Download - SCHHS Emergency Department

Scenario Template
Multi Trauma – HypotensionError! Bookmark not defined.
Learning objectives
Target audience
Setting
Overview
Mannikin/Moulage
Actors/Confederates
Equipment
Supplies
Prebrief
Handover
Events
Phase 1
Deverill 08/10/2014
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Identify causes of hypotension in the multi trauma patient
Avoidance of drugs likely to cause further hypotension
Appropriate fluid resus in the hypotensive trauma patients
Emergency Department SHOs, Registrars, RNs
Emergency Department, Sunday afternoon
Middle aged male, MBA, bike vs tree
Sim man 3G, multiple abrasions, bike helmet
Nurse confederate for SHOs, no confederate for registrars
/ RNs
Intubation trolley
Ventilator
USS
ECG machine
Defibrillator
Normal saline
Blood
Fentanyl
Morphine
Midazolam
Suxamethonium
Rocuronium
Ketamine
45yo male, MBA, bike vs tree, approx 100kph, multiple
injuries, hypotensive
 Male patient, riding along highway, lost control and hit tree
at approx 100kph, significant pain – given 20mg morphine
 Brief LOC at scene
 Patient is hypotensive on arrival despite fluids given by
QAS
 Progressively more hypotensive during resus, becomes
more difficult to control pain, requires intubation
 Hypotensive on induction
 Positive FAST scan
Phase 2
Phase 3
Phase 4
GCS
ECG
HR
BP
RR
SpO2
WOB
Pain
Temp
13
Sinus
tachy
136
86/48
26
99% on
15L
Increase
10/10
37.1
I feel [...]
Investigations
Expected Actions
Pitfalls
Discussion points
Author/Date
GCS
11
Sinus
tachy
138
74/40
32
99% on
15L
Increase
10/10
36.4
ECG
HR
BP
RR
SpO2
WOB
Pain
Temp
I feel [...]
GCS
ECG
HR
BP
RR
SpO2
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GCS
ECG
HR
BP
RR
SpO2
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WOB
Pain
Temp
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WOB
Pain
Temp
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[…]
I feel [...]
I feel [...]
 BSL
 iSTAT
 ECG
 USS – positive FAST
 CXR
 Fluid resuscitation in the trauma patient
 Activation of MTP
 Avoidance of further hypotension
 Use drugs likely to cause further hypotension
 Fluid resus in hypotensive trauma patients
 Appropriate drug use
Dr Danielle Spratt
12/06/2014