Practical ACLS Megacode Testing and Training Scenario Set Consolidated Instructor Manual Frances Wickham Lee, DBA Scenario Authors: Frances Wickham Lee, DBA John Schaefer, MD Matthew McEvoy, MD Sheila Scarbrough, RN
Table of Contents Curricular Information 3 Faculty Information-General Instructions (Training) 4 Faculty Information-Specific Instructions (Training) 6 Faculty Information-General Instructions (Testing) 13 Faculty Information-Specific Instructions (Testing) 15 Setup and Equipment 21 Case Information (Training) 22 Case Information (Testing) 25 Debriefing Information 27 2
Curricular Information ACLS Training is a set of thirteen scenarios based on the 2010 American Heart Association ACLS guidelines and written for use with the existing ACLS curriculum. The 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 2 10. Unstable Tachycardia In-Hospital 1 11. Unstable Tachycardia In-Hospital 2 12. Ventricular Fibrillation/Pulseless Ventricular Tachycardia In-Hospital 1 13. Ventricular Fibrillation/Pulseless Ventricular Tachycardia 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 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 (Bradycardia to VF/Pulseless VT to Asystole) 4. Megacode D (PEA to VF/Pulseless VT to Unstable Tachycardia) 5. Megacode E (PEA to VF/Pulseless VT to Unstable Tachycardia) 6. Megacode F (Bradycardia to VF/Pulseless VT to Asystole) 3
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 in Pause mode. Click the right facing arrow in the bottom left corner of the user interface to start the software. Click on the menu item **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. Menu folders will open and close automatically as time limits are reached or as tasks are completed. 5. There are manikin overrides located in the medication event menu location. You may use these IF the manikin sensors do not work properly. Do NOT use the overrides if the manikin sensors are working properly. The scenarios include one or more of the following overrides: a. CPR Sensor Override select this menu item to indicate the beginning of a CPR cycle if the manikin fails to register compressions. b. Shock Sensor Override select this menu item is available if the manikin fails to register defibrillation or direct cardioversion. c. Pulse Sensor Override - select this menu item if the manikin fails to register taking the pulse. 4
d. Pacing Sensor Override - select this menu item if the manikin fails to register the pacing event. 6. Scenarios that require CPR will include CPR evaluation menu items. Indicate any actions that were performed incorrectly. Training scenarios with CPR components may employ a confederate who will perform CPR the first time using an improper technique. The Team Leader must correct this technique. 7. The Team Leader must first identify the heart rhythm. The scenario will not proceed until the correct rhythm has been identified. The following flag will appear on the patient monitor 8. Throughout the training scenario, flags may appear on the patient monitor reminding participants of missed or next steps. 9. When the time is up or the Team Leader has revived the patient, the following flag will appear on the patient monitor. 5
Faculty Information Specific Instructions (Training) ACLS Training Scenarios SAMPLE EVENT MENU 6
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 BOTH 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 b. Atropine 0.5 mg. (No pacing, because patient improves) 7
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 8
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) 9
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 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 10
c. Give 6 mg Adenosine 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. Adenosine 6 mg c. Adenosine 12 mg d. Amiodarone 150 mg or other antiarrhythmic 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 11
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 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 12
Faculty Information General Instructions (Testing) 1. These Megacode Scenarios are designed to evaluate how well the participant acting as Team Leader follows the ACLS guidelines. Each Megacode contains three heart rhythms that need to be treated. 2. Scenarios will open in Pause mode. Click the right facing arrow in the bottom left corner of the user interface to start the software. Click on the menu item **START SCENARIO** to begin the scenario and the built in timer (10 minutes per Megacode). 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. Facilitators should NOT prompt the team leaders during Megacodes. 4. Facilitators should click on each menu item as it occurs. Menu folders will open and close automatically as time limits are reached or as tasks are completed. 5. There are manikin overrides located in the medication event menu location. You may use these IF the manikin sensors do not work properly. Do NOT use the overrides if the manikin sensors are working properly. The scenarios include one or more of the following overrides: a. CPR Sensor Override select this menu item to indicate the beginning of a CPR cycle if the manikin fails to register compressions. b. Shock Sensor Override - select this menu item if the manikin fails to register defibrillation or direct cardioversion. 13
c. Pulse Sensor Override - select this menu item if the manikin fails to register taking a pulse. d. Pacing Sensor Override - select this menu item if the manikin fails to register the pacing event. 6. Scenarios that require CPR will include CPR evaluation menu items. Indicate any actions that were performed incorrectly. Training scenarios with CPR components may employ a confederate who will perform CPR the first time using an improper technique. The team leader must correct this technique. 7. The following flag will appear on the patient monitor at certain times during the Megacode testing. 8. When the Megacode time is up the following flag will appear on the patient monitor. 14
Faculty Information Specific Instructions (Testing) ACLS Megacode Testing Scenarios SAMPLE EVENT MENU 15
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 need for TCP 4. 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 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. 16
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 and 3. Give adenosine 6 mg 4. Complete Rx within 3 minutes VF/Pulseless VT Required Steps are: 8. Identify Ventricular Fibrillation rhythm 9. Start CPR within 10 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: 1. Identify PEA rhythm 2. Start CPR within 10 seconds 3. Give 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 C (Joanna Miles) GENERAL OVERVIEW - You are called to the ICU, where you find a post-op patient experiencing chest pain. 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 need for TCP VF/Pulseless VT Required Steps are: 17
15. Identify Ventricular Fibrillation rhythm 16. Start CPR within 10 seconds 17. Defibrillate initially 18. Give either epinephrine or vasopressin IV and Defibrillate (either may be given first; two doses of epi or epi and vaso may be given) 19. Give Amiodarone and Defibrillate 20. Perform CPR correctly throughout 21. 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--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 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 PEA to VF/Pulseless VT to Unstable Tachycardia Pathways. PEA Required Steps are: 1. Identify PEA rhythm 2. Start CPR within 10 seconds 3. Give epinephrine or vasopressin IV 4. Complete Rx in 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 18
7. Complete Rx within 5 minutes Unstable Tachycardia Required Steps are: 1. Identify Unstable Tachycardia 2. Sedation before Cardioversion 3. Synchronized Cardioversion 4. Complete Rx within 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 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 PEA to VF/Pulseless VT to Unstable Tachycardia Pathways. PEA Required Steps are: 1. Identify PEA rhythm 2. Start CPR within 10 seconds 3. Give epinephrine or vasopressin IV 4. Complete Rx in 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 Unstable Tachycardia Required Steps are: 1. Identify Unstable Tachycardia 2. Synchronized Cardioversion 3. Complete Rx within 2 minutes 19
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 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. Bradycardia Required Steps are: 1. Identify Bradycardia 2. Give Atropine 0.5 mg IV/IO 3. Verbalize need for TCP 4. 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--The Megacode is designed to test the ACLS participant in the Team Leader role. The Team Leader must acknowledge or direct each required action. 20
Setup and Equipment Suggested Scenario Logistics: For use with the 2010 ACLS approved curriculum 6 in-hospital Megacode scenarios 13 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 Lidocaine Procainamide Sotalol 21
Case Information (Training) Asystole In-Hospital 1 Patient Name: Jane Johnson 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 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 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 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. 22
PEA In-Hospital 1 Patient Name: 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. PEA In-Hospital 2 Patient Name: 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. PEA In-Hospital 3 (Bradycardia PEA) Patient Name: 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. Stable Tachycardia In-Hospital 1 (Narrow, Regular) Patient Name: 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. Stable Tachycardia In-Hospital 2 (Wide, Regular) Patient Name: 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. 23
Unstable Tachycardia In-Hospital 1 Patient Name: 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. Unstable Tachycardia In-Hospital 2 Patient Name: 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 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 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 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. 24
ACLS In-Hospital Megacode A Patient Name: Michael Jones 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 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 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 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. 25
ACLS In-Hospital Megacode E Patient Name: 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. ACLS In-Hospital Megacode F Patient Name: 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. 26
Debriefing Information The Practical ACLS Megacode and Training 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. www.healthcaresimulationsc.com/simstore/ Sample Practical ACLS Training set debrief log 27
Sample Practical ACLS Megacode set debrief log 28