Simulation Study Scenario Description:
Condition 1 (initial presentation):
82 yo female brought in to Emergency Department by daughter (who is away parking car or registering patient during scenario) for altered mental status noticed that morning. RN (confederate) informs student (participant) that patient is diaphoretic and confused, and to please assess the patient. Patient is initially verbal but clearly disoriented (repeatedly asking “Who are you?” to student, “Where am I?” etc.). If student asks RN for history on patient, RN tells student that patient has history of “hypertension and diabetes” but her med list is unknown. Patient is initially not on a monitor and has had no vitals taken prior to encounter:
VS: T 37.4, P 126, R 24, BP 144/88, O2 97% on RA
HEENT:NCAT, PERRL, EOMI, Oropharynx dry
NECK:Supple, trachea midline
CHEST:CTA bilaterally, no wheezes or crackles
CV:RRR, no M/R/G, normal S1 and S1
ABDOMEN:Soft, NT, ND, + BS, no masses
EXT:Warm, no C/C/E, CRT < 2 sec
NEURO:Alert. Oriented to person, but not time, place, or situation. Moderately drowsy, arousable to verbal stimuli. CN intact, + gag reflex, remainder of neurologic exam nonfocal.
Condition 2 (decompensation):
After 2 minutes have elapsed, OR if student asks for blood glucose measurement, patient appears to have a seizure and then becomes pulseless and apneic. Note that a blood glucose reading is not yet available at this time (see “recovery”). Monitor should show PEA (initial HR of 100, trending towards 40 over 2 minutes if no glucose is given). Respiratory rate and blood pressure are zero, and O2 sat trends to 20% over 2 minutes.
Condition 3 (recovery):
ONLY IF the participant initiates rescue breathing and performs proper CPR, THEN the nurse may then reveal the blood glucose (21 mg/dL), if previously asked for. The patient will recover only if the participant initiates rescue breathing and CPR (with the assistance of the RN) and orders IV glucose. If so, patients HR trends up to 60, RR trends up to 10 breaths/minute, and BP comes up to 90/40. If participant does not perform all of the above, pt. remains in PEA arrest. Scenario terminates after 7 minutes or when patient recovers.
SIMULATION STUDY —PHYSICAL EXAM NOTES
HEENT:NCAT, PERRL, EOMI, Oropharynx dry
NECK:Supple, trachea midline
CHEST:CTA bilaterally, no wheezes or crackles
CV:RRR, no M/R/G, normal S1 and S1
ABDOMEN:Soft, NT, ND, + BS, no masses
EXT:Warm, no C/C/E, CRT < 2 sec
NEURO:Alert. Oriented to person, but not time, place, or situation. Moderately
drowsy, arousable to verbal stimuli. CN intact, + gag reflex, remainder of
neurologic exam nonfocal.