Scenario States, Modifiers and Triggers- PATIENT #2 (Neonate) Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline Flat. Learner Actions Modifiers Rhythm: sinus Not crying. - Dry & warm Changes to patient condition based on learner action HR: 40/min Minimal - Position airway - PPV O2 65%, HR 45 BP: ?/? respiratory - Consider suctioning (mouth RR: 20/min effort. then nose) 58% - Stimulate Triggers T: 36.5oC No meconium - Check HR start PPV with 21% For progression to next state O2 (rate 40-60/min) - 1 min 2. 60 Second Mark - Initiate SpO2 monitoring - Check cap sugar: 5.2 2. 60 Second Mark Unchanged. Learner Actions Modifiers HR:45 - Re-check HR at 60 sec - 2 min O2SAT 65% RR: bagging rate - CPR at 90 sec - 3 min 70% O2: 65% - Change to 100% O2 - Maintain 3:1 ratio for CPR Triggers *same as above if no (120 events/min) - 4 min 3. HR >60 BMV started - HR/RR q1min - Epi 0.01mg/kg IV after 1st HR check if still <60 after CPR - Prepare for intubation 3. HR > 60 Appears less Learner Actions Modifiers grey. - Intubate - 5 min O2SAT 80% HR 80 - Obtain iv/io access RR 40 - Prepare for UVC placement O2SAT 75% - IVF bolus (20ml/kg =50ml) BP 55/30 - Check cap sugar (if not yet) Triggers - Send blood work, including - 7 min 4. HR >100 (set to blood cultures slowly return to normal)
Scenario States, Modifiers and Triggers- PATIENT #2 (Neonate) Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline Rhythm: sinus HR: 40/min BP: ?/? RR: 20/min 58% T: 36.5oC Flat. Not crying. Minimal respiratory effort. No meconium Learner Actions - Dry & warm - Position airway - Consider suctioning (mouth then nose) - Stimulate - Check HR start PPV with 21% O2 (rate 40-60/min) - Initiate SpO2 monitoring - Check cap sugar: 5.2 Modifiers Changes to patient condition based on learner action - PPV O2 65%, HR 45 Triggers For progression to next state - 1 min 2. 60 Second Mark 2. 60 Second Mark HR:45 RR: bagging rate O2: 65% *same as above if no BMV started Unchanged. Learner Actions - Re-check HR at 60 sec - CPR at 90 sec - Change to 100% O2 - Maintain 3:1 ratio for CPR (120 events/min) - HR/RR q1min - Epi 0.01mg/kg IV after 1st HR check if still <60 after CPR - Prepare for intubation Modifiers - 2 min O2SAT 65% - 3 min 70% Triggers - 4 min 3. HR >60 3. HR > 60 HR 80 RR 40 O2SAT 75% BP 55/30 Appears less grey. Learner Actions - Intubate - Obtain iv/io access - Prepare for UVC placement - IVF bolus (20ml/kg =50ml) - Check cap sugar (if not yet) - Send blood work, including blood cultures Modifiers - 5 min O2SAT 80% Triggers - 7 min 4. HR >100 (set to slowly return to normal)
breech-nrp.docx