philosophy & simulation the emergence of synthetic...
TRANSCRIPT
Today• Questionnaire, assessment and consent
• Case Based Discussion
• Checklist Experiment
• Learning Simulation
• Lunch
• More Learning Simulations.
Does the RSI Checklist help?
The Approach
A to E assessment Vitals SAMPLE history++
Patient Arrives
Summary
Emergency Actions
SAMPLESymptoms
Allergies
Medicines
Past Medical History
Last Meal
Events
Saturations
EtCO2
Pulse
Rythmn
Blood Pressure
pulse
blood pressure
Resp rate
SpO2
Temperature
Symptoms
Allergies
Meds
Pmh
Events
pulse 121
blood pressure 134/81
Resp rate 34
SpO2 89
Temperature 38.1
Symptoms Cough
Allergies penicillin
Meds Inhalers
Pmh 65 M, COPD
Events 4 days of Abx.
pulse
blood pressure
Resp rate
SpO2
Temperature
Symptoms Barking Cough
Allergies none
Meds none
Pmh 6 yr Male, no pmh
Events Viral URTI 2 days
Patient Assessment
AIRWAY Stridor yes
Snoring no
Snot / Secretions no
Saddle See Saw no
Soot no
Sore throat yes
BREATHING Respiratoy Rate
Increased Work yes
Decreased Work no
Crackles or Wheezes no
Oxygen Saturations
CIRCULATION Pulse
Capillary Refill Time <2
Too hot Peripherally? yes
Heart Sounds OK
Blood Pressure 92/40
DISABILITY Pupils 4 mm , equal and reactive
Posturing none
GCS 15
Movements all f limbs
Sensation
EXPOSURE Rash or Injuries
Temperature
Blood Sugar
pulse
blood pressure
Resp rate
SpO2
Temperature
Symptoms Headache
Allergies nil
Meds Warfarin
Pmh 65 F, AF
Events Collapse
Patient Assessment
AIRWAY Stridor no
Snoring yes
Snot / Secretions yes
Saddle See Saw no
Soot no
Sore throat no
BREATHING Respiratoy Rate
Increased Work no
Decreased Work no
Crackles or Wheezes no
Oxygen Saturations
CIRCULATION Pulse
Capillary Refill Time 4 seconds
Too hot Peripherally? no
Heart Sounds normal
Blood Pressure
DISABILITY Pupils Right 2 mm Left 5mm
Posturing no
GCS 10
Movements not moving the right side
Sensation no withdrawal on right
EXPOSURE Rash or Injuries nil
Temperature
Blood Sugar 10.6
pulse
blood pressure
Resp rate
SpO2
Temperature
Symptoms
Allergies
Meds
Pmh
Events
Patient Assessment
AIRWAY Stridor
Snoring yes
Snot / Secretions yes
Saddle See Saw
Soot
Sore throat
BREATHING Respiratoy Rate 12
Increased Work
Decreased Work
Crackles or Wheezes
Oxygen Saturations
CIRCULATION Pulse
Capillary Refill Time 4 seconds
Too hot Peripherally?
Heart Sounds normal
Blood Pressure
DISABILITY Pupils Right 2 mm Left 5mm
Posturing
GCS 10
Movements not moving the right side
Sensation no withdrawal on right
EXPOSURE Rash or Injuries nil
Temperature
Blood Sugar
pulse 112
blood pressure 180/70
Resp rate 35
SpO2 89
Temperature 37.2
Symptoms sob
Allergies nil
Meds lasix, ramipril, asa, bisoprolol
Pmh 71 yr Male, MI, CHF
Events 2 days increasing sob
Patient Assessment
AIRWAY Stridor
Snoring
Snot / Secretions
Saddle See Saw
Soot
Sore throat
BREATHING Respiratoy Rate
Increased Work
Decreased Work
Crackles or Wheezes
Oxygen Saturations
CIRCULATION Pulse
Capillary Refill Time
Too hot Peripherally?
Heart Sounds
Blood Pressure
DISABILITY Pupils
Posturing
GCS
Movements
Sensation
EXPOSURE Rash or Injuries
Temperature
Blood Sugar
What makes this Real?
The “Real” Thing
Safety
To err is human
• When a meeting, or part thereof, is held under the Chatham House Rule, participants are free to use the information received, but neither the identity nor the affiliation of the speaker(s), nor that of any other participant, may be revealed. -
Communication
PatientAssess ABCDETakes an essential HistoryTreats ABCDEBest TherapyBest Lab TestsBest RadiologyBy the Best Available Evidence
EnvironmentBest MonitoringLean Procedural SystemsLean Decision Support MaterialsRedundant EquipmentSafety SystemsEvidence Based PoliciesStaff and Patient Protection
Team Leader or selfManagement of our own behaviourTactical BreathingCognitive Off-loadingSituational AwarenessCommentary workingAdaptabilityLogistically Aware
Team Leader or selfManagement of our own behaviourGraded AssertivenessCorrect PPESkilledCommentary workingMutual Performance MonitoringAdaptabilityClosed Loop Communication
Culture
