Case Details

SECTION I: SCENARIO DEMOGRAPHICS

SECTION II: SCENARIO DEVELOPERS

SECTION III: CURRICULUM INTEGRATION

Scenario Title: Let’s Get the Pads On This Guy! (A case of V-Tach & Cardioversion)

Date of Development: 9/22/2020

Target Learning Group: Participants Telesimulation Conference Workshop

Scenario Developer(s): Jonathan St George, Nada Ray

Affiliations/Institution(s): Weill Cornell Medicine, School of Visual Arts

Contact E-mail (optional): jos7007@med.cornell.edu

Learning Goals & Objectives

Educational Goal: 1. Teach the basic principles of videography to enhance the translation of simulation-based knowledge into the digital space for the purposes of remote learning.

CRM Objectives: 1. Work with team using the current remote environment and equipment to create a telesimulation that effectively translates the test case’s medical objectives and teaching goals.

Medical Objectives:

1. Identify unstable V-Tach.2. Successfully perform synchronized cardioversion.

SECTION IV: SCENARIO SCRIPT

Case Summary: Brief Summary of Case Progression and Major Events

Background. A patient with recent cardiac bypass surgery is recovering in the hospital when he complains of palpitations and dizziness. The nurse sees that he is pale and confused and decides to put him on the monitor, get an EKG and call the care team. On arrival the care team notes the patient to have a heart rate over 200 bpm, hypotensive, pale and confused. After unstable ventricular tachycardia is identified by the team, the crash cart is brought to the bedside the defibrillator pads are placed on the patient’s chest and synchronized cardioversion is performed with a return to normal sinus rhythm and improvement of the patient.

A. Clinical Vignette: To Read Aloud at Beginning of CaseHi, I’m glad you’re here! The patient is a 63 year old man who’s recovering from a CABG ten days ago. He’e been doing great post-op, but he just started saying his heart was racing, then he got pale and dizzy and a little confused so I put him on the monitor and got an EKG and called you.

B. Scenario, Cast & Realism

Patient: Computerized Mannequin

Realism:

Select most important dimension(s)

Conceptual

Mannequin SIM Man 3G

Physical

Standardized Patient

Emotional/Experiential

Hybrid Other:

Task Trainer N/A

Confederate(s) RN in the room

C. Required Monitors

Monitor Leads/Wires

Oxygen Saturation Monitor Central Venous Line

SECTION V: PATIENT DATA AND BASELINE STATE

NIBP Cuff Defibrillator With Pads Capnography

Arterial Line Other:

D. Required SIM EquipmentStretcher Crash cart Zoll-R defibrillator with pads

E. Required Filming Equipment

Lighting Audio Cameras Accessories Other

Natural (overhead)

Multidirectional microphone Webcam #1 IV pole

Overhead lighting (night) iPhone OSMO Mobile

F. MoulageIn hospital gown, occasional moaning, eyes open occasionally, non-verbal.

G. Approximate Timing

Set-Up: Scenario: 2-3 min Debriefing: 20 min

A. Patient Profile and History

Patient Name: John Carter Age: 63 Weight: 80Kg

Gender: M F Code Status: Full Code

Chief Complaint: My heart is racing

Past Medical History: HTN, CAD

Allergies: NKDA Surgical: s/p CABG (POD10)

Social History: no smoking, occasional alcohol, no illicit drugs

Family History: Non contributory

SECTION VI: SCENARIO PROGRESSION & SHOOTING SCRIPT

B. Baseline Simulator State and Physical Exam

No Monitor Display Monitor On - No Data Displayed Monitor on - Data Displayed

HR: 220 BP: 70/40 RR: 30/min by BVM

O2SAT: 89%

Rhythm: V-Tach T: 36.9oC Glucose: 90 mmol/L

GCS: 10

General Status: Lethargic, incoherent groaning occasionally

CNS: GCS 10

HEENT: Normal

CVS: Rapid and thready

RESP: Bilateral chest wall rise with rapid shallow breathing

ABDO: NT, ND, no scars

GU: Normal

MSK: Normal, no calf swelling. SKIN Pale, clammy

Shot# Time Patient Camera Learner Actions Modifiers/Triggers

1 00:01

Rhythm: V-TachHR: 220 bpmBP: 70/40 mmHgRR: 30/minO2SAT: 89%Confused

Camera #1 Webcam on poleWide/StaticTrigger: None

Gets history from RN

Modifiers NoneTriggersVital signsEKG

2 00:30

Rhythm: V-TachHR: 220 bpmBP: 70/40 mmHgRR: 30/minO2SAT: 89%Confused

Camera #2 iPhone/OSMO 3Active/Tight ViewTrigger: RN hands EKG to Learner(moves in to view EKG)

Gets handed EKG

Modifiers If doesn’t identify v-tach RN promptsTriggersVital signsEKG

301:00 - 02:30

Rhythm: V-TachHR: 220 bpmBP: 70/40 mmHgRR: 30/minO2SAT: 89%Confused

Camera #1 Wide/StaticTrigger: Learner moves to crash cart

1. Brings crash cart and defibrillator to bedside

2. Places pads on patient

Modifiers If doesn’t identify v-tach RN promptsTriggersVital signsEKG

401:00 - 02:30

Rhythm: V-TachHR: 220 bpmBP: 70/40 mmHgRR: 30/minO2SAT: 89%Confused

Camera #2 iPhone/OSMO 3Active/Tight ViewTrigger: learner moves to defibrillator(view of defibrillator screen for synchronized cardioversion)

1. Brings crash cart and defibrillator to bedside

2. Place pads on patient

Modifiers If doesn’t identify v-tach RN promptsTriggersVital signsEKG

5 03:00

Rhythm: NSRHR: 78 bpmBP: 115/73 mmHgRR: 20/minO2SAT: 96%Less confused

Camera #2 iPhone/OSMO 3(moves out slowly toward camera #1)

Prepare for debrief

END OF CASE

Shooting Choreography Shot Notes

Sketch of SIM with camera locations and shots

SECTION VII: SUPPORTING DOCS, LAB RESULTS & MULTIMEDIA     Images (ECGs, CXRs, etc.)

SECTION VIII: DEBRIEFING GUIDE General Debriefing Plan

Individual With Group With Video Without Video

Objectives

Educational Goal: 1. Understand how to set up multiple cameras via ZOOM 2. Understand basics of videography (lighting, audio, cameras) 3. Understand the basics of choreography integration into SIM

Medical Objectives: Use key principles of filmmaking and videography to enhance the ability of telesimulation to translate medical knowledge to the next generation of medical learners.

Sample Questions for Debriefing How well did the education goals of this simulation translate into the digital space?

How might they be improved?

What might be the future direction you would take this telesimulation

Required Critical ActionsUnderstand the basic Set-up to connect multiple cameras to a platform like ZOOM

Demonstrate effective use of basic principles of lighting, audio, camera angles and choreography

Successfully outline a filming script that translates the learning objectives of this case scenario

Capture the EKG findings for remote learners

Demonstrate the key steps of synchronized cardioversion for remote learners