ED Simulator Based Training – Scenario Guide 15 Set Scenario (Start) Scenario (Progression) Equipment Adult 35yr old male. Presented having fallen down half a flight of stairs, deformed ankle. Not eaten for the past 3 hours, has had 2-3 pints of lager, but not for 2 hours. PMH: Nil DHx: Nil SHx Works as a train driver Weekend alcohol use, smoker 20/ day Sedation Assessment To include: “LEMON”/ structured approach Monitoring to be applied inc CO2 Ensure required staff/ skills present Drugs Given (Candidate can select regime) Becomes apnoeic, requiring BVM Sim-Man (complete kit) Lifepak defib with training leads Training ‘resus’ equipment trolley Plaster Trolley (team to obtain) Mallampati Image ED Resus Room Time: (45 mins) Simulation: 30 Debrief: 10 Recover: 5 Main objectives (Clinical and Educational Context): To demonstrate effective assessment for Sedation Application of gold standard monitoring for sedation. Ensure Correct Equipment and Skill Set – Sedationist, Proceduralist, Plasterer, Nurse. Involvement of Anaesthetist or ED consultant for sedation/ Formulation of Sedation Plan Recognition and management of apnoeic patient – can discuss merits of abandoning the procedure, but not “wrong” to continue if ventilating Simulator start state Position Alert on ED trolley in resus bay Physiology A – Clear & self maintaining. B - Rate 15, SpO2 98%. C - Pulse 96, BP 120/75 D – E4 V5 M6 pupils equal E – Tpr 35.9 Clinical Findings Initially no ‘adverse’ clinical features Mallampati 2 No loose teeth/ caps crowns Deformed ankle – pulseless/ skin tenting Expected course: Recognise need to manip in ED  Sedation Assessment  Formulation Of Sedation Plan  Correct Monitoring, staff and equipment  initiation of safe emergency sedation  Recognises apnoea/ desaturation  Aborts Procedure and BVM  Patient Stabalises.

15 Incorrect Skills and Monitoring Sedation Given Non-effective BVM (consider if poor sedation assessment/ monitoring) Use Adjuncts Cardiac Arrest Apnoea and Desat to 70% over 3 mins Verbal Contact Not Maintained Sedation Assessment Correct Skills and Monitoring Sedation Given Effective BVM Maintains Verbal Contact Pt will not tolerate manip Obs Stabilise More Sedation Given

Mallampati Assessment 15 Mallampati Assessment

LEMON Teaching Aid (For Debrief not for use in Scenario) 15 LEMON Teaching Aid (For Debrief not for use in Scenario)