Course: Scenario: F2-MI-VF

PATIENT DETAILS
Name: Sam Smith Age:55 years
Current Illnesses:Right Inguinal Hernia repair, Post-op Day 1
Past Medical History:Indigestion. Smokes 2-3 cigarettes a day. Occasional alcohol over weekends. Stayed in overnight as he was sick post-op.
Social History:Married, lives with family. Taxi driver.
Drug Therapy:Gaviscon, Ranitidine over the counter
Allergies:None / INVESTIGATIONS
Hb / 12.4 / Na+ / 142 / pH / 7.11
WCC / 10.2 / K+ / 4.7 / PaCO2 / 6.9
Platelets / 212 / Urea / PaO2 / 4.7
Glucose / 5.6 / Creat / BE / -11
CRP / 9 / O2 Sat / 79%
Lactate / 4.4
HCO3 / 18.2
CXR / NAD
ECG / ST elevation with ectopics
PATIENT BRIEF
Stage 1:Patient is unresponsive.
Stage 2:Patient is unresponsive.
Stage 3: Patient is unresponsive.
Stage 4: Coughing, gagging
ROLE PLAYER 1 (Ward Nurse)
You are a newly qualified ward nurse. You are keen to help but distracted, over-burdened with work. You are under pressure from the bed manager to get the bed cleared. You also have to prepare for the morning round, and can’t really help. You are busy sorting outthe handover notes, or on the phone. You are ALS trained and know how to use the defibrillator.
ROLE PLAYER 2 (Resus Officer)
You were tied up in another arrest and will come in only if resuscitation is being inadequate. You will go in, introduce yourself, and start asking questions about the consultant, trying to fix responsibility. You do not volunteer to join in the resuscitation, but will do if asked.
TELEPHONE BRIEF (Medical ST4)
You are busy on the ward. You can give advice over the phone. You are generally supportive but un-available. You can offer to send an F2 doctor to help.
SCENARIO PROGRESSION/STAGES
Stage 1: Dr called in to discharge the patient. Notes on the trolley. TTOs not done.
Stage 2:Pt unresponsive. In VF arrest. Candidate must identify and start CPR + initiate arrest call.
Stage 3: VF Arrest
RR nil ECG VF > after 3st shock + 1 correct dose of adrenaline, patient reverts into sinus rhythm with ST elevation and ventricular ectopics
Stage 4: ROSC
HR 140 BP 90/54 RR 26 SpO2 95 ECG Sinus rhythm, ST elevation, Ventricular ectopics.
End of scenario
LEARNING OBJECTIVES
  1. Identification, treatment and ongoing management of VF arrest
  2. Human factors in an unexpected life threatening event.
  3. SBAR, liaison with ward and resus teams.
/ MANIKIN SETUP
SimMan. 1 venflon in situ, with ability to draw blood and give drugs and fluids.
Ability to monitor and shock
Manikin / patient voice
DEBRIEFING
  1. Management of VF arrest
  2. ALS algorithm
  3. Communication, Team working
  4. SBAR, asking for help, getting help
  5. Record keeping
/ ROOM SET UP
Medical ward. Notes. Notes trolley. Anaesthetic notes.
Basic monitor with HR, BP, SpO2 with or without trace.
PC with lab results. Phone. Resus trolley available outside.
DISTRACTIONS
Relative being upset / asking questions.
2nd F1 doctor
Student nurse asking questions
Full resus team arrives
SPECIAL PROPS
CXR: Normal
ECG: ST elevation with ectopics
ABG: During arrest, Arterial (given above)

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