1. 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.

2. 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

3. Mallampati Assessment15
Mallampati Assessment

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