Download Hospital Stroke Module - Illinois State University

You are a physician in the Emergency room at St.
Normal Hospital. Your specialty is radiology. You
are the doctor who reads CT scans, MRI’s, PET
scans, angiograms. You have been a doctor for
some time now, and are interested in becoming
chief of staff at the hospital. Your “performance”
here may help determine whether or not you get
this prestigious role.
The POINTS that you gain in each scene will help
the selection committee decide whether or not you
are a good person for the job! The way to gain the
most points is to get the correct answer on the first
try. To do this, you’ll need to do a bit research
before submitting a response.
St. Normal hospital has all its patient files (vitals, history, test results) and
protocol (the order in which certain tests should be done when) located
on a local intranet. A computer on a rolling stand is located by each
patient bed where you, the patient’s
doctor, can access the
information at any time.
Here is a sample of
Patient
what that computer
Doctor Notes
EMR
Protocol
History
screen looks like.
Images from
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exams will
Dr.
Electronic
Patient
Notes:
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Medical
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you
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protocol:
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Click this “Go” button
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testyou
as
or making
complete
decisions
each scene.
about
your patient.
Click Here
to Begin!
Beep! Beep! Beep!
Your pager goes off and indicates that
you are being called to a suspected
stroke case that is coming into the
Emergency Room (ER) from an
ambulance. You will meet the
neurosurgeon, as well as the ER doctor
there to assess the situation as soon as
the ambulance arrives. So you hurry off
to the ER, ready to start your day!
Hospital Stroke Module
Scene A
Scene A
Act 1
Help & Reference Materials
Protocol
Descriptions & Actions
a. Participant clicks
on Patient history
tab
b. History is given
Doctor Notes
EMR
Patient
History
1. Check patient
vitals, symptoms
and history. (Hint:
Click patient history tab
above.)
c. Once they’ve
gone to that link,
the second
protocol directions
come up.
Next Act
Patient History
•
•
•
•
•
Patient name: Shawn Idieh Jones
Patient age: 45
Medications patient has taken in the last 2 weeks:
carvedilol-brandname Coreg (a blood pressure medicine)
Misc. Behaviors: smoker, non-drinker, lifts weights three times a
week.
• Family history of:
• Heart disease
• Cancer
• Diabetes
• Symptoms: (compare to symptoms in EMR)
– When Shawn, a farm mechanic, was working on a combine, he
suddenly got the most severe headache he had ever had. He began
throwing up and sweating profusely. He was able to call his wife, who in
turn called an ambulance and met him at the hospital. He is
unconscious as he arrived in the ER.
• Vitals:
• Blood Pressure: 149/90
• Pulse: 98 beats per minute
Back to ER
Scene A
Act 2
Help & Reference Materials
Protocol
Descriptions & Actions
a. Participant will be
reviewing patient
history, and filling in
radio buttons.
b. All should be
selected except
inactive. Feedback
should be
individualized —
see details in
template.
c.
Once participant
gets the correct
answer & feedback
automatically go to
next act.
Doctor Notes
Patient
History
EMR
Click all that apply!
• high blood
pressure
•Heart
disease
•Inactive
•Smoking
•Diabetes
•High
cholesterol
1. Check patient vitals,
symptoms and history.
2. Determine
which high risk
factors the patient
has for stroke. (Hint:
Review patient history)
Next Act
Help & Reference Materials
Scene A
Act 3
Description of NIH
Stroke
The ER doctor
pipesScale
in… Scores
The NIH Stroke Scale
Protocol
Doctor Notes
•No, don’t
give
Score
was 17.
WhatEMRdo
treatment:
1. Check patient vitals, symptoms
you think
Dr. (participant’s
patient will
and history.
recover
last name)?
Should
werisk factors
2. Determine
which high
without
the patient
has for
intervention.
treat this
patient
orstroke.
not?
Patient
History
Descriptions & Actions
a. A pop up of the face of
the ER doctor gives the
stroke score. Participant
should still be able to
access the question as
well as the EMR & Tell
me more buttons
b.
Correct answer: “Yes.”
Feedback details are in
the template.
c.
Once participant gets
the correct answer &
feedback automatically
go to next act.
Tell me more
•Yes, give
treatment.
•No, don’t give
treatment:
patient is too
severe for
treatment.
3. Determine whether or
not treatment will help or
hinder the patient, by
Closethe
window
using
NIH stroke scale
score. Get ER Docs help.
(Make it link)
Next Act
Feedback example screen
The NIH Stroke Scale Score is 17. What do you think Dr.
(participant name entered here) should we treat this patient
or not?” Hint: - The Electronic Medical Record will help you
decipher the NIH Score.
• Sorry, Be sure to read in the EMR, how to
decipher the NIH Stroke Scale score.
Return to the ER
Feedback example screen
The NIH Stroke Scale Score is 17. What do you think Dr.
(participant name entered here) should we treat this patient
or not?” Hint: - The Electronic Medical Record will help you
decipher the NIH Score.
• Correct, The NIH score was 17, which is in
between 4-22. This makes the patient a
perfect candidate for treatment.
Return to the ER
EMR & Tell Me More Button
Scene A: Act 3
• NIH Stroke Scale Scores:
• Basic Description:
• Interpreting Scores:
– 1-3 = No treatment, patient will recover
without intervention
– 4-22 = Give treatment: patient will benefit from
intervention
– Higher than 22 = give no treatment: patient is
too severe for treatment
Back to ER
Scene A
Act 4
Help & Reference Materials
Descriptions of Ischemic
and Hemorrhagic strokes
Protocol
Descriptions & Actions
a. Participant uses EMR
& Tell me more button
to learn about the
differences between
the 2 types of strokes.
b. Correct answer is
Hemorrhagic.
Feedback details in
the template.
c.
Once participant gets
the correct answer &
feedback
automatically go to
next act.
Ischemic
Hemorrhagic
Doctor Notes
EMR
Patient
History
1. Check patient vitals, symptoms
and history.
2. Determine which high risk factors
the patient has for stroke.
3. Determine whether or not
treatment will help or hinder the
patient.
4. Determine what type
of stroke the patient
had.
Tell me more
Next Act
Feedback example screen
Determine what type of stroke
the patient had.
• Incorrect: Compare the stroke symptoms
of Ischemic and Hemorrhagic stroke in the
EMR.
Return to the ER
Feedback example screen
Determine what type of stroke
the patient had.
• Correct: Mr. Jones most likely had a
hemorrhagic stroke because the stroke
symptoms did NOT include weakness or
numbness of the face, but DID include
nausea, vomiting, and loss of
consciousness.
Return to the ER
EMR & Tell Me More Button
Scene A: Act 4
•
•
Difference Between Ischemic & Hemorrhagic strokes
Ischemic stroke symptoms: (83% of all strokes): Occurs when a blood
vessel contains a clot
–
–
–
–
–
•
Sudden severe headache
Sudden weakness or numbness of the face and extremities (usually to one side)
Loss of speech or difficulty understanding speech
Sudden dimness or loss of vision
Unexplained dizziness or sudden falls, particularly if accompanied with the above
symptoms.
Hemorrhagic stroke symptoms: (only 17% of all strokes): Occurs when a
blood vessel ruptures causing blood to leak into the brain.
–
–
–
–
–
Sudden severe headache
Nausea
Vision impairment
Vomiting
Loss of consciousness
Back to ER
Dr. ________’s Notes
For Scene A
Editor’s Note: The
notes should not be
added all at once, but
only after participants
reach the correct
responses.
• #2. Patient has many of the risk factors associated
with stroke: high blood pressure, heart disease,
smoking, diabetes, and high cholesterol.
• #3. NIH Stroke Scale Score Results: NIH score was
17, which is in between 4-22. This makes the patient a
perfect candidate for treatment.
• #4. Type of stroke: Mr. Jones most likely had a
hemorrhagic stroke because the stroke symptoms did
NOT include weakness or numbness of the face, but DID
include nausea, vomiting, and loss of consciousness.
• #5. Primary Diagnostic Test: We are ordering a CT
scan instead of a MRI or PET scans because a CT scan
will show us if the patient has bleeding in his brain in the
shortest amount of time.
Back to ER
Scene A
Act 5
Help & Reference Materials
Descriptions of the three
types of diagnostic tests.
Protocol
Descriptions & Actions
a. Participants will use
the EMR or Tell me
more button to learn
about the different
tests.
b. Correct answer is
CT scan: Feedback
details in template.
c. Once participant
gets the correct
answer & feedback
go to final scene
screen.
•MRI
•PET scan
•CT scan
Doctor Notes
EMR
Patient
History
1. Check patient vitals, symptoms and
history.
2. Determine which high risk factors the
patient has for stroke.
3. Determine whether or not treatment
will help or hinder the patient.
4. Determine what type of stroke the
patient had.
5. What test should be
done to confirm your
diagnosis?
Tell me more
Last screen
Feedback example screen
What test should be done to
confirm your diagnosis?
• Correct: A CT scan will show us if Mr.
Jones has bleeding in his brain in the
shortest amount of time.
Return to the ER
Feedback example screen
What test should be done to
confirm your diagnosis?
• Incorrect: A PET scan will show us brain
functioning but not anatomy. Look at MRI
and CT scan in the -EMR
Return to the ER
Feedback example screen
What test should be done to
confirm your diagnosis?
• Incorrect: Mr. Jones’ symptoms started an
hour ago and an MRI will take 45-60
minutes, leaving us little time to treat him.
Look at CT scan and PET scan in the EMR to se if you can find a better test.
Return to the ER
EMR & Tell Me More Button
Scene A: Act 5
• MRI
– What types of images it creates
– When the test is best utilized
• CT
– What types of images it creates
– When the test is best utilized
• PET scan
– What types of images it creates
– When the test is best utilized
Back to ER Scene A
Back to ER Scene B
Congrats Dr. ________ !
• You’ve completed the first step of
treatment for the patient Mr. Jones.
• Your total score for this scene is 25/25 You
are off to a great start! Continue using the
EMR and patient history before you make
any decisions regarding your patient, and
the committee looking for a chief of staff
might just take a second look at your
nomination!
• Remember…Your instructor may want you
to print this page. Editor’s note: This is just a sample of what
this page would say! See template for
other options.
Hospital Stroke Module
Scene B
Scene B,
Act 1
Help/Reference Materials:
How a CT scan works
Protocol
jjlkjkjlkjk
jkj
Doctor Notes
EMR
Patient
History
1. Run CT Scan
Tell me more
Description/Actions:
a.
Student clicks on
Scan button
b.
Patient enters CT
machine
c.
Move to Act 2
Run
Ct
Scan
Next Act
Scene B,
Act 2
Help/Reference Materials:
CT scan of nSAH stroke
How to read a CT scan
Normal brain CT
Protocol
Doctor Notes
M
1. Run CT Scan
Description/Actions:
a.
CT results appear
on computer along
with diagnostic
options
b.
If student chooses
SAH stroke, move
to Act 3
c.
If student choose
nSAH stroke, a
window should
appear showing
what a CT scan of
an nSAH stroke
looks like
jjlkjkjlkjk
jkj
Subarachnoid
Hemorrhagic
(SAH) stroke
EMR
Patient
Patient
History
History
2. Confirm
primary diagnosis
Tell me more
Non-subarchnoid
Hemorrhagic
(nSAH) stroke
Next Act
Scene B,
Act 3
Help/Reference Materials:
Causes of hemorrhagic
strokes and the
corresponding treatments.
Protocol
Doctor Notes
Patient
History
EMR
1. Run CT Scan
jjlkjkjlkjk
jkj
Actions:
A.
B.
Student
determines
probably cause of
hemorrhage by
reading about
causes of SAH
stroke in VMT.
Student chooses
desired course of
action.
What is causing this
brain hemorrhage?
Based on your research, will
you…
•
•
Send the patient for
neurosurgery?
Order a second
diagnostic test?
2. Confirm primary diagnosis
3. Determine
the cause of
the bleed
Tell me more
Next Act
Scene B,
Act 4
Help/Reference Materials:
Definitions/examples of MRI,
PET scans and CT angiograms
with their commons uses.
Protocol
Doctor Notes
EMR
Patient
History
1. Run CT Scan
jjlkjkjlkjk
jkj
Actions:
A.
Student chooses
desired test to
find aneurysm.
B.
If chooses
correctly, moves
to Scene C
Secondary test options:
•
•
•
MRI
PET scan
CT angiogram
2. Confirm primary diagnosis
3. Determine the cause of the
bleed
4. Order a second
diagnostic test
Tell me more
Last Screen
Dr. _______’s Notes
• Ordered CT Scan
– Faster
– Can find bleed in brain
– Less expensive
Return to ER
Hospital Stroke Module
Introduction
Prepared by Elisa Palmer & Darci Harland
EMR & Tell Me More Button
Scene B: Act 1
How a CT Scan Works
Return to ER
Dr. _______’s Notes
• Ordered CT Scan: faster, can find bleed in
brain, less expensive
• Subarachnoid hemorrhagic (SAH) stroke
diagnosed
Bleeding
Return to ER
EMR & Tell Me More Button
Scene B: Act 2
•
•
•
•
•
How to read a CT scan
Normal brain CT
Descriptions of nSAH and SAH strokes
CT scan of nSAH stroke
CT scan of SAH stroke
Back to ER
Feedback example screen
SAH stroke
Bleeding
• Correct! The bright
white areas indicate a
bleed in the
subarachnoid space.
Great job Dr
_______! Proceed!
• Return to ER
Feedback example screen
nSAH Stroke
• CT scan of nSAH
stroke
• Your patient’s CT
scan
• Does your patient’s
CT scan match this
one? Try again!
• Return to ER
EMR & Tell Me More Button
Scene B: Act 3
• Causes of SAH hemorrhagic strokes and
their treatments
Back to ER
Feedback example screen
Neurosurgery for Mr. Jones?
• Sorry, Mr. Jones’s SAH stroke if probably
due to an aneurysm since there is no
recent trauma in his medical history.
Therefore, surgery is not a good choice for
him. Try again!
Return to the ER
Feedback example screen
A second test for Mr. Jones?
• Correct! Mr. Jones’s SAH stroke if
probably due to an aneurysm since there
is no recent trauma in his medical history.
• Now, you must determine the best test for
to find Mr. Jones’s aneurysm. Hurry, the
clock is ticking!
Return to the ER
Dr. _____’s Notes – Act 3
• SAH stroke is probably due to an
aneurysm since there is no trauma in Mr.
Jones’ recent patient history
Back to ER Act 3
Feedback example screen
CT Angiogram for Mr. Jones?
• Correct! A CT Angiogram will allow you to
find the location of the suspected
angiogram. Proceed to the CT Angiogram
room!
Last Screen
Feedback example screen
An MRI for Mr. Jones?
• This patient’s symptoms started over an
hour ago and an MRI will take 45-60
minutes. This may not leave you enough
time for treatment. Try again!
Feedback example screen
A PET scan for Mr. Jones?
• PET scans are normally used to show
brain functioning, not cardiovascular
anatomy. Try again!
Dr. ________’s Notes
• CT angiogram ordered in order to
determine the location of the aneurysm.
MRI rejected due to time issues and PET
scan rejected because it would show brain
functioning, not brain anatomy.
Congrats Dr. ________ !
• You’ve completed the second step of
treatment for the patient Mr. Jones.
• Your total score for this scene is 15/15:
You are off to a great start! Continue using
the EMR and patient history before you
make any decisions regarding your
patient, and the committee looking for a
chief of staff might just take a second look
at your nomination!
• Remember…Your instructor may want you
to print this page. Editor’s note: This is just a sample of what
this page would say! See template for
other options.
Hospital Stroke Module
Scene C
Scene C,
Act 1
EMR:
Description of how and why CT
Angiograms are done.
Protocol
jjlkjkjlkjk
jkj
Description/Actions:
Student clicks on “Run
CT Angiogram” and
video pops up,
showing a patient
having a CT
angiogram scan.
Move to Act 2.
Doctor Notes
EMR
Patient
History
1. Perform
CT angiogram
Tell me more
• Run CT
Angiogram
Next Act
Scene C
Electronic Medical Record:
Brain blood vessel anatomy
Information about clipping
aneurysms
Information about coiling
aneurysms
Protocol
Act 2
Doctor Notes
EMR
M
1. Perform CT angiogram
Description/Actions:
CT angiogram results
show that the
patient has an
aneurysm in the
anterior
communicating
artery. Student must
choose to either clip
or coil the artery.
jjlkjkjlkjk
jkj
Choose a course
of treatment:
Clip the
aneurysm
Patient
Patient
History
History
2. Determine
course
of treatment
Tell me more
Coil the
aneurysm
Next Act
Scene C,
Act 3
Electronic Medical Record:
Video of emoblization
(coiling) process.
Protocol
Doctor Notes
Patient
History
EMR
1. Perform CT angiogram
Description/Actions
:
jjlkjkjlkjk
jkj
A. Student clicks on
“coil the
aneurysm”.
B. Coiling
procedure
video or
simulation is
shown.
Insert a coil into
the aneurysm.
2. Determine course
of treatment
3. Perform
embolization
(coiling) on the
aneurysm.
Tell me more
Next Act
Scene C,
Act 4
EMR:
HHH therapy
Vasospasms (causes and
treatments)
Protocol
Doctor Notes
Patient
History
EMR
1. Perform CT angiogram
Student
clicks on
“Send
patient to
ICU”
jjlkjkjlkjk
jkj
Coiling of aneurysm was
successful.
Send patient to ICU
with orders for HHH
therapy and
vasospasm
monitoring
2. Determine course
of treatment
3. Perform embolization
(coiling) on the aneurysm.
4. Send patient
to ICU
Tell me more
Last Screen
EMR & Tell Me More Button
Scene C: Act 1
• Description of how/why CT Angiograms
are performed.
Return to ER
Dr. _______’s Notes
• CT Angiogram shows aneurysm in the anterior
communicating artery
•
Aneurysm in Anterior Communicating Artery
• Have decided to coil/embolyze the aneurysm
due to the patient’s age and lack of invasiveness
of this procedure.
Return to ER
EMR & Tell Me More Button
Scene C: Act 2
• Brain Blood Vessel Anatomy
• Information about Clipping Aneurysms
• Information about Coiling Aneurysms
Return to ER
EMR & Tell Me More Button
Scene C: Act 2
Clipping Aneurysms
… Info on Coiling
Return to ER
EMR & Tell Me More Button
Scene B: Act 2
Coiling Aneurysms
Return to ER
EMR & Tell Me More Button
Scene B: Act 3
Coiling Aneurysms
• Insert a coil into the aneurysm. (animation)
Return to ER
Dr. _____’s Notes
• Aneurysm successfully coiled.
• Sent patient to ICU for recovery. Ordered
HHH therapy and monitoring for
vasospasms.
Congratulations!
• You have successfully treated Mr. Jones within
the necessary 3 hour time window! If you have
scored a ___ or higher, you are still in the
running to become Chief of Staff – great job! If
you have scored lower than a ___, perhaps the
next stroke patient to come through the doors of
St. Normal Hospital will have better results. Also,
please realize that Mr. Jones’ journey is not over.
He will have a 10-14 day stay in the ICU (where
the rate of mortality from strokes is very high 212 days following the initial stroke) and then
undergo physical therapy.
EMR & Tell Me More Button
Scene C: Act 4
• HHH Therapy
• Vasospasms
Back to ER
Feedback example screen
Clip the Aneurysm
• This procedure is highly invasive and
should only be done when the aneurysm is
located close to the surface of the brain
and on younger patients. Please think
carefully before proceeding with this
procedure on this patient.
Return to Patient
Feedback example screen
Coil the Aneurysm
• Correct! This procedure is much less
invasive and a better choice for this
patient. Go forward with your treatment of
this patient.
Return to patient