Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline State GCS 8. Learner Actions Modifiers Rhythm: sinus tach Moaning only. - Monitors, 2 large IVs Changes to patient condition based on learner action HR: 120/min - Trauma labs (include βHCG), - 2L NS BP 85/45, HR 115 BP: 80/40 cap sugar (7.1) RR: 22/min - Bolus 1L NS O2SAT: 96% - Call for blood T: 36.1oC - Primary survey Triggers - CXR/Pelvic xray For progression to next - FAST to r/o FF (+RUQ) - Intubation 2. Intubation - Bind pelvis - 5 minutes 3. Hypotension - Give TXA 1g iv - Call gen sx/ortho/neurosx 2. Intubation Unchanged. Learner Actions Modifiers - Have vasopressor on hand - Propofol used BP 60/30 Keep vitals same as - Appropriate induction state prior (etomidate or ketamine) Triggers - Paralytic administration - Intubated from State 1 - Inline stabilization 3. Hypotension - ± Lidocaine/fentanyl pre-tx - Intubated from State 3 - Post-intubation CXR 4. Herniation - Initiate sedation 3. Hypotension Patient Learner Actions Modifiers unchanged - Call ortho/gen sx - 1 unit PRBC BP 70/35 BP 65/35 from previous - Bind pelvis (if not yet) HR 130 state. - Administer 2u PRBC - Consider massive transfusion Triggers If intubated RR 12 - FAST (if not yet done) - Intubation 2. Intubation - 2 units PRBC 4. Herniation 4. Herniation Patient’s vitals Learner Actions Modifiers reflect - Intubate (if not yet done) HR 45 herniation. Left - Hyperventilate patient BP 75/45 - HOB to 30 degrees Triggers
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: 120/min BP: 80/40 RR: 22/min O2SAT: 96% T: 36.1oC GCS 8. Moaning only. Learner Actions - Monitors, 2 large IVs - Trauma labs (include βHCG), cap sugar (7.1) - Bolus 1L NS - Call for blood - Primary survey - CXR/Pelvic xray - FAST to r/o FF (+RUQ) - Bind pelvis - Give TXA 1g iv - Call gen sx/ortho/neurosx Modifiers Changes to patient condition based on learner action - 2L NS BP 85/45, HR 115 Triggers For progression to next - Intubation 2. Intubation - 5 minutes 3. Hypotension 2. Intubation Keep vitals same as state prior Unchanged. Learner Actions - Have vasopressor on hand - Appropriate induction (etomidate or ketamine) - Paralytic administration - Inline stabilization - ± Lidocaine/fentanyl pre-tx - Post-intubation CXR - Initiate sedation Modifiers - Propofol used BP 60/30 Triggers - Intubated from State 1 3. Hypotension - Intubated from State 3 4. Herniation 3. Hypotension BP 65/35 HR 130 If intubated RR 12 Patient unchanged from previous state. Learner Actions - Call ortho/gen sx - Bind pelvis (if not yet) - Administer 2u PRBC - Consider massive transfusion - FAST (if not yet done) Modifiers - 1 unit PRBC BP 70/35 Triggers - Intubation 2. Intubation - 2 units PRBC 4. Herniation 4. Herniation HR 45 BP 75/45 Patient’s vitals reflect herniation. Left Learner Actions - Intubate (if not yet done) - Hyperventilate patient - HOB to 30 degrees Modifiers Triggers
pelvic-fracture-and-sdh.docx