1. Stroke Module Scene A – Trauma Room

2. Scene A Introduction In this module, you are role playing a physician in the Emergency room at St. Normal Hospital. Your specialty is radiology. You are the doctor who reads CT scans, MRI’s, PET scans, angiograms. You have been a doctor for some time now, and are interested in becoming chief of staff at the hospital. Your “performance” here may help determine whether or not you get this prestigious role. The POINTS that you gain in each scene will help the selection committee decide whether or not you are a good person for the job! The way to gain the most points is to get the correct answer on the first try. To do this, you’ll need to do a bit research before submitting a response. (not sure if we’re still doing the points) Note to computer programmers & animators: Underlined words should be links to the specific part of the EMR.

4. Beep! Beep! Beep! Your pager goes off and indicates that you are being called to a suspected stroke case that is coming into the Emergency Room (ER) from an ambulance. You will meet the neurosurgeon, as well as the ER doctor in the Trauma room to assess the situation as soon as the ambulance arrives. So quickly make your way to the trauma room. Note to computer programmers & animators: This could be its own screen maybe in a bubble that pops up after the participant has clicked on the Ready to Begin link on the previous slide.

5. Protocol EMREMR Dr.’s Notes Patient History Protocol: 1. Check patient vitals, symptoms and history (Click on patient history.) Click Protocol to begin. Patient name: Shawn Idieh Jones Patient age: 45 Medications patient has taken in the last 2 weeks: (blood pressure medicine) Misc. Behaviors: smoker, non-drinker, lifts weights three times a week. Family history of: Heart disease Cancer Diabetes Symptoms: (compare to symptoms listed in the EMR) When Shawn, a farm mechanic, was working on a combine, he suddenly got the most severe headache he had ever had. He began throwing up and sweating profusely. He was able to call his wife, who in turn called an ambulance and met him at the hospital. He is unconscious as he arrives in the ER. Vitals: Blood Pressure: 149/90 Pulse: 98 beats per minute Close/Next This is the text box that should pop up when participant clicks on patient history. This is the text box that should pop up when participant clicks on protocol. Once participant hits the close/next button on the patient history pop up, the second set of directions should appear in the protocol box.

6. Protocol EMREMR Dr.’s Notes Patient History Protocol: 1.Check patient vitals, symptoms and history (Click on patient history.) 2.Determine which high risk factors the patient has for stroke. (Hint: go to the EMR and read about stroke risk factors and re-read patient history. When ready to submit your answer, click on the link above.) This sentence should be a link to the text box below. When the participant clicks on # 2 in the protocol box, this is what they should see. Once a participant has completed previous protocol directions, they can stay on the screen, but make them smaller or a different color. When there are too many, a scroll bar should allow the participant to go back and see them all. Correct Answer: All should be selected EXCEPT answer C What is in parenthesis is the feedback the participant should receive. When they get it correct the feedback should be “Great job! You understand Shawn’s risk factors for stroke. Remember, this information will be stored in your Dr.’s notes if you need to read this again in the future.” #2: Risk Factors for stroke that Shawn Jones has: (click all that apply then click submit: you receive the most points if you get it right on the first submission!) High blood pressure (if doesn’t check: “See what medications the patient is taking.”) Heart disease (if doesn’t check: “Check family history”) Inactive-little exercise (shouldn’t be checked, if it is “Check Misc. behaviors.”) Smoking (if doesn’t check: “Check Misc. Behaviors”) Diabetes (if doesn’t check: “Check family history”) High cholesterol (if doesn’t check: “See what medications the patient is taking.”) Radio buttons Submit answer Add this to the Dr.’s Notes once participant answers #2 correctly. Patient has many of the risk factors associated with stroke: high blood pressure, heart disease, smoking, diabetes, and high cholesterol.

7. Protocol EMREMR Dr.’s Notes Patient History Protocol: 2.Determine which high risk factors the patient has for stroke. 3.Determine whether or not treatment will help or hinder the patient by reading the NIH stroke scale score. (Hint: go to the EMR. When ready to submit your answer, click on the link above.) This sentence should be a link to the text box below. When the participant clicks on # 3 in the protocol box, this is what they should see. Once a participant has completed previous protocol directions, they can stay on the screen, but make them smaller or a different color. When there are too many, a scroll bar should allow the participant to go back and see them all. Correct Answer: B Correct answer feedback: “Correct: The NIH score was 17, which is in between 4- 22. This makes the patient a perfect candidate for treatment.” Wrong answer feedback: “Be sure to read in the EMR, how to decipher the NIH Stroke Scale score.” Submit answer The NIH Stroke Scale Score is 17. What do you think Dr. (participant name entered here), should we treat this patient or not?” Hint: The EMR will help you decipher the NIH Score. No, give no treatment: patient will recover without intervention Yes, give treatment: patient will benefit from intervention No, give no treatment: patient is too severe for treatment Add to EMR: Info on NIH stroke scale and how it is interpreted Add this to the Dr.’s Notes once participant answers #3 correctly. NIH Stroke Scale Score Results: NIH score was 17, which is in between 4-22. This makes the patient a perfect candidate for treatment.

8. Protocol EMREMR Dr.’s Notes Patient History Protocol: 2.Determine which high risk factors the patient has for stroke. 3.Determine whether or not treatment will help or hinder the patient by reading the NIH stroke scale score. 4.Make an initial diagnosis on the type of stroke based on patient history & symptoms. This sentence should be a link to the text box below. When the participant clicks on # 4 in the protocol box, this is what they should see. Once a participant has completed previous protocol directions, they can stay on the screen, but make them smaller or a different color. When there are too many, a scroll bar should allow the participant to go back and see them all. Correct Answer: B (hemorrhagic) Correct answer feedback: “Correct: Mr. Jones most likely had a hemorrhagic stroke because the stroke symptoms did NOT include weakness or numbness of the face, but DID include nausea, vomiting, and loss of consciousness.” Incorrect answer: “Compare the stroke symptoms of Ischemic and Hemorrhagic stroke in the EMR.” Submit answer In the EMR: Ischemic stroke symptoms: (83% of all strokes): Occurs when a blood vessel contains a clot Sudden severe headache Sudden weakness or numbness of the face and extremities (usually to one side) Loss of speech or difficulty understanding speech Sudden dimness or loss of vision Unexplained dizziness or sudden falls, particularly if accompanied with the above symptoms. Hemorrhagic stroke symptoms: (only 17% of all strokes): Occurs when a blood vessel ruptures causing blood to leak into the brain. Sudden severe headache Nausea Vision impairment Vomiting Loss of consciousness Add this to the Dr.’s Notes once participant answers #4 correctly. Mr. Jones most likely had a hemorrhagic stroke because the stroke symptoms did NOT include weakness or numbness of the face, but DID include nausea, vomiting, and loss of consciousness. What type of stroke do you think Shawn Jones has had? (Hint: visit the EMR.) Ischemic Hemorrhagic (correct)

9. Protocol EMREMR Dr.’s Notes Patient History Protocol: 2.Determine which high risk factors the patient has for stroke. 3.Determine whether or not treatment will help or hinder the patient by reading the NIH stroke scale score. 4.Make an initial diagnosis on the type of stroke based on patient history & symptoms. 5.Order primary diagnostic test. What test should be done first? (Hint: in the EMR read about the different types of diagnostic tests) This sentence should be a link to the text box below. When the participant clicks on # 4 in the protocol box, this is what they should see. Once a participant has completed previous protocol directions, they can stay on the screen, but make them smaller or a different color. When there are too many, a scroll bar should allow the participant to go back and see them all. Correct Answer: B (CT scan) The feedback is located in parenthesis. After the participant gets the correct answer, the following screen should be visible. Submit answer In the EMR: MRI: Brief description of the test: What the test results are helpful in showing: Helpful in diagnosing stroke because: CT: Brief description of the test: What the test results are helpful in showing: Helpful in diagnosing stroke because: PET: Brief description of the test: What the test results are helpful in showing: Helpful in diagnosing stroke because: Angiogram: Brief description of the test: What the test results are helpful in showing: Helpful in diagnosing stroke because: Add this to the Dr.’s Notes once participant answers #5 correctly. Primary test ordered: CT because the results come back quickly and will show where the bleed is located. Primary diagnostic test: What test should be ordered first? (Be sure to visit the EMR to read about the tests suggestions.) MRI scan (Feedback: It takes a long time to get MRI results, our patient doesn’t have time to wait. Read the EMR to get some help.) CT scan (Feedback: Good job, a CT will get us results quickly and will let us know where the bleed is located so we can order a secondary test. Lets take him to the CT!”) PET scan (Feedback: Read the EMR to get some help.) CT Angiogram (Feedback: This might be good for a secondary test. Read the EMR to get some help.) Scene A conclusion: Great job Dr. ________.