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Junior Assistantship Acute Care and Simulation Training Cardiac Arrest Scenario 2 – Pulseless Electrical Activity Intended Learning Outcomes Develops competency in: The use of cardio pulmonary resuscitation The use of National Early Earning Scores The ABCDE approach to acute illness The use of the SBAR communication tool Narrative Description At 23.00 h a 76 yr old patient on the respiratory ward becomes acutely ill. The FY1s respond as part of the cardiac arrest team. Mr Thomas was admitted 12 h ago and diagnosed with suspected pneumonia. The students should demonstrate the above competencies and manage pulseless electrical activity according to Guidelines. Faculty roles Facilitator Nurse Arrest Team Support in debrief room during live feed of scenario Technician Student roles FY1 x 3 Clare Cann & Paul Frost July 2014 Junior Assistantship Simulation Session 4 – Cardiac Arrest: Scenario Pulseless Electrical Activity Equipment Manikin set-up Male in clothes, supine, monitoring attached Monitor set-up 3 wave set up, large numbers Drugs Emergency drug box Essential medical equipment NEWS chart, prescription chart Venturi Oxygen mask Oxygen mask with reservoir bag IV cannulas Fluids Stethoscope Resuscitation trolley Airway trolley Test results ECG, ABG, CXR Computer set up for patient monitor manual run – no monitoring connected Initial vital signs SpO2 : 88 % on 60% Respiratory rate: 28/min Chest auscultation sounds: bilateral crackles Heart rate: 88 bt/min BP: 111/70 mmHg Temp: 39.0°C Changes to vital signs 1. Trigger Whilst assessing patient 2. Trigger Confirm rhythm, note non shockable rhythm Change: Heart rate: 88 bt/min Heart rhythm: Pulseless Electrical Activity Change: No change Clare Cann & Paul Frost July 2014 Junior Assistantship Simulation Session 4 – Cardiac Arrest: Scenario Pulseless Electrical Activity 3. Trigger 2 min CPR Change: Heart rate : 160 bt/min Heart rhythm: Pulseless Ventricular Tachycardia 4. Trigger 1st shock Change: SpO2 : 94 % Respiratory rate: 12/min Heart rate: 120 bt/min Heart rhythm: Sinus Tachycardia BP: 120/70 mmHg Temp: 39.0°C Student Brief You are FY1s responding to the cardiac arrest call. You have been paged via the cardiac arrest pager to the respiratory ward. The nurse in charge is concerned about Mr Thomas who was admitted 12 h ago with suspected pneumonia and is receiving IV antibiotic therapy. His early warning sore is 12. The patient is: 76 yrs old PMHx: COPD managed with oxygen home therapy, Coronary heart disease Medications: Salbutamol nebulisers 2. 5mg QDS & PRN, Ipratropium nebulisers 500 micrograms QDS & PRN, Simvastatin PO 40 mg OD, Aspirin PO 75 mg OD Medication commenced on admission: Co-amoxiclav IV 1.2 g TDS plus Clarithromycin IV 500 mg BD Please assess this patient and treat/refer as you see fit. Scenario Description History from nurse: o Early warning score is 12. Patient is unable to complete sentences, responds to voice o Nurse prompts the use of cardiac monitor if not connected o At present has 60% oxygen via venturi mask o Nurse encourages respiratory examination note bilateral basal crackles. During examination the patient becomes unresponsive, heart rhythm converts to Pulseless Electrical Activity o If requested CRT = 4 s. Blood glucose 4 mmols/l The students should demonstrate the following: Check patient confirm unresponsive Clare Cann & Paul Frost July 2014 Junior Assistantship Simulation Session 4 – Cardiac Arrest: Scenario Pulseless Electrical Activity Call for help Apply head tilt / chin lift or jaw thrust Confirm no breathing Confirm help on way as resuscitation team already called. Ensure ward defibrillator brought to bedside Insert oropharyngeal airway Commence CPR 30:2 with bag valve mask attached to high flow oxygen Once defibrillator arrives attach defibrillator pads and note non shockable rhythm Commence IV fluids At 2 minute confirm rhythm note shockable rhythm / no signs of life Deliver 1st shock. Heart rhythm converts to Sinus Tachycardia Note patient becomes responsive / Stop CPR Further resuscitation team members arrive. Note reversal of hypoxaemia Students should demonstrate CPR, ABCDE approach in parallel with diagnostic synthesis by targeted history and examination Demonstrate SBAR handover to further responding members of resuscitation team. o Wants full SBAR with current vital signs o To suggest patient is transferred to ITU RR, HR and BP parameters improve following shock and high flow oxygen Scenario ends when handover given to next resuscitation team responder Exit Strategies Resuscitation team arrives and directs care Debrief Students perception Instructors perception Learning points Open for wider discussion Close Essential Reading Resuscitation Council Guidelines, October 2010 Clare Cann & Paul Frost July 2014 Junior Assistantship Simulation Session 4 – Cardiac Arrest: Scenario Pulseless Electrical Activity
