SIMULATION EVENTS TABLE:

Minute (state)	Participant action/trigger	Patient status (simulator response) & operator prompts	Monitor display (vital signs)
0:00 (Baseline)	Patient moved into bed in the emergency department.	Participants should begin by placing the patient on a monitor, obtaining history from wife, and initiating a physical exam.	T 101.3 HR 107 BP 140/84 RR 20 O2sat 100% RA
04:00	IV placed, labs drawn. Participant should perform a thorough physical exam. Peripheral smear, labs, UA, and CXR should be ordered.	If the team administers an IV fluid bolus, fever and heart rate will improve. If not, tachycardia and respiratory rate worsen. If the team does not order a peripheral smear within 2 minutes of seeing the CBC results, the lab technician will call and ask if this is something they would like to order.	IV fluid given: T 99.8 HR 94 BP 140/84 RR 20 O2sat 100% RA IVF not given T 102.5 HR 120 BP 140/84 RR 24 O2sat 100% RA
10:00	Team should suspect blast crisis after reviewing peripheral smear. Broad spectrum antibiotics should be given.	(A) If team performs an LP, patient will complain of low back pain and state “something is wrong with my legs.” Patient will now have 2/5 strength in bilateral lower extremity. The wife will insist that the participants tell her why his legs are now weak. (B) If the hospitalist/intensivist is contacted prior to talking to hematology, they will ask the team to do so given the patient’s history of CML.	IV fluid given: T 99.8 HR 94 BP 140/84 RR 20 O2sat 100% RA IVF not given T 101.3 HR 120 BP 140/84 RR 24 O2sat 100% RA