In Situ Simulation Report

Thanks to Dr. James French for this informative post

Report from In-Situ Sim SJRHEM December 2017


The Case:

Mr. Jeffs is a 60year old male with 1 hour of chest pain, he brings himself to the ED, is triaged and bought in to trauma. Past medical history, hypertension. Medications, Perindopril 4mg with no allergies. He presents with an Acute Myocardial Infarction and then goes into cardiac arrest (which was always going to happen) requiring ACLS. After ROSC he requires intubation, thrombolysis and ongoing critical care…..

Discussion Points

When the “shizzel” hits that fan it’s really hard to use closed loop communication but especially important.
When patients get worse rapidly (cardiac arrest is pretty “rapidly”) then by definition they will need lots of safety critical procedures and medicines administering rapidly. This will also be associated by an immediate adrenal response by many of the people in the room (I’m sure even our most experienced physicians would admit to feeling it when people get really sick). Teams who are adrenalized will suffer a certain amount of tunnel vision and auditory exclusion i.e. they won’t be able to see or hear things as well. Closed loop communication is designed for people working under these conditions to address these challenges. The person making the request gets an answer from the person they are speaking to, and most importantly gets the order repeated back to them. Close the loop to prevent the poop! Watch the video for a comical example of closed loop communication! https://emergencypedia.com/2014/11/13/8227/

Being Adaptable

Emerg Teams are highly adaptable. This case required a nurse to do an ECG as there was no ECG tech available. Well done!

 

Resuscitation and dose adjusting in Rapid Sequence of Anesthesia:

The induction or sedative dose should be reduced in the following circumstances:

  1. When there is hypotension
  2. When the pulse is greater than the systolic blood pressure.
  3. If there is significant comorbidity.
  4. Severe metabolic impairment from DKA, overdose, sepsis or prolonged seizure activity.

Please see the table below for examples.

The patient should also be resuscitated to a point that is appropriate for the case before the administration of drugs. In a shocked trauma patient this could be the administration of blood and splinting limb fractures. In a patient with septic shock this could be giving a fluid bolus and starting vasopressors. For More information on RSI in really sick people see this site. https://emcrit.org/racc/hop-mnemonic/

 

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New SJRHEM Dalhousie Course – Debriefing Skills for Simulation – The Basics

New SJRHEM Dalhousie Course – Debriefing Skills for Simulation – The Basics

When Is It?

8th-9th February 2018

Who is this for?

If you are interested in using simulation for education in healthcare, then this is for you! We aim to give you the basic skills needed to start debriefing in your own institution. This is a practical course with lots of opportunities to debrief.

 

 

Download (PDF, 260KB)

 

 

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ED Rounds – October 2015

This month ED Rounds were presented by Dr Mike Howlett  , Dr James French and Dr Wendy Alexander (Pediatrician SJRH).

 

Congestive Heart Failure – Dr Mike Howlett

Dr Howlett presented 4 cases that highlighted the differences in pathophysiology and approaches to treatment for CHF in the ED.

The definition of Congestive Heart Failure (ESC 2012 Guidelines)

a syndrome in which patients have typical symptoms (e.g. breathlessness, ankle swelling, and fatigue) and signs (e.g. elevated jugular venous pressure, pulmonary crackles, and displaced apex beat) resulting from an abnormality of cardiac structure or function

Diagnosis of CHF

The diagnosis of heart failure with reduced ejection fraction (Systolic) and Heart Failure with preserved ejection fraction (Diastolic) is summarised in the box below.

Diagnosis HF

The mortality of Diastolic and Systolic HF are similar

CHF_Oct_2015_pptx

Dr Howlett’s full presentation can be downloaded / viewed below:

Download (PDF, 7.3MB)

 

How to be Awesome at Simulation – Dr James French

Dr French presented an interactive session that highlighted the important steps to designing, running and debriefing a simulation.

See our Simulation Program page for more details

Presentation to be uploaded here soon…

 

Pediatric Asthma – Dr Wendy Alexander

Dr Alexander presented pediatric pearls accumulated over her 25 years of practice.

See the SJRHEM Pediatric Asthma Guidelines

 

 

 

 

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