Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline State Patient is Learner Actions Modifiers Rhythm: Sinus tach screaming and - ABC, monitors, iv access x2 Changes to patient condition based on learner action HR: 130/min moaning, not - Bolus IVF, call for blood - No needle decompression by BP: 75/35 obeying - Blood work (inc. G&S) 3 minutes BP 60/30, O2SAT RR: 26/min commands. - Needle decompress chest 90%, HR 140 O2SAT: 94% Answers - ± Chest tube insertion T: 36.2oC simple - Call for CXR/PXR Triggers questions. - Analgesia (fentanyl or For progression to next state ketamine iv) - Needle decompression - Check cap sugar (6.4) 2. Stabilization - Administer TXA 1g iv 2. Stabilization Patient still Learner Actions Modifiers moans, - Chest tube insertion - No lidocaine for tube HR 110 responds. But - CXR/PXR insertion patient screams ++ BP 95/60 less wild after - Complete px exam analgesia. - FAST to r/o FF (+ RUQ) Triggers - Td 0.5 ml IM - Chest tube inserted or FAST - Ancef 2g iv ± gentamycin iv complete 3. Repeat - Irrigate and splint open # hypotension - 8 minutes 3. Repeat hypotension 3. Repeat As above. Learner Actions Modifiers hypotension - air entry - 1 unit PRBC BP 80/40 - FAST to r/o FF (+ RUQ) - No FAST by 10 min BP 70/30 HR 125 - Pericardial U/S to r/o - No FAST by 11 min BP 65/30 BP 75/35 tamponade - Assess chest tube drainage, Triggers consider repeat CXR or U/S - 2 units PRBC and surgery called - Administer 2u PRBC 4. Resolution - Administer TXA 1g iv (if not - 12 minutes 4. Resolution yet done) - Call general surgery
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: 130/min BP: 75/35 RR: 26/min O2SAT: 94% T: 36.2oC Patient is screaming and moaning, not obeying commands. Answers simple questions. Learner Actions - ABC, monitors, iv access x2 - Bolus IVF, call for blood - Blood work (inc. G&S) - Needle decompress chest - ± Chest tube insertion - Call for CXR/PXR - Analgesia (fentanyl or ketamine iv) - Check cap sugar (6.4) - Administer TXA 1g iv Modifiers Changes to patient condition based on learner action - No needle decompression by 3 minutes BP 60/30, O2SAT 90%, HR 140 Triggers For progression to next state - Needle decompression 2. Stabilization 2. Stabilization HR 110 BP 95/60 Patient still moans, responds. But less wild after analgesia. Learner Actions - Chest tube insertion - CXR/PXR - Complete px exam - FAST to r/o FF (+ RUQ) - Td 0.5 ml IM - Ancef 2g iv ± gentamycin iv - Irrigate and splint open # Modifiers - No lidocaine for tube insertion patient screams ++ Triggers - Chest tube inserted or FAST complete 3. Repeat hypotension - 8 minutes 3. Repeat hypotension 3. Repeat hypotension HR 125 BP 75/35 As above. Learner Actions - air entry - FAST to r/o FF (+ RUQ) - Pericardial U/S to r/o tamponade - Assess chest tube drainage, consider repeat CXR or U/S - Administer 2u PRBC - Administer TXA 1g iv (if not yet done) - Call general surgery Modifiers - 1 unit PRBC BP 80/40 - No FAST by 10 min BP 70/30 - No FAST by 11 min BP 65/30 Triggers - 2 units PRBC and surgery called 4. Resolution - 12 minutes 4. Resolution
simple-mvc-with-tension-ptx.docx