Back story for patient presentation (e.g., emergency medical services (EMS) brings into the emergency department a 50-year-old gunshot victim complaining of difficulty breathing)
Expected actions from the learners
Case progression description
Criteria for completion (e.g., learners recognize asystole and begin effective CPR)
Elements to include in guided reflection/debriefing
Example of a blended simulation scenario
The following is an example of a straightforward scenario that uses a variety of the simulation modalities discussed in Chapters 4 and 5. Not all of the different modalities have to be used, but rather this serves as an illustration for how rich a scenario can be if different modalities are used.
The EMS providers can be integrated into the scenario before nursing is introduced to the patient, as they could be dispatched to a home and have to assess, treat, and transport the patient.
Title: Acute myocardial infarction (MI)
Setting: Emergency department
Learning objective: Demonstrate basic assessment and stabilization for an acute MI patient
Equipment: Oxygen tubing and setup, bag valve mask, IV supplies.
Patient presentation: EMS brings in a 70-year-old female (computerized patient simulator or standardized patient) with vague GI complaints and feelings of fatigue and malaise.
Heart rate: 55
Blood pressure: 100/60
Temperature: 98.6° F
EMS reports to nurses that they put the patient on 4 liters of oxygen via nasal cannula but were not successful in starting an IV after two attempts. (The computerized interactive IV start device is available for the EMS providers and nurses to go through the IV start process for a difficult start. Task trainer IV arms are also available to practice IV starts).
(Expected actions: Hand off report from EMS to nursing, nursing reassess patient’s ABCs, puts patient on monitor, starts IV, continues with oxygen, considers 12-lead EKG based on patient signs and symptoms.) Monitor confirms sinus bradycardia. Nursing calls for 12-lead EKG, which shows ST elevation in leads II, III, and avf, which is indicative of a right-sided MI.
(Expected actions: Notify physician to see the patient, draw labs, start IV fluids, give aspirin per protocol, do not give nitroglycerin, only consider morphine if pain is present and if blood pressure will tolerate it.) Husband comes running into the ED (standardized patient) demanding to know what is going on.
(Expected actions: One nurse goes to husband and directly communicates with him. This becomes his or her only task at this point. SP will evaluate nurse on his or her therapeutic communication skills).
Monitor starts alarming, as patient is now in ventricular fibrillation.
(Expected actions: Nurse defibrillates per ACLS protocol, team starts CPR, nurse assigned to husband stays with him and appropriately explains what is happening to his wife.) Depending on how the team does, the educator can elect to keep the code going until satisfied that the team is demonstrating excellent CPR and ACLS skills. The educator can decide if he or she wants to go down the medication path of the ACLS algorithm if appropriate for the learners. TeamSTEPPS concepts, such as SBAR, can be used when the physician arrives to report on what is happening.
Prior to the simulation, the group could participate in a tabletop role-play, in which EMS responds to the patient and brings her in. Then, the EMS providers can transfer the patient, and the nurses can continue the role-play. In this case, the role-play could act as a rehearsal, as the learners could talk through the scenario and then go to the hands-on portion, thereby reinforcing the material.