1. jjlkjkjlkjk jkj Run Ct Scan References Protocol Doctor Notes 1.Run Ct Scan 2.Determine primary diagnosis 3.Order secondary diagnosis Description/Actions: a.Student clicks on Scan button b.Patient enters CT machine c.Switch to Scene B Help/Reference Materials: How a CT scan works Act 2, Scene A

2. jjlkjkjlkjk jkj Diagnosis: A. Subarachnoid Hemorrhagic (SAH) strokeA. Subarachnoid Hemorrhagic (SAH) stroke B. Non- subarchnoid Hemorrhagic (nSAH) strokeB. Non- subarchnoid Hemorrhagic (nSAH) stroke References Protocol Doctor Notes 1.Run Ct Scan 2.Determine primary diagnosis 3.Order secondary diagnosis Description/Actions: a.CT results appear on computer along with diagnostic options b.If student chooses SAH stroke, move to Scene C 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 Act 2, Scene B

3. jjlkjkjlkjk jkj Secondary test options: a.MRI b.PET scan c.CT angiogram References Protocol Doctor Notes 1.Run Ct Scan 2.Determine primary diagnosis 3.Order secondary diagnosis Description/Actions: A.Student chooses desired test. B.If “c”, move to Act 3 C.If a or b, a window pops up explaining why this is the wrong answer. Help/Reference Materials: Definitions/examples of MRI, PET scans, and angiograms Causes of hemorrhagic strokes Act 2, Scene C

4. Act 3 Option 1 Option 2

5. jjlkjkjlkjk jkj Run CT angiogramRun CT angiogram References Protocol Doctor Notes 1.Perform CT angiogram 2.Determine course of treatment Description/Actions: A.Student clicks on “run CT angiogram” B.CT angiogram is preformed Help/Reference Materials: CT angiogram procedure Normal angiograms Act 3, Scene A, Option 1

6. jjlkjkjlkjk jkj Choose a course of treatment: a.Clip the aneurysm b.Coil the aneurysm References Protocol Doctor Notes 1.Perform CT angiogram 2.Determine course of treatment Description/Actions: A.CT angiogram results appear B.A course of treatment is chosen C.Option 2Option 2 Help/Reference Materials: Aneurysms Clipping vs. coiling Act 3, Scene B, Option 1 Aneurysm in anterior communicating artery

7. jjlkjkjlkjk jkj 1. Insert catheter into the femoral artery. 2. Guide catheter through the femoral artery, aorta, and into the vertebral artery. References Protocol Doctor Notes 1.Perform CT angiogram 2.Determine course of treatment Description/Actions: A.Student clicks on each step and it is done above. B.Automatically move to next screen when step 2 is complete. Help/Reference Materials: Catheter information Vascular system anatomy Act 3, Scene A, Option 2

8. jjlkjkjlkjk jkj 1. Inject contrast dye. References Protocol Doctor Notes 1.Perform CT angiogram 2.Determine course of treatment Description/Actions: A.Student clicks on each step and it is done above. B.Automatically move to next screen when step 2 is complete. Help/Reference Materials: Catheter information Vascular system anatomy Act 3, Scene A, Option 2

9. jjlkjkjlkjk jkj Run CT AngiogramRun CT Angiogram References Protocol Doctor Notes 1.Perform CT angiogram 2.Determine course of treatment Description/Actions: A.Student clicks on “Run CT Angiogram” and machine activates. B.Automatically moves to Scene B Help/Reference Materials: CT angiogram technology Act 3, Scene A, Option 2

10. jjlkjkjlkjk jkj Choose a course of treatment: a.Clip the aneurysm b.Coil the aneurysm References Protocol Doctor Notes 1.Perform CT angiogram 2.Determine course of treatment Description/Actions: A.CT angiogram results appear B.A course of treatment is chosen Help/Reference Materials: Aneurysms Clipping vs. coiling Act 3, Scene B, Option 2 Aneurysm in anterior communicating artery

11. jjlkjkjlkjk jkj Insert a coil into the aneurysm.Insert a coil into the aneurysm. References Protocol Doctor Notes 1.Perform embolization (coiling) on the aneurysm. 2.Send patient to ICU. Description/Actions: A.Student clicks on “coil the aneurysm”. B.Coiling procedure is shown. Help/Reference Materials: Coiling information Act 3, Scene C

12. 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

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

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

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