Gersten Jonker

Simulation at the frontier of the ZPD   87 4 infarction. Scenarios are tasks that a first-year postgraduate could encounter. The scenarios reflect the entrustable professional activities that have been defined for the Utrecht dedicated transitional year on acute care. Participants are requested to provide the best care possible within their abilities. They are allowed to use personal aids such as handbooks, written notes, and smartphones. Three scenarios are run consecutively. After all students in a group have completed a scenario in turn, the simulator is set up for the next scenario. Each scenario lasts approximately 8 to twelve 12, and participants are allowed one attempt per scenario. Right before the simulation, the participant is briefed on the emergency call by one of the facilitators. The participant is allowed to make additional enquiries (examples below) or ask for clarifications. An example of a scenario is provided below: Participant instructions The patient is Mr. Van Arnhem and is 56 years old. For about an hour he has been suffering from chest pain. You will now see him in the emergency department. Manikin operator information Additional information, to be elicited by the participant: History Chest pain came on suddenly Tight pressure-like Never had this before Started during leisurely cycling from bakery to home Pain did not improve while sitting on the couch at home Past medical history: NIDDM [non-insulin-dependent diabetes] ABCDE approach A: Not obstructed B: SpO2 90%, respiratory rate 20/min, pale, clammy/sweaty, normal breath sounds, CVP [central venous pressure] normal, trachea in midline Action: Supply O2 via nasal cannula 2 l/min, aim for SpO2 >95%. C: NIBP [noninvasive blood pressure] 120/80, heart rate 60/min, capillary refill < 2 seconds, no abdominal pain Action: Nitro spray sublingually, IV access, order blood sample and ECG Operator: Sinus rhythm C on monitor! D: Pupils equal in size and light reactive. GCS [Glasgow Coma Scale] max, glucose 5.6 mmol/l E: No edema, no external findings Sequel Patient becomes unresponsive. Declare cardiac arrest: 1. Address patient:“Mr. Van Arnhem, are you with me?” 2. Call CPR team. 3. Ascertain arrest: airway maneuver and look–listen–feel for 10 seconds. 4. Start BLS [basic life support].