Minute (state) | Participant action/ trigger | Patient status (simulator response) & operator prompts | Monitor display (vital signs) |
---|---|---|---|
0:00 (Baseline) | Learner performs primary survey, obtains HPI, performs secondary survey. | Patient is diaphoretic and clutching his chest. | T 98.7° F HR 102 BP 150/75 RR 15 O2 100% |
3:00 | Learner orders labs and requests ECG. | If labs and ECG not ordered, patient will complain of worsened pain and nurse will prompt the learner. | T 98.7° F HR 115 BP 160/85 RR 17 O2 100% |
4:00 | ECG, labs and CXR available. Learner reads ECG. |
Patient continues to complain of chest pain, but condition the same. If STEMI is recognized, proceed to 5:00A. If STEMI is not recognized, advance to 5:00B. |
T 98.7° F HR 117 BP 166/87 RR 21 O2 100% |
5:00A | Learner recognizes STEMI and recognizes lack of prompt availability of cath lab. | If learner simply orders lytics without a discussion, the patient prompts them by mentioning their recent MVC. The concerned nurse can prompt further shared decision making and review of the indications and contraindications prior to administration. If learner does not order lysis and simply tries to transfer the patient or other therapies, advance to 10:00B. |
T 98.7° F HR 117 BP 166/87 RR 21 O2 100% |
5:00B | Learner fails to identify STEMI or indication for lysis. | Chest pain worsens. Patient has runs of ventricular tachycardia, and nurse asks learner what was on the ECG. If learner recognizes STEMI, proceed to 5:00A. If learner continues to fail to recognize STEMI, continue to prompt but then eventually proceed to 10:00B. |
T 98.7° F HR 130 BP 85/30 RR 25 O2 87% |
~10:00A | Learner orders lysis. | Patient reports improvement of symptoms. | T 98.7° F HR 90 BP 130/80 RR 15 O2 100% |
~10:00B | Learner fails to order lysis or has yet to recognize STEMI even with prompting. | Patient will have persistent ventricular tachycardia and eventually suffer a cardiac arrest that will not be reversible until learner recognizes the need for thrombolytic therapy. | T 98.7° F HR 217 BP 67/palp RR 32 O2 82% |
~12:00 | Learner requests admission or transportation to a higher level of care. | If learner tries to admit patient without transfer for heart catheterization, prompt from local admitting physician or nurse to transfer. | T 98.7° F HR 90 BP 130/80 RR 15 O2 100% |
Case Completion: ~15:00 | Alternatively: Additional complications for advanced learners. | Consider post-lytic rhythm change, inclement weather barring transport, or persistent hypotension. | T 98.7° F HR 90 BP 130/80 RR 15 O2 100% |