Table 1.
States for Scenario 1: Postoperative Arterial Switch Handoff Communication
| State | Patient Status | Learner Action | |
|---|---|---|---|
| Called to room | • In ICU room, on bed, supine, sedated • VS: sinus rhythm with HR 160, RR 28, BP 75/55 (arterial line), 70/50 (cuff), SpO2 99%, ETco2 40 mmHg, CVP 7 cm H2O • Ventilation: PSIMV: rate 28, PiP 23 cm H2O, PEEP 5 cm H2O, FiO2 100% • Infusions: epinephrine 0.03 μgkg−1 min−1, nitroprusside 1 μgkg−1 min−1 |
• Attaches patient to ECG monitor, pulse oximeter, and BP cuff • Attaches patient lines to CVP transducer and a-line transducer • Attaches ETT to ventilator tubing |
Trigger to enter state: • Start of session |
| Hypertension | • BP rises to 120/70 (arterial line) over 1 min | • Notes hypertension • Administers sedation • Increases nitroprusside • Decreases epinephrine |
Operator: • Patient is hypertensive secondary to pain • If sedation is administered, BP returns to 75/55 • If nitroprusside infusion rate is increased or epinephrine is decreased, BP decreases to 40/25 and HR increases to 190 Trigger to enter state: • Simulation time 1:30 min Teaching points: • Recognition and considerations for etiology of postoperative hypertension • Acute management of hypertension secondary to pain |
| Hypoxia | • SpO2 decreases to 82% over 2 min | • Notes hypoxia • Increases FiO2 on ventilator • Increases PiP or PEEP on ventilator • Disconnects patient from ventilator and attempts BMV |
Operator: • Patient is hypoxic due to right upper lobe lung collapse • If FiO2, PiP, or PEEP are increased, or if BMV is initiated, SpO2 increases to >95% over 30 s Trigger to enter state: • Simulation time 3:30 min Teaching points: • Recognition of and considerations for etiology of hypoxia • Acute management of lung collapse in an intubated patient • Applying information provided during handoff communication in the acute management of the post-operative patient |
| Hypotension | • BP decreases to 40/25 and CVP decreases to 5 cm H2O over 1 min | • Notes hypotension • Administers volume • Decreases nitroprusside • Increases epinephrine • Administers calcium |
Operator: • Patient is hypotensive secondary to continued blood loss • If volume is administered, BP increases to 75/55 and CVP increases to 7 over 30 s • If nitroprusside is turned off, epinephrine is increased, or calcium is administered, state remains unchanged Trigger to enter state: • Simulation time 5:00 min Teaching points: • Recognition and considerations for etiologies for postoperative hypotension • Acute management of decreased preload • Applying information provided during handoff communication in the acute management of the postoperative patient |
Fio2 indicates fraction of inspired oxygen.
VS, vital signs; HR, heart rate; RR, respiratory rate; BP, blood pressure; SpO2, saturation of oxygen by pulse oximetry; ETCO2, end-tidal carbon dioxide; CVP, central venous pressure; PSIMV, synchronized intermittent mandatory ventilation, pressure limited; PiP, peak inspiratory pressure; PEEP, positive end-expiratory pressure; FiO2, fraction of inspired oxygen; ECG, electrocardiogram; a-line, arterial line; ETT, endotracheal tube; BMV, bag-mask ventilation; JET, junctional ectopic tachycardia.