Fibrillation/Pulseless Ventricular Tachycardia In-Hospital Post Cardiac Arrest Care In-Hospital Post Cardiac Arrest Care In-Hospital 2 ACLS Testing is a set of six scenarios based on the 2010 American Heart Association ACLS guidelines and written for use with the existing ACLS curriculum. The ACLS Testing set includes the following: 1. Megacode A (Bradycardia to VF/Pulseless VT to Asystole) 2. Megacode B (Stable Tachycardia to VF/Pulseless VT to PEA) 3. Megacode C (Stable Tachycardia to VF/Pulseless VT to PEA) 4. Megacode D (Unstable Tachycardia to VF/Pulseless VT to PEA) 5. Megacode E (Unstable Tachycardia to VF/Pulseless VT to PEA) 6. Megacode F (Bradycardia to VF/Pulseless VT to Asystole) 3

4 Faculty Information General Instructions (Training) 1. These training scenarios are designed to train the participant acting as Team Leader to follow the ACLS guidelines. 2. Scenarios will open with the following screen. Click on Start Scenario to begin the scenario and the built in timer (6 to 10 minutes depending on the scenario). 3. Team Leaders should be instructed to verbalize actions and decisions that may not be apparent otherwise. Team Leaders must direct or acknowledge each required action. 4. Facilitators should click on each menu item as it occurs. Categories will appear and disappear automatically as time limits are reached or as tasks are completed. 5. There are a few menu items that should be automatically sensed by the manikin. These include: Check pulse; Attach 3-Lead ECG; Measure Blood Pressure; Attach Pulse Oximeter; Start Compressions; Deliver Shock. If the manikin DOES NOT SENSE one of these items when it is performed, click on the item to register the action. 6. Scenarios that require CPR will include CPR evaluation menu items. Indicate any actions that were performed incorrectly. 7. In the Training scenarios, the Team Leader must first identify the heart rhythm. The scenario will not proceed until the correct rhythm has been identified. 4

5 Faculty Information Specific Instructions (Training) Asystole In-Hospital 1 (Jane Johnson): SCENARIO OVERVIEW--You are a hospital interventionist and respond to a cardiac arrest in the hospital admission area. A patient collapsed while giving registration information. She had been referred for elective cardiac catheterization. Hospital admissions personnel initiated CPR and called a code. CORRECT STEPS for Asystole Scenario--Required Steps to revive Patient: a. Identify Asystole b. CPR start (sensed or override) c. Epi or Vasopressin Drug therapy that leads to recovery--epi or Vasopressin. OTHER GRADING POINTS--6-minute time limit for this scenario. OPERATOR NOTES--Team Leader must acknowledge or direct each action. Asystole In-Hospital 2 (John Wiggins) SCENARIO OVERVIEW--You are a nursing supervisor and code Team Leader on night shift. You respond to a code on the general medical floor. A patient is found unresponsive. Personnel initiated CPR and called a code. CORRECT STEPS for Asystole Scenarios--Required Steps to revive Patient: a. Identify Asystole, b. CPR start (sensed or override) c. Epi or Vasopressin Drug therapy that leads to recovery--epi or Vasopressin. OTHER GRADING POINTS--6-minute time limit for this scenario. OPERATOR NOTES--Team Leader must acknowledge or direct each action. Bradycardia In-Hospital 1 (Ed Stokes) SCENARIO OVERVIEW-- An elderly man was brought from triage complaining of dizziness. He tells you that his symptoms began about an hour ago. He is lying on a stretcher and becomes poorly responsive, but regains consciousness in a few seconds. CORRECT STEPS--Required Steps to revive Patient: a. Identify Bradycardia 5

6 b. Atropine 0.5 mg. (No pacing, because patient improves) OTHER GRADING POINTS--6-minute time limit for this scenario. OPERATOR NOTES--Team Leader must acknowledge or direct each action. Bradycardia In-Hospital 2 (Grace Hardy) SCENARIO OVERVIEW--This patient is brought by EMS. They report finding her on the floor at home. Her husband said she clutched her chest and collapsed. EMS gave her 1 mg of atropine, she improved and had stable vital signs, but now she is complaining of dizziness again and her HR has dropped to 28. After initial Atropine therapy, the patient is conscious but confused. Monitor shows thirddegree AV block, HR 40. CORRECT STEPS--Required Steps to revive Patient: a. Identify Bradycardia b. Transcutaneous Pacing (Note: initial Atropine already administered; additional drug therapy Epinephrine or Atropine may be given prior to pacing.) OTHER GRADING POINTS--6-minute time limit for this scenario. OPERATOR NOTES--Team Leader must acknowledge or direct each action. PEA In-Hospital 1 (Mary Kettle) SCENARIO OVERVIEW--You are a nursing supervisor and code Team Leader on night shift. You respond to a code on the general medical floor. A patient is found unresponsive. Personnel initiated CPR and called a code. CORRECT STEPS --Required Steps to revive Patient: a. Identify PEA b. CPR start (sensed or override) c. Epi or Vasopressin, then d. Epi or Vasopressin (Vasopressin may be given as first or second dose, not both) OTHER GRADING POINTS--6-minute time limit for this scenario. OPERATOR NOTES--Team Leader must acknowledge or direct each action. 6

7 PEA In-Hospital 2 (Ellen Engles) SCENARIO OVERVIEW--You are a nursing supervisor and code Team Leader on day shift. You respond to a code on the general medical floor. A patient is found unresponsive. Personnel initiated CPR and called a code. CORRECT STEPS --Required Steps to revive Patient: a. Identify PEA b. CPR start (sensed or override) c. Epi or Vasopressin, then d. Epi or Vasopressin (Vasopressin may be given as first or second dose, not both) OTHER GRADING POINTS--6-minute time limit for this scenario. OPERATOR NOTES--Team Leader must acknowledge or direct each action. PEA In-Hospital 3 (Bradycardia PEA) (Peter Pumpkin) SCENARIO OVERVIEW--You are a physician and respond to an in-hospital cardiac arrest. You find CPR already in progress by the nursing staff. They report that the patient was admitted for observation following a motor vehicle collision and planned surgery for treatment of an open leg fracture. He was the unbelted driver of the car. CORRECT STEPS--Required Steps to revive Patient: a. Identify PEA b. CPR start (sensed or override) c. Epi or Vasopressin OTHER GRADING POINTS - This scenarios has a 6-minute timer. OPERATOR NOTES--Team Leader must acknowledge or direct each action. VF Pulseless VT In-Hospital Scenario I (Neal Hannity) SCENARIO OVERVIEW--You respond to a cardiac arrest in the ED registration area. A patient, brought by car, collapsed while complaining of chest pain. The triage personnel have initiated CPR. CORRECT STEPS for VF Pulseless VT -- Required Steps to revive Patient: a. Check Rhythm and correctly identify VF-Pulseless VT b. Start CPR (sensed or override) c. Give 1st shock 7

8 d. Start CPR (sensed or override) e. 2 nd Shock (start CPR after each shock) and Epinephrine or Vasopressin f. Amiodarone 300mg IV or Lidocaine 1-1.5mg/kg g. 3 rd Shock OTHER GRADING POINTS--There is a 10-minute time limit built into this scenario - Second dose of Epi or Vasopressin is allowed, but not required. OPERATOR NOTES-- The team leader must acknowledge or direct each action. VF Pulseless VT In-Hospital Scenario 2 (Julia Ann Moore) SCENARIO OVERVIEW--You respond to a cardiac arrest in the hospital admission area. A patient collapsed while giving registration information. She had been referred for elective cardiac catheterization. Hospital admissions personnel initiated CPR and called a code. CORRECT STEPS for VF Pulseless VT -- Required Steps to revive Patient: a. Check Rhythm and correctly identify VF-Pulseless VT b. Start CPR (sensed or override) c. Give 1st shock d. Start CPR (sensed or override) e. 2 nd Shock (start CPR after each shock) and Epinephrine or Vasopressin f. Amiodarone 300mg IV or Lidocaine 1-1.5mg/kg g. 3 rd Shock OTHER GRADING POINTS--There is a 10-minute time limit built into this scenario - Second dose of Epi or Vasopressin is allowed, but not required. OPERATOR NOTES-- The team leader must acknowledge or direct each action. Stable Tachycardia In-Hospital 1 (Narrow, Regular) (Nancy Nero) SCENARIO OVERVIEW--You are in the ED and are evaluating a 63-year-old female who presented complaining of palpitations. She tells you she has had a history of recurrent fast heart rates, but several episodes today brought her to the ED. While you are doing her examination, she suddenly complains of palpitations. CORRECT STEPS-- Required Steps to revive Patient: a. Identify Stable Tachycardia, narrow QRS, regular b. Attempt Vagal Maneuver c. Give 6 mg Adenosine 8

9 d. Followed by 12 mg Adenosine OTHER GRADING POINTS - This scenario has a 6-minute timer. OPERATOR NOTES--Team Leader must acknowledge or direct each action. Stable Tachycardia In-Hospital 2 (Wide, Regular) (Willy Coyote) SCENARIO OVERVIEW--A 35-year-old male arrives in the ED complaining of palpitations. He tells you he has had a history of recurrent fast heart rates. He has been having palpitations for several days. Today symptoms were worse and coworkers phoned 911. He thinks he is having a heart attack. CORRECT STEPS-- Required Steps to revive Patient: a. Identify Stable Tachycardia, wide QRS, regular b. Attempt Vagal Maneuver c. Adenosine 6 mg OTHER GRADING POINTS-- This scenario has a 6-minute timer. OPERATOR NOTES--The Team Leader must acknowledge or direct each required action. Unstable Tachycardia In-Hospital 1 (Johnny Jett) SCENARIO OVERVIEW--You are a nurse on a monitored unit. A 55-year-old man is recovering from an anterior MI following fibrinolysis in the ED. The monitor alarms and you go into the room. CORRECT STEPS Required Steps to revive Patient: a. Identify Unstable Tachycardia b. Synchronized Cardioversion (sedation should be considered prior to Cardioversion) OTHER GRADING POINTS - This scenario has a 6-minute timer. OPERATOR NOTES--The Team Leader must acknowledge or direct each required action. Unstable Tachycardia In-Hospital 2 (Mary Contrary) SCENARIO OVERVIEW-- In the ER you are evaluating a 26-year-old woman. She was born with heart abnormalities and has chronic palpitations. A corrective 9

10 surgical procedure was performed as a child. She has passed out once in her life. Today her palpitations will not stop, and she came to the ER. CORRECT STEPS Required Steps to revive Patient: a. Identify Unstable Tachycardia b. Synchronized Cardioversion X 2 (sedation should be considered prior to Cardioversion) OTHER GRADING POINTS - This scenario has a 6-minute timer. OPERATOR NOTES--The Team Leader must acknowledge or direct each required action. Post Cardiac Care In-Hospital 1 (Jane Johnson) SCENARIO OVERVIEW--You are a hospitalist who has responded to a cardiac arrest in the hospital admission area. After performing appropriate Asystole treatment, you are responsible for the Post Arrest Care. CORRECT STEPS--Follow ACLS Guidelines for Post Cardiac Arrest Care: a. Identify Return of Spontaneous Circulation b. Verbalize Intubation Need c. Monitor O2 Saturation d. Verbalize Capnography Need e. Measure Blood Pressure f. Consider Hypotension Treatment g. Obtain 12-Lead ECG h. Order Labs i. Consider Therapeutic Hypothermia OTHER GRADING POINTS--6 minute time limit for this scenario. OPERATOR NOTES--Team Leader must acknowledge or direct each action. This scenario is designed for the evaluation of the Team Leader. Post Cardiac Care In-Hospital 2 (Neal Hannity) SCENARIO OVERVIEW--You respond to a cardiac arrest in the ED registration area. A patient, brought by car, collapsed while complaining of chest pain. The triage personnel called a code. After performing appropriate VFib treatment, you are responsible for the Post Arrest Care. 10

11 CORRECT STEPS--Follow ACLS Guidelines for Post Cardiac Arrest Care: 1. Identify Return of Spontaneous Circulation 2. Verbalize Intubation Need 3. Monitor O2 Saturation 4. Verbalize Capnography Need 5. Measure Blood Pressure 6. Consider Hypotension Treatment 7. Obtain 12-Lead ECG 8. Order Labs 9. Consider Therapeutic Hypothermia OTHER GRADING POINTS--6 minute time limit for this scenario. OPERATOR NOTES--Team Leader must acknowledge or direct each action. This scenario is designed for the evaluation of the Team Leader. 11

12 Faculty Information Specific Instructions (Testing) Initial Required Steps are: All Megacode Scenarios 1. Check Pulse within 10 seconds 2. Check Airway Patency within 30 seconds 3. Check Breathing within 30 seconds 4. Assign Roles within 1 minute 5. Place AED or ECG within 1 minute 6. Attach Pulse Oximeter within 1 minute 7. Identify Rhythm within 1 minute Required Steps for Pathway are listed in the following sections. Post Cardiac Care Required Steps are: 1. Identify Return of Spontaneous Circulation 2. Verbalize Intubation Need 3. Monitor O2 Saturation 4. Verbalize Capnography Need 5. Measure Blood Pressure 6. Consider Hypotension Treatment 7. Obtain 12-Lead ECG 8. Order Labs 9. Consider Therapeutic Hypothermia ACLS In-Hospital Megacode A (Michael Jones) GENERAL OVERVIEW-- You are evaluating a 57-year-old man complaining of indigestion. He is brought immediately from triage (arrived by personal car) and placed in ED room 2. He is cold, clammy, and diaphoretic. He states that he feels as if he is about to faint. The triage nurse is working with you and has obtained vital signs: HR 38, BP 70/P, RR 16. CORRECT STEPS--This scenario will move from Bradycardia to VF/Pulseless VT to Asystole Pathways. Bradycardia Required Steps are: 1. Identify Bradycardia 2. Give Atropine 0.5 mg IV/IO 3. Verbalize consideration of TCP 4. Seek Expert Opinion 12

13 5. Complete Rx within 3 minutes VF/Pulseless VT Required Steps are: 1. Identify Ventricular Fibrillation rhythm 2. Start CPR within 15 seconds 3. Defibrillate initially 4. Give either epinephrine or vasopressin IV and Defibrillate (either may be given first; two doses of epi or epi and vaso may be given) 5. Give Amiodarone and Defibrillate 6. Perform CPR correctly throughout 7. Complete Rx within 5 minutes Asystole Required Steps are: 1. Identify Asystole rhythm 2. Start CPR within 15 seconds 3. Give either epinephrine or vasopressin IV 4. Complete Rx in 2 minutes OTHER GRADING POINTS--The Megacode is designed to test the ACLS participant in the Team Leader role. The Team Leader must acknowledge or direct each required action. ACLS In-Hospital Megacode B (Alvin McIntosh) GENERAL OVERVIEW--In the ED you are evaluating a 65-year old man complaining of palpitations. He is in no distress. He has a history of coronary artery disease and had a stent in the past. Otherwise he is healthy with no other medical problems. CORRECT STEPS--This scenario will move from Stable Tachycardia to VF/Pulseless VT to PEA Pathways. Tachycardia Required Treatment Steps are: 1. Identify Stable, Narrow Complex, Regular, Tachycardia 2. Attempt vagal maneuvers 3. Give adenosine 6 mg 4. Complete Rx within 3 minutes VF/Pulseless VT Required Steps are: 1. Identify Ventricular Fibrillation rhythm 2. Start CPR within 15 seconds 3. Defibrillate initially 13

14 4. Give either epinephrine or vasopressin IV and Defibrillate (either may be given first; two doses of epi or epi and vaso may be given) 5. Give Amiodarone and Defibrillate 6. Perform CPR correctly throughout 7. Complete Rx within 5 minutes PEA Required Steps are: 1. Identify PEA rhythm 2. Start CPR within 15 seconds 3. Give epinephrine or vasopressin IV 4. Complete Rx in 2 minutes. OTHER GRADING POINTS--This Megacode is designed to test the ACLS participant in the Team Leader role. The Team Leader must acknowledge or direct each required action. ACLS In-Hospital Megacode C (Joanna Miles) GENERAL OVERVIEW - You are called to the ICU, where you find a post-op patient experiencing chest pain. Tachycardia Required Treatment Steps are: 1. Identify Stable, Narrow Complex, Regular, Tachycardia 2. Attempt vagal maneuvers 3. Give adenosine 6 mg 4. Complete Rx within 3 minutes VF/Pulseless VT Required Steps are: 1. Identify Ventricular Fibrillation rhythm 2. Start CPR within 15 seconds 3. Defibrillate initially 4. Give either epinephrine or vasopressin IV and Defibrillate (either may be given first; two doses of epi or epi and vaso may be given) 5. Give Amiodarone and Defibrillate 6. Perform CPR correctly throughout 7. Complete Rx within 5 minutes PEA Required Steps are: 1. Identify PEA rhythm 2. Start CPR within 15 seconds 3. Give epinephrine or vasopressin IV 4. Complete Rx in 2 minutes. 14

15 OTHER GRADING POINTS--This Megacode is designed to test the ACLS participant in the Team Leader role. The Team Leader must acknowledge or direct each required action. ACLS In-Hospital Megacode D (Mary Ann Fremont) GENERAL OVERVIEW-- You are called to a patient room where you find an elderly woman. She was admitted for a total knee replacement and was moved from ICU this morning. CORRECT STEPS--This scenario will move from Unstable Tachycardia to VF/Pulseless VT to PEA Pathways. Unstable Tachycardia Required Steps are: 1. Identify Unstable Tachycardia 2. Consider Sedation before Cardioversion 3. Synchronized Cardioversion 4. Complete Rx within 3 minutes VF/Pulseless VT Required Steps are: 1. Identify Ventricular Fibrillation rhythm 2. Start CPR within 15 seconds 3. Defibrillate initially 4. Give either epinephrine or vasopressin IV and Defibrillate (either may be given first; two doses of epi or epi and vaso may be given) 5. Give Amiodarone and Defibrillate 6. Perform CPR correctly throughout 7. Complete Rx within 5 minutes PEA Required Steps are: 1. Identify PEA rhythm 2. Start CPR within 15 seconds 3. Give epinephrine or vasopressin IV 4. Complete Rx in 2 minutes OTHER GRADING POINTS--This Megacode is designed to test the ACLS participant in the Team Leader role. The Team Leader must acknowledge or direct each required action. 15

16 ACLS In-Hospital Megacode E (Lois Lane) GENERAL OVERVIEW-- You are called to a patient room where you find an elderly woman. She was admitted three days ago for a fractured hip. CORRECT STEPS--This scenario will move from Unstable Tachycardia to VF/Pulseless VT to PEA Pathways. Unstable Tachycardia Required Steps are: 5. Identify Unstable Tachycardia 6. Consider Sedation before Cardioversion 7. Synchronized Cardioversion 8. Complete Rx within 3 minutes VF/Pulseless VT Required Steps are: 8. Identify Ventricular Fibrillation rhythm 9. Start CPR within 15 seconds 10. Defibrillate initially 11. Give either epinephrine or vasopressin IV and Defibrillate (either may be given first; two doses of epi or epi and vaso may be given) 12. Give Amiodarone and Defibrillate 13. Perform CPR correctly throughout 14. Complete Rx within 5 minutes PEA Required Steps are: 5. Identify PEA rhythm 6. Start CPR within 15 seconds 7. Give epinephrine or vasopressin IV 8. Complete Rx in 2 minutes OTHER GRADING POINTS--This Megacode is designed to test the ACLS participant in the Team Leader role. The Team Leader must acknowledge or direct each required action. ACLS In-Hospital Megacode F (Forrest Gump) GENERAL OVERVIEW - You are evaluating a 63-year-old man in the Emergency Room. He arrived by personal car and is cold, clammy and diaphoretic. He states that he feels as if he is about to faint. The triage nurse is working with you and has obtained vital signs of HR 50 BP66/P RR18. CORRECT STEPS--This scenario will move from Bradycardia to VF/Pulseless VT to Asystole Pathways. 16

17 Bradycardia Required Steps are: 1. Identify Bradycardia 2. Give Atropine 0.5 mg IV/IO 3. Verbalize consideration of TCP 4. Seek Expert Opinion 5. Complete Rx within 3 minutes VF/Pulseless VT Required Steps are: 1. Identify Ventricular Fibrillation rhythm 2. Start CPR within 10 seconds 3. Defibrillate initially 4. Give either epinephrine or vasopressin IV and Defibrillate (either may be given first; two doses of epi or epi and vaso may be given) 5. Give Amiodarone and Defibrillate 6. Perform CPR correctly throughout 7. Complete Rx within 5 minutes Asystole Required Steps are: 1. Identify Asystole rhythm 2. Start CPR within 10 seconds 3. Give epinephrine or vasopressin IV 4. Complete Rx in 2 minutes OTHER GRADING POINTS--This Megacode is designed to test the ACLS participant in the Team Leader role. The Team Leader must acknowledge or direct each required action. 17

18 Setup and Equipment Suggested Scenario Logistics: For use with the 2010 ACLS approved curriculum 6 in-hospital Megacode scenarios 15 in-hospital training scenarios Individual Scenario Run Time - 6 to 10 minutes Debriefing time varies per group - Estimate 20 minutes per scenario Equipment Needed: Simulated IV in place Nasal Cannula or O2 Mask Defibrillator or AED Crash Cart or simulated Crash Cart with at least: o BVM o Backboard o Simulated drug vials and syringes Epinephrine Vasopressin Atropine Amiodarone Adenosine Procainamide Sotalol 18

19 Case Information (Training) Asystole In-Hospital 1 Patient Name: Jane Johnson Age: 59 Height: 65 in Weight: 175 lbs. SCENARIO OVERVIEW--You are a hospital interventionist and you respond to a cardiac arrest in the hospital admission area. A patient collapsed while giving registration information. She had been referred for elective cardiac catheterization. Hospital admissions personnel initiated CPR and called a code. Asystole In-Hospital 2 Patient Name: John Wiggins Age: 60 Height: 70 in Weight: 220 lbs. SCENARIO OVERVIEW--You are a nursing supervisor and code team leader on night shift. You respond to a code on the general medical floor. A patient is found unresponsive. Personnel initiated CPR and called a code. Bradycardia In-Hospital 1 Patient Name: Ed Stokes Age: 98 Height: 68 in Weight: 160 lbs. SCENARIO OVERVIEW-- An elderly man was brought from triage complaining of dizziness. He tells you that his symptoms began about an hour ago. He is lying on a stretcher and becomes poorly responsive, but regains consciousness in a few seconds. Bradycardia In-Hospital 2 Patient Name: Grace Hardy Age: 72 Height: 62 in Weight: 110 lbs. SCENARIO OVERVIEW--This patient is brought by EMS. They report finding her on the floor at home. Her husband said she clutched her chest and collapsed. 19

20 EMS gave her 1 mg of atropine, she improved and had stable vital signs, but now she is complaining of dizziness again and her HR has dropped to 28. After initial Atropine therapy, the patient is conscious but confused. Monitor shows thirddegree AV block, HR 40. PEA In-Hospital 1 Patient Name: Mary Kettle Age: 82 Height: 62 in Weight: 155 lbs. SCENARIO OVERVIEW--You are a nursing supervisor and code team leader on night shift. You respond to a code on the general medical floor. A patient is found unresponsive. Personnel initiated CPR and called a code. PEA In-Hospital 2 Patient Name: Ellen Engles Age: 74 Height: 56 in Weight: 130 lbs. SCENARIO OVERVIEW--You are a nursing supervisor and code team leader on day shift. You respond to a code on the general medical floor. A patient is found unresponsive. Personnel initiated CPR and called a code. PEA In-Hospital 3 (Bradycardia PEA) Patient Name: Peter Pumpkin Age: 54 Height: 69 in Weight: 185 lbs. SCENARIO OVERVIEW--You are a physician and respond to an in-hospital cardiac arrest. You find CPR already in progress by the nursing staff. They report that the patient was admitted for observation following a motor vehicle collision and planned surgery for treatment of an open leg fracture. He was the unbelted driver of the car. Stable Tachycardia In-Hospital 1 (Narrow, Regular) Patient Name: Nancy Nero Age: 63 Height: 64 in Weight: 160 lbs. 20

21 SCENARIO OVERVIEW--You are in the ED and are evaluating a 63-year-old female who presented complaining of palpitations. She tells you she has had a history of recurrent fast heart rates, but several episodes today brought her to the ED. While you are doing her examination, she suddenly complains of palpitations. Stable Tachycardia In-Hospital 2 (Wide, Regular) Patient Name: Willy Coyote Age: 35 Height: 69 in Weight: 185 lbs. SCENARIO OVERVIEW--A 35-year-old male arrives in the ED complaining of palpitations. He tells you he has had a history of recurrent fast heart rates. He has been having palpitations for several days. Today symptoms were worse and coworkers phoned 911. He thinks he is having a heart attack. Unstable Tachycardia In-Hospital 1 Patient Name: Johnny Jett Age: 55 Height: 71 in Weight: 220 lbs. SCENARIO OVERVIEW--You are a nurse on a monitored unit. A 55-year-old man is recovering from an anterior MI following fibrinolysis in the ED. The monitor alarms and you go into the room. Unstable Tachycardia In-Hospital 2 Patient Name: Mary Contrary Age: 26 Height: 67 in Weight: 125 lbs. SCENARIO OVERVIEW-- In the ER you are evaluating a 26-year-old woman. She was born with heart abnormalities and has chronic palpitations. A corrective surgical procedure was performed as a child. She has passed out once in her life. Today her palpitations will not stop and she came to the ER. VF Pulseless VT In-Hospital 1 Patient Name: Neal Hannity Age: 50 21

22 Height: 72 in Weight: 180 lbs. SCENARIO OVERVIEW--You respond to a cardiac arrest in the ED registration area. A patient, brought by car, collapsed while complaining of chest pain. The triage personnel have initiated CPR. VF Pulseless VT In-Hospital 2 Patient Name: Julia Ann Moore Age: 62 Height: 70 in Weight: 180 lbs. SCENARIO OVERVIEW--You respond to a cardiac arrest in the hospital admission area. A patient collapsed while giving registration information. She had been referred for elective cardiac catheterization. Hospital admissions personnel initiated CPR and called a code. Post Cardiac Care In-Hospital 1 Patient Name: Jane Johnson Age: 59 Height: 65 in Weight: 175 lbs. SCENARIO OVERVIEW--You are a hospitalist who has responded to a cardiac arrest in the hospital admission area. After performing appropriate Asystole treatment, you are responsible for the Post Arrest Care. Post Cardiac Care In-Hospital 2 Patient Name: Neal Hannity Age: 50 Height: 72 in Weight: 180 lbs. SCENARIO OVERVIEW--You respond to a cardiac arrest in the ED registration area. A patient, brought by car, collapsed while complaining of chest pain. The triage personnel called a code. After performing appropriate VFib treatment, you are responsible for the Post Arrest Care. 22

23 ACLS In-Hospital Megacode A Patient Name: Michael Jones Age: 57 Height: 69 in Weight: 245 lbs. Case Information (Testing) GENERAL OVERVIEW-- You are evaluating a 57-year-old man complaining of indigestion. He is brought immediately from triage (arrived by personal car) and placed in ED room 2. He is cold, clammy, and diaphoretic. He states that he feels as if he is about to faint. The triage nurse is working with you and has obtained vital signs: HR 38, BP 70/P, RR 16. ACLS In-Hospital Megacode B Patient Name: Alvin McIntosh Age: 65 Height: 71 in Weight: 250 lbs. GENERAL OVERVIEW--In the ED you are evaluating a 65-year old man complaining of palpitations. He is in no distress. He has a history of coronary artery disease and had a stent in the past. Otherwise he is healthy with no other medical problems. ACLS In-Hospital Megacode C Patient Name: Joanna Miles Age: 54 Height: 65 in Weight: 168 lbs. GENERAL OVERVIEW - You are called to the ICU, where you find a post-op patient experiencing chest pain. ACLS In-Hospital Megacode D Patient Name: Mary Ann Fremont Age: 75 Height: 64 in Weight: 140 lbs. 23

24 GENERAL OVERVIEW-- You are called to a patient room where you find an elderly woman. She was admitted for a total knee replacement and was moved from ICU this morning. ACLS In-Hospital Megacode E Patient Name: Lois Lane Age: 95 Height: 61 in Weight: 98 lbs. GENERAL OVERVIEW-- You are called to a patient room where you find an elderly woman. She was admitted three days ago for a fractured hip. ACLS In-Hospital Megacode F Patient Name: Forrest Gump Age: 63 Height: 70 in Weight: 200 lbs. GENERAL OVERVIEW-- You are evaluating a 63-year-old man in the Emergency Room. He arrived by personal car and is cold, clammy and diaphoretic. He states that he feels as if he is about to faint. The triage nurse is working with you and has obtained vital signs of HR 50 BP66/P RR18. 24

25 Debriefing Information The Practical ACLS Training and Testing scenarios are designed and programmed for debriefing using the Diagnostic Educational Objective-based Reflection (DEOR) methodology. Dr. John Schaefer, HealthCare Simulation South Carolina (HCSSC), developed DEOR to provide objective-based feedback to scenario participants. More information about using the DEOR method of debriefing can be found at the HCSSC website. Sample Practical ACLS Megacode Testing and Training set debrief logs 25

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