Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline GCS 14 as Learner Actions Modifiers Rhythm: Wide QRS above. ++ - IV, O2, monitors Changes to patient condition on learner action HR: 110/min agitated - Blood work (tox + sepsis + - Antipyretic no effect BP: 120/80 TSH + CK) - 1L IV NS HR 105, BP 125/85 RR: 18/min Inducible - Cap glucose - 1amp NaHCO3 narrowing of 99% clonus + - ECG (wide QRS) QRS (ECG with prolonged QT) T: 39.5oC - NaHCO3 for wide QRS - IV NS 1L Triggers - Consider antipyretic For progression to next state - antibiotics - All actions complete or 5 - dip, βHCG minutes 2. Torsades - ± Portable CXR - Consider head CT 2. Torsades Patient GSS Learner Actions Modifiers Rhythm: torsades drops to 8 - Cardioversion at 100-200J - Cardioversion before HR: 180/min (moaning) - MgSO4 2g IV brief NSR then back to torsades BP: 60/30 - Repeat ECG RR: 18/min Triggers O2SAT: 93% - MgSO4 given 4. More Agitated T: 40.5oC - No MgSO4 by 3 min 3. Arrest 3. Arrest Patient loses Learner Actions Modifiers Rhythm: torsades pulse - IV MgSO4 - Defibrillation only No ROSC HR: 180/min - Defibrillation at 200J BP: 0/0 - High quality CPR Triggers RR: 0 - given 4. More Agitated O2- ??? 4. More Agitated Patient GCS 13. Learner Actions Modifiers Rhythm: NSR Very jumpy. - IV Benzos until more calm - 1st dose benzos HR 110 HR: 120/min Speaking - Active cooling BP: 140/90 nonsense. - Consider intubation for Triggers RR: 16/min adequate sedation & cooling - Cooling + benzos given O2SAT: 99% - Call Poison Control 5. Labs Back
Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline Rhythm: Wide QRS HR: 110/min BP: 120/80 RR: 18/min 99% T: 39.5oC GCS 14 as above. ++ agitated Inducible clonus + Learner Actions - IV, O2, monitors - Blood work (tox + sepsis + TSH + CK) - Cap glucose - ECG (wide QRS) - NaHCO3 for wide QRS - IV NS 1L - Consider antipyretic - antibiotics - dip, βHCG - ± Portable CXR - Consider head CT Modifiers Changes to patient condition on learner action - Antipyretic no effect - 1L IV NS HR 105, BP 125/85 - 1amp NaHCO3 narrowing of QRS (ECG with prolonged QT) Triggers For progression to next state - All actions complete or 5 minutes 2. Torsades 2. Torsades Rhythm: torsades HR: 180/min BP: 60/30 RR: 18/min O2SAT: 93% T: 40.5oC Patient GSS drops to 8 (moaning) Learner Actions - Cardioversion at 100-200J - MgSO4 2g IV - Repeat ECG Modifiers - Cardioversion before brief NSR then back to torsades Triggers - MgSO4 given 4. More Agitated - No MgSO4 by 3 min 3. Arrest 3. Arrest Rhythm: torsades HR: 180/min BP: 0/0 RR: 0 O2- ??? Patient loses pulse Learner Actions - IV MgSO4 - Defibrillation at 200J - High quality CPR Modifiers - Defibrillation only No ROSC Triggers - given 4. More Agitated 4. More Agitated Rhythm: NSR HR: 120/min BP: 140/90 RR: 16/min O2SAT: 99% Patient GCS 13. Very jumpy. Speaking nonsense. Learner Actions - IV Benzos until more calm - Active cooling - Consider intubation for adequate sedation & cooling - Call Poison Control Modifiers - 1st dose benzos HR 110 Triggers - Cooling + benzos given 5. Labs Back