Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline State Significant Learner Actions Modifiers Rhythm: Sinus tach work of - Monitors, IV/IO access Changes to patient condition based on learner action HR: 180/min breathing with - Leave child in position of - O2 applied SpO2 92% BP: 80/46 stridor, comfort with parent - Neb epi HR 190, RR 60/min, RR: 65/min suprasternal - Humidified O2 without still stridorous 90 % RA retractions, agitating child (blow by) T: 38.4oC poor air - Portable CXR Triggers bilaterally - Antipyretic (Tylenol 180 mg) For progression to next state - Epi neb (5 mg/dose) - Epi nebs, humidified O2, dex, - Dexamethasone (0.6 mg/kg) given 2. Respiratory failure PO/IV/IM - 5 minutes 2. Respiratory failure Drowsy, Learner Actions Modifiers 2. Respiratory failure decreased - Use BVM with 100% O2 + - BVM with 100% O2, PEEP HR: 150, weak respiratory PEEP valve difficulty bagging, SpO2 to 82% peripheral pulses rate, cyanotic, - Call Anesthesia, RT, ENT - 1st intubation attempt BP: 75/35 poor air entry (ENT/Anesthesia unavailable) unsuccessful, SpO2 to 75% RR: 12 bilaterally. - Call for difficult airway cart, - No intubation considered 2 O2SAT: 80% GCS 11 (E3 V3 glide scope, needle mins into state RN states really “I M5) cricothyroidotomy supplies think you need to intubate.” - Multiple ETT sizes present - Insert IV and draw labs (VBG, CBC, lytes, Cr, Blood Cx) Triggers - IV fluid bolus 20 ml/kg - Second intubation attempt, or use of LMA 3. Failed Intubation
Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline State Rhythm: Sinus tach HR: 180/min BP: 80/46 RR: 65/min 90 % RA T: 38.4oC Significant work of breathing with stridor, suprasternal retractions, poor air bilaterally Learner Actions - Monitors, IV/IO access - Leave child in position of comfort with parent - Humidified O2 without agitating child (blow by) - Portable CXR - Antipyretic (Tylenol 180 mg) - Epi neb (5 mg/dose) - Dexamethasone (0.6 mg/kg) PO/IV/IM Modifiers Changes to patient condition based on learner action - O2 applied SpO2 92% - Neb epi HR 190, RR 60/min, still stridorous Triggers For progression to next state - Epi nebs, humidified O2, dex, given 2. Respiratory failure - 5 minutes 2. Respiratory failure 2. Respiratory failure HR: 150, weak peripheral pulses BP: 75/35 RR: 12 O2SAT: 80% Drowsy, decreased respiratory rate, cyanotic, poor air entry bilaterally. GCS 11 (E3 V3 M5) Learner Actions - Use BVM with 100% O2 + PEEP valve - Call Anesthesia, RT, ENT (ENT/Anesthesia unavailable) - Call for difficult airway cart, glide scope, needle cricothyroidotomy supplies - Multiple ETT sizes present - Insert IV and draw labs (VBG, CBC, lytes, Cr, Blood Cx) - IV fluid bolus 20 ml/kg Modifiers - BVM with 100% O2, PEEP difficulty bagging, SpO2 to 82% - 1st intubation attempt unsuccessful, SpO2 to 75% - No intubation considered 2 mins into state RN states “I really think you need to intubate.” Triggers - Second intubation attempt, or use of LMA 3. Failed Intubation