1. Hospital Stroke Module Scene C

2. jjlkjkjlkjk jkj Run CT AngiogramRun CT Angiogram EMR Protocol Doctor Notes 1.Perform CT angiogram 2. Determine course of treatment Description/Actions: Student clicks on “Run CT Angiogram” and video pops up, showing a patient having a CT angiogram scan. Move to Act 2. EMR: Description of how and why CT Angiograms are done. Scene C, Act 1 Patient History

3. jjlkjkjlkjk jkj M Choose a course of treatment: 1. Clip the aneurysm 1. Clip the aneurysm (Learn more about this procedure in the EMR)Learn more about this procedure in the EMR) 2. Coil the aneurysm 2. Coil the aneurysm (Learn more about this procedure in the EMR)Learn more about this procedure in the EMR) Description/Actions: CT angiogram results show that the patient has an aneurysm in the anterior communicating artery. Student must choose to either clip or coil the artery. Electronic Medical Record: Brain blood vessel anatomy Information about clipping aneurysms Information about coiling aneurysms Scene C, Act 2 1.Perform CT angiogram 2. Determine course of treatment Protocol EMR Patient History Protocol Doctor Notes Patient History

4. jjlkjkjlkjk jkj Insert a coil into the aneurysm. EMR Protocol Doctor Notes 1.Perform embolization (coiling) on the aneurysm. 2. Send patient to ICU Electronic Medical Record: Video of emoblization (coiling) process. Scene C, Act 3 Patient History Description/Actions : A. Student clicks on “coil the aneurysm”. B. Coiling procedure video or simulation is shown.

5. jjlkjkjlkjk jkj 1.Perform embolization (coiling) on the aneurysm. 2. Send patient to ICU. EMR Protocol Doctor Notes EMR: HHH therapy Vasospasms (causes and treatments) Scene C, Act 4 Patient History Coiling of aneurysm was successful. Send patient to ICU with orders for HHH therapy and vasospasm monitoring Student clicks on “Send patient to ICU”

6. EMR Scene C – Act 1 Description of how/why CT Angiograms are performed. Return to ER

7. Dr. _______’s Notes CT Angiogram shows aneurysm in the anterior communicating artery Aneurysm in Anterior Communicating Artery Have decided to coil/embolyze the aneurysm due to the patient’s age and lack of invasiveness of this procedure. Return to ER

8. EMR – Scene C, Act 2 Brain Blood Vessel Anatomy Information about Clipping Aneurysms Information about Coiling Aneurysms Return to ER

9. Coiling Aneurysms Return to ER

10. Clipping Aneurysms Return to ER

11. EMR – Scene B, Act 3 Insert a coil into the aneurysm.Insert a coil into the aneurysm. Return to ER

12. Dr. _____’s Notes Aneurysm successfully coiled. Sent patient to ICU for recovery. Ordered HHH therapy and monitoring for vasospasms.

13. Congratulations! You have successfully treated Mr. Jones within the necessary 3 hour time window! If you have scored a ___ or higher, you are still in the running to become Chief of Staff – great job! If you have scored lower than a ___, perhaps the next stroke patient to come through the doors of St. Normal Hospital will have better results. Also, please realize that Mr. Jones’ journey is not over. He will have a 10-14 day stay in the ICU (where the rate of mortality from strokes is very high 2-12 days following the initial stroke) and then undergo physical therapy.

14. EMR – Scene C Act 4 HHH Therapy Vasospasms

15. Clip the Aneurysm This procedure is highly invasive and should only be done when the aneurysm is located close to the surface of the brain and on younger patients. Please think carefully before proceeding with this procedure on this patient. Return to Patient

16. Coil the Aneurysm Correct! This procedure is much less invasive and a better choice for this patient. Go forward with your treatment of this patient. Return to patient