1. Hospital Stroke Module Scene B

2. jjlkjkjlkjk jkj Run Ct Scan EMR Protocol Doctor Notes 1.Run Ct Scan 2.Confirm primary diagnosis Description/Actions: a.Student clicks on Scan button b.Patient enters CT machine c.Switch to Act 2 Help/Reference Materials: How a CT scan works Scene B, Act 1 Patient History

3. jjlkjkjlkjk jkj M Diagnosis: A. Subarachnoid Hemorrhagic (SAH) strokeA. Subarachnoid Hemorrhagic (SAH) stroke B. Non- subarchnoid Hemorrhagic (nSAH) strokeB. Non- subarchnoid Hemorrhagic (nSAH) stroke Description/Actions: a.CT results appear on computer along with diagnostic options b.If student chooses SAH stroke, move to Act 3 c.If student choose nSAH stroke, a window should appear showing what a CT scan of an nSAH stroke looks like Help/Reference Materials: CT scan of nSAH stroke How to read a CT scan Normal brain CT Scene B, Act 2 1.Run Ct Scan 2. Confirm primary diagnosis Protocol EMR Patient History Protocol Doctor Notes Patient History

4. jjlkjkjlkjk jkj EMR Protocol Doctor Notes 1.Run Ct Scan 2.Confirm primary diagnosis 3.Determine what is causing the bleed (VMT) Help/Reference Materials: Causes of hemorrhagic strokes and the corresponding treatments. Scene B, Act 3 Patient History What is causing this brain hemorrhage? Based on your research, will you… A.Send the patient for neurosurgery?Send the patient for neurosurgery? B.Order a second diagnostic test?Order a second diagnostic test? Actions: A.Student determines probably cause of hemorrhage by reading about causes of SAH stroke in VMT. B.Student chooses desired course of action.

5. jjlkjkjlkjk jkj EMR Protocol Doctor Notes 1.Run Ct Scan 2.Confirm primary diagnosis 3.Determine what is causing the bleed (VMT) 4.Order a second diagnostic test Help/Reference Materials: Definitions/examples of MRI, PET scans and CT angiograms with their commons uses. Scene B, Act 4 Patient History Secondary test options: A.MRIMRI B.PET scanPET scan C.CT angiogramCT angiogram Actions: A.Student chooses desired test to find aneurysm. B.If chooses correctly, moves to Scene C

6. Dr. _______’s Notes Ordered CT Scan –Faster –Can find bleed in brain –Less expensive Return to ER

7. How a CT Scan Works Return to ER

8. Dr. _______’s Notes Ordered CT Scan: faster, can find bleed in brain, less expensive Subarachnoid hemorrhagic (SAH) stroke diagnosed Return to ER Bleeding

9. EMR – Scene B, Act 2 CT scan of nSAH stroke CT scan of SAH stroke How to read a CT scan Normal brain CT Descriptions of nSAH and SAH strokes

10. SAH stroke Correct! The bright white areas indicate a bleed in the subarachnoid space. Great job Dr _______! Proceed! Return to ER Bleeding

11. nSAH Stroke CT scan of nSAH stroke Does your patient’s CT scan match this one? Try again! Your patient’s CT scan Return to ER

12. EMR – Scene B, Act 3 Causes of SAH hemorrhagic strokes and their treatments Return to ER

13. Neurosurger for Mr. Jones? Sorry, Mr. Jones’s SAH stroke if probably due to an aneurysm since there is no recent trauma in his medical history. Therefore, surgery is not a good choice for him. Try again! Return to the ER

14. A second test for Mr. Jones? Correct! Mr. Jones’s SAH stroke if probably due to an aneurysm since there is no recent trauma in his medical history. Now, you must determine the best test for to find Mr. Jones’s aneurysm. Hurry, the clock is ticking! Return to the ER

15. Dr. Notes – Act 3 SAH stroke is probably due to an aneurysm since there is no trauma in Mr. Jones’ recent patient history

16. EMR: Scene B, Act 4 Definitions/examples of MRI w/common uses Definitions/examples of PET scan w/common uses Definitions/examples of CT angiogram w/common uses Return to ER

17. CT Angiogram for Mr. Jones? Correct! A CT Angiogram will allow you to find the location of the suspected angiogram. Proceed to the CT Angiogram room!

18. An MRI for Mr. Jones? This patient’s symptoms started over an hour ago and an MRI will take 45-60 minutes. This may not leave you enough time for treatment. Try again!Try again!

19. A PET scan for Mr. Jones? PET scans are normally used to show brain functioning, not cardiovascular anatomy. Try again!Try again!

20. Dr. ________’s Notes CT angiogram ordered in order to determine the location of the aneurysm. MRI rejected due to time issues and PET scan rejected because it would show brain functioning, not brain anatomy.