Scenario title. Pear Shaped- prepare for intubation on the ward. Designed for (specific group) ICU MET team. Scenario Design team.

Transcription

1 Scenario title Pear Shaped- prepare for intubation on the ward Designed for (specific group) ICU MET team Scenario Design team Name Maurice Le Guen Cameron Knott Organisation Austin Hospital Date of creation 13/03/2016 1

2 Table of Contents Simulation Proforma... Error! Bookmark not defined. Overall Goals... 3 Learning Objectives:... 3 Faculty Requirement:... 3 Participants... 4 Details for Facilitators... 4 Summary... 4 Simulation Equipment Requirement... 4 Medical Equipment Requirement... 4 Patient Demographics... 6 Scenario Specific Details... 6 Set up overview... 7 Available blood results... 7 Timeline Overview... 7 Key Debrief Points (expected)... 8 Key message slides / handouts... 9 Supportive Educational Material... Error! Bookmark not defined. References

3 Overall Goals To provide real time inter-professional training in the management of a deteriorating patient on CPAP For MET team to develop their understanding of preparation for intubation on the ward For MET team to develop their approach to resource use and communication outside of the ICU Learning Objectives: No. Learning Objective 1 Demonstrate recognition and assessment of deteriorating hypoxic patient 2 Organised approach to preparation for intubation on the ward 3 Demonstrate effective teamwork, communication and situational awareness 4 Note: this is not an intubation drill. Once the learners have prepared for the intubation the scenario will stop. 5 Faculty Requirement: Role Facilitator Manikin Operator Observer Required (tick if yes) Notes 3

4 Nurse faculty member Confederate Participants Role Notes 1 ICU MET Doctor Senior help available only over the phone 2 Bed Side nurse 3 ICU MET nurse 4 Details for Facilitators Summary 42 y.o female with exacerbation of asthma on the ward on CPAP. Beginning to tire Simulation Equipment Requirement specific manikin is given for reference purposes only Simulator Adult mannikin Gas Supply AV Equipment Miscellaneous Medical Equipment Requirement (Equipment required to optimise fidelity of simulation) ( available, on manikin / actor) 4

5 Airway, C-Spine & Respiratory Hard Collar Blocks/towels Tape Oxygen Supply CPAP O 2 Reservoir Facemask Intubated Nasal Cannula Head-box Suction Yankuer Suction Catheter Self-inflating Bag Ayers T piece Nasopharyngeal airway Oropharyngeal Airway LMA Trachy Kit Intubation Equipment: Humidified Oxygen Fiberoptic Laryngoscope Laryngoscopes (2) ETT Sizes.. Bougies T piece / circuit Filter Stethoscope ET CO 2 detection tape ETT position length at 22 Ventilator itime sec Insp O 2 Rate PIP PEEP Oxygen Sats Monitor Nebuliser Chest Drain Cardiovascular ECG leads BP cuff Art line CVP Picc Line Cannulas 24G Cannulas 22G Cannulas 20-16G Intraosseous kit Urinary catheter Hickman Line Neurological Blood glucose stick Pen Torch Bleeding nares / ears Ant fontanelle bulge Abdominal AXR USS Wound Exposure / Miscellaneous Rash Limb injury Thermometer 5

6 O Negative Blood Paperwork FBC result U&Es result Blood Gas results Copy of CXR Copy of AXR Copy of CT Scan Copy of USS BNF TEG Crashcall.net sheet Em Dept sheet Drug Chart Patient Demographics Details Age 42 Weight 100 Sex Female relevant Scenario Specific Details Initial Handover given to candidates S admitted to resp ward from ED with exacerbation of asthma. Nurse worried B Normally well. Known Asthma. Previous ICU admission for asthma A on CPAP. FiO2 of 0.5 (max on ward?). Patient drowsy and breathing becoming slow. RR was 32 now 24. R 6

7 Set up overview Manikin in bed, on CPAP. Eyes closed. Wheeze throughout chest. One 20g cannula in- situ. Available results: Stage 1 ABG in ED.?CXR available Stage 2 Stage 3 Timeline Overview Initial settings A B C D E CPAP 90%SpO2 HR 115 (ST), BP92/56 Eyes closed, responds to voice MET call. Stage 1: Initial Assessment & Management Bedside nurse provides SBAR above Settings on manikin as indicated. Wheeze throughout chest Initial Settings A B C D CPAP 88%SpO2 HR 115 (ST), BP92/56 Eyes closed, responds to voice E Stage 2: Deterioration Expected Actions ABCD assessment. Requests ABG, CXR, +/- additional bloods Increases O2 on CPAP to maximum. May consider additional bronchodilators, Steroids, Mg, etc Prompting Required Do they need more oxygen? Should we get a gas? When did they last have ventolin? Stage 1 7

8 Despite additional treatment measures patient doesn t improve. Expected Actions A B C D E CPAP 92%SpO2 HR 127 (ST), BP92/56 Eyes closed, responds to voice Starts to consider need for intubation and verbalises same to team Preparation o Patient: informs patient; position; max O2; airway assessment (not difficult apart from weight); Additional IV access o Equipment: ETTx 2-3; bougie; suction; BVM and additional O2; guedel; LMA; End Tidal CO2 o Team: roles; airway ABCD plans; induction plan (meds); on-going sedation plan o Communication:? informed ICU; informed home team; informed patient!!! Prompting Required Stage 2 Key steps which should be prompted if missed: o Additional O2 o Additional airway devices o Suction o Additional IV access o End tidal CO2 o Verbalisation of plans ABCD: including roles and drugs; If asks for additional senior help: on phone senior states that will be coming up in 5 mins or so as dealing with intubation in ICU: can they please get everything ready for an urgent intubation END: sim ends once intubation is fully prepared Key Debrief Points (expected) No Points 1 Recognition of deteriorating hypoxic patient 2 Additional treatment measures for Asthma 3 Preparation for intubation: systematic approach: patient; equipment; team; communication 4 5 8

9 Key message slides / handouts 1) see Teaching Points doc 2) 3) 4) References Simulation Proforma: adopted from North West Simulation Education Network, UK Chrimes N; Fritz P; Leeuwenburg T. Airway Management of the Critically Ill Patient: Modifications of Traditional Rapid Sequence Induction and Intubation. Critical Care Horizons 2015; 1: NAP4. Royal College of Anaethetists and Difficult Airway Society. 9