In Situ ED & ITU Simulation -Twas the night before Christmas
December 23, 2021
Joe Schrieber
Learning Objectives
Learning objectives - Non clinical
Trauma Team leadership and teamworking in resus.
ED and Multi-Specialty collaboration
Communication/Pre-brief
Handover/Receipt of Patient
Learning objectives - Clinical (Medical)
Utility of Primary Survey to Identify potential significant injuries
Pelvic Injury Management
Learning objectives - Clinical (Nursing)
Trauma Team involvement
Attach Monitoring
IV access
Splinting pelvis
Prepare for CT transfer
Major haemorrhage protocol preparation
Faculty - Alex Belcher & Joe Schrieber
RCEM Curriculum Coverage Topics (SLOs)
SLO 3 – Identify sick adult patients, be able to resuscitate and stabilise and know when it is appropriate to stop
SLO 4 – Care for injured patients across the full range of complexity
FICM Curriculum Coverage Topics (HiLLOs)
HiLLO 5 - Doctors specialising in Intensive Care Medicine can identify, resuscitate and stabilise a critically ill patient, as well as undertake their safe intra-hospital or inter-hospital transfer to an appropriately staffed and equipped facility.
Initial VBG
The Case
55Yr old pre-alerting following a fall from roof 1hr ago. Paramedics assessed and found tachycardia, hypotension and pain in abdomen, hips and left lower limb.
Pre-alerted: Trauma Call Activation should be instigated
Pre-Brief – allocation of roles, set up environment, predicted injuries/expected plan etc
Arrival of patient: Hands off handover if stability to do so (If this is not led by TTL, then paramedic to give disorganised hand-over and start transferring equipment/patient etc)
Primary Survey – Efficient survey with contemporaneous communication back to TTL
Acknowledgement of need for Massive Haemorrhage Protocol and organisation of this.
Take Home Points
(focus changed due to a relative junior group of SHOs and limited senior support)
Tannoy system to summon help/inform of expected patient with significant injury/abnormal physiology
Direct communication and specific requests for action (not just “trauma call” but “call switch via 2222 and state Trauma Call in ED resus now” for example)
Pelvic binder should be considered prior to arrival and placed (as demonstrated on the packet) over greater trochanters and tightened.
Latent Threats identified
Blood gas machine Log ins (no one available in resus with a log in)
Some comments from participant feedback:
6 x feedback forms completed, mix of medical and nursing staff. Ratings varied from 8/10 – 10/10 for usefulness of the session to their training and development.
Learned Importance of Assigned roles and trauma call/major haemorrhage protocol
How to organise /plan for arrival of the patient
Important to try to reduce noise level/number of people speaking at once
Suggested improvements from participants:
More simulations please
Faculty Debrief:
Focus had to be amended to clinical assessment/management and pelvic binder due to SHOs with limited senior cover
Missed opportunity to start by 0915 and 2 high acuity patients took away clinical resource thereafter – Always aim 9am start in future?
Need to always ensure SHO and Reg or Consultant involvement (not just SHO)
Pre-brief (and discussion with seniors in dept at the time) should emphasise need to (where possible/safe to do so) treat this patient as another resus patient, rather than a learning opportunity for juniors
Future sessions:
Planned next simulation on 10/02/22 (Paeds) – as Paeds resus day clash on 3/2/22 (unless it could be incorporated)
Aim for minimum 2 consultant faculty +/- sim/resus fellow involvement.
Need SHO and reg involvement/availability (and senior/experienced resus nurses) to enable leadership focus as well as clinical
Faculty to take turns in designing the scenario and writing up the session report.
Acknowledgements
Thanks to Dr Kirsten Walthall (NWSEN) for creating the scenario back in December 2014
