Table 1. The detailed scenario template, which is submitted to the simulation lab’s technical staff, who then program the mannequin and supply necessary materials for the case.

Pre-Scenario
You are a registered nurse working in a surgery inpatient unit. You are rounding on your patients.
History
Reason for admission	Sarah Pratt is a 59-year-old female electrician who underwent bilateral total knee replacements three days ago. She is alert and oriented to person, place, and time.
Handover notes	She had her epidural topped and pulled yesterday and has had poor pain control since it was removed. Mrs. Pratt becomes very anxious when the pain medication starts to wear off and is refusing to ambulate with the physio. Dr. Blue assessed her and changed her pain medication to morphine 10 mg subcut Q4H PRN. Mrs. Pratt is receiving her Q4H medication regularly. She becomes nauseated with the pain medication and takes Gravol 50 mg intravenous (IV) each time with the morphine. Mrs. Pratt’s vitals have been stable. She is receiving O2 40% via venturi mask to keep her O2 sats at 92%. She is currently drowsy but easily aroused.
Medications	Pariet – 20 mg PO daily Xarelto – 10 mg PO daily Acetaminophen – 650 mg PO QID Morphine – 2–5 mg subcut Q4H PRN
Past medical history	Osteoarthritis, GERD, appendectomy (2000)
Allergies	NKDA
Social history	Smoker – 40 pack-year history
Baseline vitals	HR 90 BP 100/60 spO2 92%, 40% venturi RR 18 T 38 eyes open, alert and talking, diaphoretic, bilateral crackles
Begin Scenario: Learner enters the patient’s room
Objective 1: Recognize the deterioration of the client’s condition and apply a team approach to care
Additional data/findings	Vitals	Appropriate Learner Action
Client is sitting in bed, diaphoretic with O2 40% via venturi mask. About three minutes into the scenario, the client will state that she is not feeling well. She will feel weak and short of breath.	HR 110 BP 86/50 spO2 90% RR 30	Repeat vitals. Calls in other nurse(s) for help.
Objective 2: Initiate timely and appropriate Code Blue response
Client arrests.	VF Arrest: HR VF RR 0	Nurse initiates Code Blue. Assigns team roles and sends someone to get the crash cart.
Objective 3: Provide effective client care in a Code Blue situation prior to and after the arrival of the resuscitation team
Starts cardiopulmonary resuscitation (CPR).		Provide effective respirations with bag-valve-mask (BVM) ventilation, look for evidence of chest rising. Start compressions, minimum of two inches deep to a maximum of 1/3 depth of the chest. Bring crash cart to bedside and apply pads. Record events. Start timing for effective switch out of CPR.
Objective 4: Demonstrate clear effective communication techniques to health team members
Resident arrives, first shock given.		Nurse gives situation, background, assessment, recommendation (SBAR). Resident will identify client needs shock.
Resident takes over team lead role and follows cardiac arrest algorithm.		Resume CPR.
Second shock given, orders epinephrine.		Epinephrine drawn up.
Epinephrine given.	Return of spontaneous circulation: HR 80 BP 80/50 spO2 88 RR 16	End of scenario.