T: 36oC from arm - Control local bleeding minutes nurse to cue “she’s laceration - Analgesia bleeding a lot from that arm” - rVIII 50U/kg - TxA 1g IV over 10min Triggers - FAST US exam For progression to next state - 8 minutes or all learner actions - Portable CXR, PXR complete 2. Back from CT - CT Head, C-spine, Chest, Abdo, (assume 20 minutes passed) Pelvis - Arm x-ray - Hematology consult 2. Back from CT **At state Learner Actions Modifiers Rhythm: sinus onset, verbal - Re-assess patient - No sedation by 12 mins patient HR: 95/min report from - rVIII & TxA if not already pulls out IV & becomes verbally BP: 125/80 radiology given aggressive RR: 12/min “small ICH, no - Check cap sugar O2SAT: 100% shift” - IV/IM sedation for agitation Triggers - ± Plan for intubation - Verbalize plan for intubation 3. Patient initially - Neurosurgery consult Intubation complains of - Hematology consult (if not yet - No plan for intubation but mild HA. Vomit done) patient sedated and actions x1 in scanner. complete 4. Labs Back Two minutes into state, patient wants to leave AMA 3. Intubation Patient calm Learner Actions Modifiers Rhythm: sinus after sedation - RA Pupils/neuro exam prior - Propofol given BP 95/70, HR HR: 100/min given to paralysis 105 BP: 120/80 - Pre-oxygenate with 100% RR: 15/min - Neuro-protective measures O2SAT: 100 % - Elevate head of bed - Post-intubation CXR & Triggers sedation - Intubation complete 4. Labs Back 4. Labs Back * start state by Learner Actions Rhythm: sinus giving labs to - ICU consult HR: 85/min team - Discuss with Heme if any BP: 115/75 further management required END CASE PRN RR: 12/min O2SAT: 100%
T: 36oC from arm laceration - Control local bleeding - Analgesia - rVIII 50U/kg - TxA 1g IV over 10min - FAST US exam - Portable CXR, PXR - CT Head, C-spine, Chest, Abdo, Pelvis - Arm x-ray - Hematology consult minutes nurse to cue “she’s bleeding a lot from that arm” Triggers For progression to next state - 8 minutes or all learner actions complete 2. Back from CT (assume 20 minutes passed) 2. Back from CT Rhythm: sinus HR: 95/min BP: 125/80 RR: 12/min O2SAT: 100% **At state onset, verbal report from radiology “small ICH, no shift” Patient initially complains of mild HA. Vomit x1 in scanner. Two minutes into state, patient wants to leave AMA Learner Actions - Re-assess patient - rVIII & TxA if not already given - Check cap sugar - IV/IM sedation for agitation - ± Plan for intubation - Neurosurgery consult - Hematology consult (if not yet done) Modifiers - No sedation by 12 mins patient pulls out IV & becomes verbally aggressive Triggers - Verbalize plan for intubation 3. Intubation - No plan for intubation but patient sedated and actions complete 4. Labs Back 3. Intubation Rhythm: sinus HR: 100/min BP: 120/80 RR: 15/min O2SAT: 100 % Patient calm after sedation given Learner Actions - RA Pupils/neuro exam prior to paralysis - Pre-oxygenate with 100% - Neuro-protective measures - Elevate head of bed - Post-intubation CXR & sedation Modifiers - Propofol given BP 95/70, HR 105 Triggers - Intubation complete 4. Labs Back 4. Labs Back Rhythm: sinus HR: 85/min BP: 115/75 RR: 12/min O2SAT: 100% * start state by giving labs to team Learner Actions - ICU consult - Discuss with Heme if any further management required END CASE PRN
hemophilia-case.docx