Table 4.
Differences in Two Participants’ Description of Their Experience in the Brown Scenario.
| Participant 1 | Participant 2 | |
|---|---|---|
|
| ||
| Time 1 | ||
| Cues | – Abdominal pain | – Hypotensive |
| – Peripheral IVs | – “Dirty abdomen” | |
| Assessment | – Patient is sick | – Patient will be sick for 24 hours |
| – Patient requires immediate action | – Patient likely to develop sepsis Differential includes: | |
| – Anemia from blood loss | ||
| – Atrial fibrillation | ||
| – Poor pain control | ||
| Actions | – Reviewed patient history to learn about blood loss, blood/fluids administered, change since surgery | – Checked dressing on wound |
| – Checked blood pressure | ||
| – Ordered IV fluids | ||
| – Ordered medication to increase blood pressure | ||
| – Increased oxygen | ||
| Time 2 | ||
| Cues | – Low oxygen status | – Patient appears mildly confused |
| – Crackles on lungs suggest fluid overload | ||
| – Patient had not received blood products | ||
| – Combination of low blood pressure, high heart rate, high temperature, low urine output | ||
| Assessment | Differential includes: | Differential includes: |
| – Fluid overload | – Sepsis | |
| – Under-resuscitation | – Bleeding | |
| – Heart failure | ||
| – Pulmonary edema | ||
| – Poor pain control | ||
| – Collapsed lungs | ||
| – Free air or bowel perforation | ||
| – Fluid filled process in lungs | ||
| Actions | – Conducted physical exam | – Held off ordering pain medication to monitor and assess mental status |
| – Ordered labs, CBC panel and lactate | ||
| – Ordered pain medication | ||
| – Ordered medication to increase blood pressure | – Ordered ABG to assess ventilation and lactate | |
| – Ordered IV fluids | – Assessed belly again | |
| – Called to have more blood available | – Told nurse to prepare to intubate | |
| – Ordered imaging of chest and abdomen | ||
| Time 3 | ||
| Cues | – Elevated lactate | – Elevated lactate |
| Assessment | Differential includes: | Differential includes: |
| – Under-resuscitation | – septic shock | |
| – Transfusion-related lung injury | ||
| – Transfusion-related cardiac injury | ||
| – Acute heart failure | ||
| – Postoperative pain | ||
| – Flash pulmonary edema | ||
| – Acute kidney injury | ||
| Actions | – Called the surgical team | – Ordered pain medication |
| – Planned to move patient to intensive care unit | – Committed to intubating | |
| – Called the surgical team | ||
| – Planned to move patient to intensive care unit | ||
| End of simulation | ||