COMPASS© 09/04/2018

Case Study 1

Facilitator Card CASE 1: (BLS) The important things to get across in this case are:

• Recognise that the patient has collapsed and needs immediate attention • Demonstrate BLS skills • Correct placement of a Guedels airway • Correct bag/mask ventilation • Simple airway manoeuvres-jaw thrust, chin lift & head tilt • Proper use of a minijet • Referring to COMPASS flow chart

Cause of deterioration: bowel prep without any fluid replacement, resulting in

hypovolaemia & low potassium resulting in a cardiac arrest • Med chart- hasn’t had metoprolol • No fluid balance or base line vital signs • When ECG attended it indicates ischaemia • When bloods ordered shows

o K+ of 2.0 o Urea & Creatinine slightly elevated o ABGs

acidotic PO2 282 (hyperventilated) PCO2 elevated 55 (period of apnea) Lactate elevated 5.0

COMPASS© 09/04/2018

Case1: AIM: To demonstrate correct basic life support and MET procedures Group Objectives:

1. Emergency activation followed 2. BLS skills demonstrated 3. History of patient conveyed appropriately 4. Procedures often required at a MET call are practised

a. Awareness of deficits often encountered at METs

i. Removal of equipment ii. Importance of handover of the patient iii. Opening mini-jets iv. Importance of patient history and notes v. Scribing the incident

5. Clear communication between team members 6. Diagnosis & Management plan in place at the end of the

scenario. Equipment/Tools required

• Mannequin • Facilitator Card • Player 1 Card – RN • Resuscitator • Guedels (Optional) • IV Cannula • Mini-jet • Scribing Code Blue Form • Medication Chart • Blood Test results • Blank Observation chart and Fluid balance chart • ECG

Roles in the scenario

1. Patient – Mannequin 2. Registered Nurse (RN1) 3. Intern 4. Additional Nurse 5. Medical Registrar 6. Optional extras:

a. Additional nurse RN or EN b. Relative

Scenario Patient is a Mannequin Jim Carey UR 123456 Jim Carey, a 54-year-old male is admitted to hospital for a colonoscopy; he has completed his bowel preparation (2 Litres of Colon-lytely) and is due for the scope this afternoon. Family history of Bowel cancer Previous medical history of IHD and Hypertension. Jim has been admitted to the ward and is waiting in the room for his procedure. Jim has been stressed about having the procedure and has felt nauseated since drinking the bowel preparation. Suddenly he develops chest pain he reaches out to buzz the nurse, after pressing the buzzer he collapses on to the floor in the corner of the room. He is unresponsive, with the absence of spontaneous respirations or a pulse. To start the scenario:

1. Assign roles to each player 2. Set up room with furniture knocked over

and a mannequin placed in the corner of the room.

3. Give the first player card to the player designated as RN1

4. Once the RN1 calls for help, allow Player 2, the Intern to enter

5. Allow the scenario to build on itself prompting other players to enter as called for or prompt if necessary

6. Supply players with further information such as medication charts, observations or blood results when asked

COMPASS© 09/04/2018

During the scenario: Prompt as required RN (Player Card)

1. What are your first actions?

• Call for Help • DRABC

Facilitator to direct the entry of the other participants Intern: You are working in the day surgery unit (DSU). You are writing the discharge summary from a morning case. When you hear an emergency buzzer?

1. What is your first action? • ABC – Help • BLS • Guedels • IV Access

2. What information do you require?

• History RN 2: You are a RN working on a DSU. You are at the desk waiting for a discharge summary from the Intern when you both hear an Emergency Buzzer come from one of the rooms.

1. What are your actions? (Prioritise)

2. What Information do you require?

Medical Registrar: You are a medical registrar carrying a code pager. A Code Blue has just been alerted in the Day Surgery Unit?

1. What are your actions? (Prioritise) ABC

Expected flow of scenario (Prompt as required)

1. Basic Life Support algorithm followed a. Danger – Equipment cleared &

patient moved to appropriate area for resuscitation

b. Airway & Breathing– Guedel measured and inserted correctly plus correct use of a resuscitator, 2 effective breaths given

c. Circulation – Compressions correct technique, correct depth and rate, Ratio 30:2 (5 cycles then re-assess)

2. After BLS commenced, facilitator states based on the monitored rhythm the patient requires Adrenaline 1 mg via a mini-jet.

3. Post adrenaline there is return of circulation and breathing let the team know this.

To summarise Questions:

1. What management plan does this patient need? • Suggested flow of treatment: • Oxygen • IV Access x 2 • IVT Fluids and see response • 15 min Obs

2. Who needs to be consulted? • ICU • Home Team • Family

3. How often will observations need to be performed until transfer to new destination? • 15 min

4. What escort/monitoring would the patient require to their new destination? • Cardiac Monitoring & Medical Escort

COMPASS© 09/04/2018

Ask the group: 1. What they thought went well? 2. What suggestions would they make to

improve their roles?

Take home messages from Case 1

1. Call for HELP early 2. Communicate using SBAR 3. Management Plans post MET

COMPASS© 09/04/2018

Case Study 1 Player 1 RN 1 You are working in a day surgery ward. Today is a Gastro Clinic day and most patients are here to have either a gastroscope or colonoscopy. Mr Carey is a 54-year-old male who is admitted for a colonoscopy, he has completed his bowel preparation (2 Litres of Colon-lytely) and is due for the scope this afternoon. Previous medical history of IHD and Hypertension. NKA. You have admitted him to the unit. Noting that he seemed very stressed about having the procedure. He also complained of nausea since completing the bowel prep. You are on your way to complete his admission vital signs when he buzzes and you hear the bedside table crash to the floor.

COMPASS© 09/04/2018

Case Study 1 Blood Results Normal Range ABG Normal Range Hb 138 115-160 PH 7.15 7.35-7.45 Hct 0.45 0.32-0.47 PO2 282 80-100 WCC 5.6 4.0-11.0 PCO2 55 35-45 Na 128 137-145 HCO3 14 22-26 K 2.0 3.5-5.0 Lactate 5.0 0.5-2.0 Urea 10 2.5-7.5 BE -16 -2.4-+2.3 Creatinine 130 60-110 SaO2 98 95-98% Glucose 10.1 3.7-5.2

COMPASS© 09/04/2018

An uncompensated Metabolic Acidosis (low bicarb and negative base excess) with a Respiratory Acidosis (High CO2)

COMPASS© 09/04/2018

ECG ST Elevation in Anterior leads with some minor reciprocal depression in inferior leads. T-wave inversion in Anteroseptal Leads. Indicating Ischaemia

COMPASS© 09/04/2018

COMPASS© 09/04/2018

COMPASS© 09/04/2018

COMPASS© 09/04/2018