Scenario States, Modifiers and Triggers Patient Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline State Decreased Learner Actions Modifiers Rhythm: Sinus mental status, -Attaches monitors Changes to patient condition based on learner action HR: 55/min GCS 3 -Acquires IV access - O2 by facemask O2SAT to 84% BP: 100 / 65 Pulse present. -Supplemental O2 - O2 by BVM O2SAT to 88% RR: 4/min Pupils 1mm -Hx/Physical Exam O2SAT: 79% bilaterally. -EKG/CXR Triggers T: 34.5oC -Lab investigations For progression to next state -Recognizes opioid toxidrome -Naloxone bolus # 1 2. Acute -Naloxone IV bolus #1 Pulmonary Edema -5 minutes 2. Pulmonary Edema 2. Acute Pulmonary Increased Learner Actions Modifiers Edema mental status -Warm IV NS bolus or drip - Naloxone IV bolus #2 or Drip HR: 60/min GCS: 7 -Naloxone IV bolus #2 RR to 14, pupils to 4mm bilat BP: 109/71 E1none -Intubation and reactive RR: 8/min V2sounds -Optimizes preoxygenation - Preoxygenation with BiPAP or O2SAT: 88% M4 withdraws -Apneic oxygenation assisted ventilation with Trending to 70% Pupils 2 mm -Induction med BVM+PEEP Valve O2SAT to 90% over 2 minutes bilaterally -Intubation paralytic med Triggers -Intubation 3. Intubation 3. Intubation Pt paralyzed Learner Actions Modifiers HR: 90 post intubation -Confirmation of tube - Bair Hugger T to 36.0oC BP: 110/70 -NG tube O2SAT: 92% Catheter RR: set -Post intubation CXR Display -Naloxone IV Drip Triggers FiO2 = 1.0 -Antibiotics (Ceftriaxone & -3 minutes into state Tv = 500 Vancomycin) 4. Resolution PEEP = 5 -Bair Hugger Tv = 500 mL - Lung Protective Settings
Scenario States, Modifiers and Triggers Patient Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline State Rhythm: Sinus HR: 55/min BP: 100 / 65 RR: 4/min O2SAT: 79% T: 34.5oC Decreased mental status, GCS 3 Pulse present. Pupils 1mm bilaterally. Learner Actions -Attaches monitors -Acquires IV access -Supplemental O2 -Hx/Physical Exam -EKG/CXR -Lab investigations -Recognizes opioid toxidrome -Naloxone IV bolus #1 Modifiers Changes to patient condition based on learner action - O2 by facemask O2SAT to 84% - O2 by BVM O2SAT to 88% Triggers For progression to next state -Naloxone bolus # 1 2. Acute Pulmonary Edema -5 minutes 2. Pulmonary Edema 2. Acute Pulmonary Edema HR: 60/min BP: 109/71 RR: 8/min O2SAT: 88% Trending to 70% over 2 minutes Increased mental status GCS: 7 E1none V2sounds M4 withdraws Pupils 2 mm bilaterally Learner Actions -Warm IV NS bolus or drip -Naloxone IV bolus #2 -Intubation -Optimizes preoxygenation -Apneic oxygenation -Induction med -Intubation paralytic med Modifiers - Naloxone IV bolus #2 or Drip RR to 14, pupils to 4mm bilat and reactive - Preoxygenation with BiPAP or assisted ventilation with BVM+PEEP Valve O2SAT to 90% Triggers -Intubation 3. Intubation 3. Intubation HR: 90 BP: 110/70 O2SAT: 92% RR: set Display FiO2 = 1.0 Tv = 500 PEEP = 5 Tv = 500 mL Pt paralyzed post intubation Learner Actions -Confirmation of tube -NG tube Catheter -Post intubation CXR -Naloxone IV Drip -Antibiotics (Ceftriaxone & Vancomycin) -Bair Hugger - Lung Protective Settings Modifiers - Bair Hugger T to 36.0oC Triggers -3 minutes into state 4. Resolution