Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline State Somnolent, Learner Actions Modifiers Rhythm: sinus brady responding to - IV, O2, monitors Changes to patient condition based on learner action with 1st degree pain only. - IV NS 1L bolus - Narcan no effect block - Tox bloodwork, VBG - 1L bolus BP 92/50 transiently HR: 50/min - ECG - Glucagon given emesis BP: 87/43 - Go through med list RR: 10/min - More history/px exam Triggers O2SAT: 95% RA - Check glucose (6.8) For progression to next state T: 36oC - Trial narcan - 3 min 2. Persistent - Call poison centre Hypotension 2. Persistent Patient status Learner Actions Modifiers Hypotension unchanged - Ca gluconate 2g iv bolus, - Post calcium BP 83/46 consider Ca infusion 2-3g/hr BP 75/45 - Insulin infusion (1u/kg/hr with 0.5u/kg bolus) with Triggers D10NS @ 150ml/hr - All 3 agents started 3. More - Trial glucose q15 min Somnolent - Repeat NS bolus - 9 min 3. More Somnolent - Add vasopressor infusion 3. More Somnolent Begin state Learner Actions Modifiers with RN saying - Check glucose (7.1) - Narcan No effect RR 6 seems to - narcan (if not before) “she O2SAT 91% be making less - Assist breathing (bagging) Triggers respiratory - Prepare for intubation - Intubation 4. Intubation effort” - If don’t intubate give VBG. At 12 min 5. Arrest Learner Actions Modifiers 4. Intubation With - Appropriate RSI - Propofol for intubation BP - Post-intubation CXR 50/22 O2SAT 95% - Sedation infusion - Prepare for central line Triggers
Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline State Rhythm: sinus brady with 1st degree block HR: 50/min BP: 87/43 RR: 10/min O2SAT: 95% RA T: 36oC Somnolent, responding to pain only. Learner Actions - IV, O2, monitors - IV NS 1L bolus - Tox bloodwork, VBG - ECG - Go through med list - More history/px exam - Check glucose (6.8) - Trial narcan - Call poison centre Modifiers Changes to patient condition based on learner action - Narcan no effect - 1L bolus BP 92/50 transiently - Glucagon given emesis Triggers For progression to next state - 3 min 2. Persistent Hypotension 2. Persistent Hypotension BP 75/45 Patient status unchanged Learner Actions - Ca gluconate 2g iv bolus, consider Ca infusion 2-3g/hr - Insulin infusion (1u/kg/hr with 0.5u/kg bolus) with D10NS @ 150ml/hr - glucose q15 min - Repeat NS bolus - Add vasopressor infusion Modifiers - Post calcium BP 83/46 Triggers - All 3 agents started 3. More Somnolent - 9 min 3. More Somnolent 3. More Somnolent RR 6 O2SAT 91% Begin state with RN saying “she seems to be making less respiratory effort” Learner Actions - Check glucose (7.1) - Trial narcan (if not before) - Assist breathing (bagging) - Prepare for intubation Modifiers - Narcan No effect Triggers - Intubation 4. Intubation - If don’t intubate give VBG. At 12 min 5. Arrest 4. Intubation With O2SAT 95% Learner Actions - Appropriate RSI - Post-intubation CXR - Sedation infusion - Prepare for central line Modifiers - Propofol for intubation BP 50/22 Triggers
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