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CSESaR Medical Simulation
Scenario Setup Checklist
rev. July 16, 2005
A. Simulation Environment
bed:
personnel:
actor roles:
ED / clinic / hospital / intensive care
Manikin operator x __
Audiovisual technician
Facilitator x __
Actor x __
Family / Friend x __
Nurse (ED / clinic / hospital / intensive care) x __
Respiratory technician
Radiology technician
Senior physician (expert) x __
________________
Consultant physician x __
________________
B. Simulation Manikin Patient
Manikin:
SimMan / SimBaby /AirMan/ MegaCode Kid /Other
age group:
infant / child / teenager / adult / elderly adult
gender:
male / female
clothing:
street clothing / hospital patient garb / other ________
moulage / props: ___________________________________________
___________________________________________
IV x __ / location(s) _____ / gauge(s)_____
programming: ___________________________________________
___________________________________________
**For Scripted Scenarios Please Attach Script..
patient medical forms: ED chartwork (triage note / RN note / physician note)
transfer paperwork
other (medication lists, inpatient charts)
Electrocardiogram(s) x __
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X-ray(s) x __
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CT(s) x __
___________________________________________
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Ultrasound
___________________________________________
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MRI
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Other
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DE-IDENTIFY IMAGES AND PROPS TO
COMPLY WITH HIPAA REGULATIONS!!!
C. Medical equipment
-patient assessment equipment
blood pressure cuff
cardiac monitor
EKG machine
pulse oximeter
stethoscope
thermometer
-standard resuscitation equipment (“code cart” / “crash cart”)
protective equipment (gloves / goggles / gowns)
CPR board
defibrillator (electrodes / defib gel or pads / recorder paper)
basic airway management devices
oropharyngeal airway (OPA; assorted)
nasopharyngeal airway (NPA; assorted)
bag-valve mask (adult)
intubation equipment
laryngoscope handles / blades / batteries (assorted)
water-based lubricant
endotracheal tubes (assorted)
intravenous access equipment
tourniquets
gauze pads
intravenous catheters (assorted)
intravenous fluid tubing drip sets (micro + macro)
intravenous fluid bags (normal saline, D5W, LR)
phlebotomy supplies
sterile saline for flushes
stopcocks and connectors
dressings (assorted)
end-tidal CO2 monitor
naso-/oro-gastric tubes (assorted)
nebulizer
oxygen source
oxygen delivery devices (face masks, nasal cannulas)
syringes (catheter tip; assorted)
syringes (lavage tip)
tape
urinary catheters (assorted)
ventilator
wall suction and suction tubing (Yankower and tracheal suction)
-additional airway management equipment
CombiTubeTM
cricothyroidotomy kit / surgical tracheostomy kit
endotracheal tubes (assorted, including size ___ )
fiberoptic bronchoscope and light source
laryngeal mask airway (LMA)
lighted stylet
other ______________________________________________
D. Medications
general medications (parenteral unless otherwise indicated)
activated charcoal bottle
adenosine
albuterol inhaler / nebulizer
amiodarone
antibiotic ___________________________________________
aspirin tablets
atropine
dextrose (D50)
diltiazem
dobutamine infusion
dopamine infusion
epinephrine (1:1000 / 1:10000)
fentanyl
haloperidol
hydromorphone
ipratropium inhaler / nebulizer
isoproterenol infusion
labetalol
lidocaine
lorazepam
magnesium
metoprolol
morphine
naloxone
nitroglycerin (tablets / paste / infusion)
sodium bicarbonate
steroids (dexamethasone / hydrocortisone / prednisolone)
vasopressin
verapamil
rapid sequence induction / intubation medications
e.g. etomidate / midazolam / ketamine
e.g. succinylcholine / vecuronium
blood products (PRBC / FFP / platelets / other ________________)
additional medications (e.g. thrombolytics, specific antidotes)
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E. Additional equipment and medications for optional sections:
________________________________________________________
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Notes or Special Needs: