Section VI: Scenario Progression Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results No results given during case. Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next 1. Call from ward RN with Learner Actions Modifiers HR: 98/min vignette. Reads - Ask RN for vitals Changes to patient condition based on learner action BP: 175/60 vitals out over - Instruct RN to place patient O2SAT: 91% RA phone if asked on oxygen Triggers T: Afebrile (but provides - Ask for ECG For progression to next state no other - Ask for chart at bedside - Conversation ends with RN 2. details) - Go see patient Arrival to Ward 2. Arrival to ward Patient Learner Actions Modifiers and able to - Establish 2nd IV - Patient to cue after each nitro Rhythm: Sinus tach answer - Draw blood work including spray that still having CP HR: 101/min questions short VBG and troponin BP: 179/90 sentences. - Portable CXR (unavailable) RR: 30/min Diaphoretic. - ECG O2SAT: 93% on 35% - Read through chart Triggers T: 36.7oC - Nitro 0.4mg SL q5min x3 - Nitro x3 3. Hypoxia - Call RT for BiPap - 8 minutes 3. Hypoxia - 40mg iv ± foley 3. Hypoxia Patient Learner Actions Modifiers complains that - Repeat ECG - No repeat ECG RN to prompt HR 98 pain is worse. - Start nitro infusion RR 40 (50mcg/min iv to start) BP 160/85 RN to prompt - Initiate BiPap O2SAT 88% that patient - Call cath lab for STEMI looks more - ASA 160 mg PO chew SOB, CXR now - Heparin 4000mg iv Triggers done (CHF). - Ticagrelor or Plavix load - Cath called End Case - Prepare for intubation, call ICU or anesthesia
Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next 1. Call from ward HR: 98/min BP: 175/60 O2SAT: 91% RA T: Afebrile RN with vignette. Reads vitals out over phone if asked (but provides no other details) Learner Actions - Ask RN for vitals - Instruct RN to place patient on oxygen - Ask for ECG - Ask for chart at bedside - Go see patient Modifiers Changes to patient condition based on learner action Triggers For progression to next state - Conversation ends with RN 2. Arrival to Ward 2. Arrival to ward Rhythm: Sinus tach HR: 101/min BP: 179/90 RR: 30/min O2SAT: 93% on 35% T: 36.7oC Patient and able to answer questions short sentences. Diaphoretic. Learner Actions - Establish 2nd IV - Draw blood work including VBG and troponin - Portable CXR (unavailable) - ECG - Read through chart - Nitro 0.4mg SL q5min x3 - Call RT for BiPap - 40mg iv ± foley Modifiers - Patient to cue after each nitro spray that still having CP Triggers - Nitro x3 3. Hypoxia - 8 minutes 3. Hypoxia 3. Hypoxia HR 98 RR 40 BP 160/85 O2SAT 88% Patient complains that pain is worse. RN to prompt that patient looks more SOB, CXR now done (CHF). Learner Actions - Repeat ECG - Start nitro infusion (50mcg/min iv to start) - Initiate BiPap - Call cath lab for STEMI - ASA 160 mg PO chew - Heparin 4000mg iv - Ticagrelor or Plavix load - Prepare for intubation, call ICU or anesthesia Modifiers - No repeat ECG RN to prompt Triggers - Cath called End Case Section VI: Scenario Progression Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results No results given during case.
chest-pain-on-the-ward.docx