Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline Sitting upright Learner Actions Modifiers Rhythm: Sinus tach - History & physical Changes to patient condition based on learner action HR: 120/min Patient complains of - IV, blood work, EKG -Ask patient about his goals of BP: 130/80 hip and back pain. - Saline bolus care, he will say Cindy” “ask RR: 30/min back…my hip. - Glucose check “My O2SAT:84 % (2L NP) Need meds.” - CXR “It Triggers T: 36.8oC hurts.” - Call RT “Can’t For progression to next state breathe.” All other - Apply O2 -Read clinic note or 5 mins into responses: - Team member to read “don’t the case 2. Stabilization know” and clinic note “ask Cindy.” 2. Stabilization Learner Actions Modifiers Rhythm: Sinus tach - Try to find code status -Pain meds given HR 100 HR: 110/min documentation -If attempt intubation, daughter BP: 140/90 - POCUS for PCE, CHF, to arrive/phone asking for MD RR: 24/min PNA and PTX O2SAT:94% (NRB) - Treat bone pain Triggers T: 36.8oC - Call SDM -Call POA or attempt intubation 3. Goals of Care Discussion 3. Goals of Care Cindy arrives or on Learner Actions Modifiers Discussion the phone. - of care -Oncology/Palliative care will Rhythm: Sinus tach Asks about current discussion with POA to see in ED in 30 min HR: 100/min status. - Call Oncology BP: 140/90 to know - Call Palliative care Triggers RR: 24/min prognosis and -All actions complete or 7 min O2SAT:92 % (NRM) options. into the case 4. Worsening resp Wants to know your status recommendation. 4. Worsening Patient complains of Learner Actions Modifiers Respiratory Status ongoing shortness of - Ongoing goals of care Rhythm: Sinus tach breath. discussion w/ POA Triggers
Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline Rhythm: Sinus tach HR: 120/min BP: 130/80 RR: 30/min O2SAT:84 % (2L NP) T: 36.8oC Sitting upright Patient complains of hip and back pain. “My back…my hip. Need meds.” “It hurts.” “Can’t breathe.” All other responses: “don’t know” and “ask Cindy.” Learner Actions - History & physical - IV, blood work, EKG - Saline bolus - Glucose check - CXR - Call RT - Apply O2 - Team member to read clinic note Modifiers Changes to patient condition based on learner action -Ask patient about his goals of care, he will say “ask Cindy” Triggers For progression to next state -Read clinic note or 5 mins into the case 2. Stabilization 2. Stabilization Rhythm: Sinus tach HR: 110/min BP: 140/90 RR: 24/min O2SAT:94% (NRB) T: 36.8oC Learner Actions - Try to find code status documentation - POCUS for PCE, CHF, PNA and PTX - Treat bone pain - Call SDM Modifiers -Pain meds given HR 100 -If attempt intubation, daughter to arrive/phone asking for MD Triggers -Call POA or attempt intubation 3. Goals of Care Discussion 3. Goals of Care Discussion Rhythm: Sinus tach HR: 100/min BP: 140/90 RR: 24/min O2SAT:92 % (NRM) Cindy arrives or on the phone. Asks about current status. to know prognosis and options. Wants to know your recommendation. Learner Actions - of care discussion with POA - Call Oncology - Call Palliative care Modifiers -Oncology/Palliative care will to see in ED in 30 min Triggers -All actions complete or 7 min into the case 4. Worsening resp status 4. Worsening Respiratory Status Rhythm: Sinus tach Patient complains of ongoing shortness of breath. Learner Actions - Ongoing goals of care discussion w/ POA Modifiers Triggers
palliative-resp-case.docx