Improving Perioperative and Anesthesia Care Training in Africa- Simulation Scenario Development
Simulation Scenario Development
Name of Person Submitting Scenario __________________________________________(Last, First)
Date of submission (mm/dd/yy):_________________________
Please enter a one sentence summary of the case:
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Level of training (select one):
Anesthesiologist
Non-anesthesiologist physician/resident
KRNA
RN
CO
RCOA
Other (Specify):__________________________
Hospital where you work (write name): _____________________________
Select where case occurred (select one):
Teaching Hospital (name) ____________________
National Referral Hospital (name) _________________
Provincial Hospital (name) _____________________
District Hospital(name) ___________________________
Sub-District Hospital: (name) _________________
Private-for-profit Hospital (name) ________________
Private (Non-profit/Mission Hospital) (name) _________________
Other (Specify)_________________
Patient Demographics
Approximate Date of occurrence (MM/YYYY):
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The patient arrived to Operating Theatre from which of the of the following locations?
(Select one)
Casualty
Outpatient
General Ward
ICU
HDU
Burn Unit
Newborn Unit
Referral or transfer
Patient Age (select one; if unknown, please estimate):
<1 mo
>1 mo, but < 3 mo
>12 yrs, but >18 yrs
Gender:
Female
Patient Weight (kg):
>3 mo, but < 3 yrs
>18 years, but < 65 yrs
>3 yrs, but <12 yrs
>65 yrs
Male
<2
2-3
4-10
10-50
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Improving Perioperative and Anesthesia Care Training in Africa- Simulation Scenario Development
50-70
70-100
Physical Status Class:
>100
1
2
3
4
5
Case Information: Use fields below to select appropriate criteria about your
case then write a brief summary of the most pertinent events needed to
recreate this as a simulation.
Emergency case?
Yes
No
Trauma (only count if this is 1st operation after trauma event):
MVA (car, truck, etc)
Auto v. Pedestrian
Blunt trauma (attack, sports, accidental)
Length of time since trauma:
Transportation to hospital:
Bicycle
Motorcycle
Penetrating injury (knife, GSW)
Fall-related injury
Hours(if <24 hrs)
Ambulance
Not a trauma case
Days (if >24 hrs)
Private vehicle (car, truck, van)
Not a trauma
Motorcycle
Walk
Please describe the History of Present Illness (the recent and ongoing events when the patient
presented to the Operating Theatre
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Time:
Daytime (normal hrs M-F)
Night (5p-7a M-F)
Weekend (Sat/Sun)
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Improving Perioperative and Anesthesia Care Training in Africa- Simulation Scenario Development
Please describe the Preoperative Management(include: laboratory studies,
investigations such as x-rays, consults, interventions, medication)
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Anesthetic Information:
Anesthetic Type:
Epidural
Local Only
MAC/Sedation with or without local
Combined Spinal-Epid
Other Regional Block
Peripheral Nerve Block Site (if applicable):
Infra/supra-clavicular
Saphenous
Sciatic
Interscalene
Ankle
Spinal
Combined Regional/General
Axillary
Lumbar Plexus
General
Femoral
Paravertebral
Popliteal
Other
Localizing Technique Used:
Nerve stimulator
Ultrasound
Parethesia
Transarterial
Other
Neuraxial Block Site (if applicable):
L4-5
Caudal
Thoracic
Lumbar: L2-3
Lumbar: L3-4
Lumbar:
Not Applicable
If SPINAL ANESTHESIA was used, what was the size of the needle?
25G
22G
20G
18G
spinal not used
If spinal or epidural was used, please record the number of attempts:
4 or more
1
2
3
___unsuccessful attempts, converted to GA
Primary Procedure type (ask Supervisor if uncertain about which choice is appropriate):
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Improving Perioperative and Anesthesia Care Training in Africa- Simulation Scenario Development
Neurosurgery-intracranial
Neurosurgery-Spine
Orthopedic-upper extremity
Plastic surgery
Orthopedic-lower extremity
Vaginal Delivery –normal
Vaginal Delivery – high risk
C-section – fetal distress
C-section – maternal bleeding
C-section –other ____________________
Gynecology (tubal ligation)
liver/kidney/vascular
Ear, Nose, Throat (ENT)
Orthopedic-spine
C-section – elective
C-section pre-eclampsia/eclampsia
Gynecology (hysterectomy, ruptured ectopic, ovarian mass)
Intra-abdominal – bowel/pancreas/bladder
Intra-abdominal-
Cardiac or thoracic
Other (please specify)________________________________________
Procedure Location:
OR
Induction Technique:
PACU
Mask (inhalation)
Airway Management Techniques Performed:
ICU
Other
RSI(IV)
non-RSI (IV)
Room Air Oxygen Only
Supplemental Oxygen Only (cannula, face mask, etc.)
Direct Laryngoscopy and Intubation
Cricothyroidotomy
Airway Decide Used:
Supraglocitc Airway (LMA, etc.)
Awake Fiberoptic
Asleep Fiberoptic
Other (please describe)_____________________
None
Nasal Cannula or Face Mask
LMA
Oral ETT
Nasal ETT
Double Lumen ETT
Airway Management:
1 attempt
2 attempts
>3 attempts, secured by trainee (unanticipated DA)
(unanticipated DA)
Peripheral IV Lines:
Airway aborted, patient awakened
1
2
Invasive Techniques Performed:
guided)
3
Emergency surgical airway
>3
Arterial Catheter (landmark)
Central Venous Catheter (landmark)
Invasive Procedure Complication:
>3 attempts, secured by supervisor
Central Venous Catheter (U/S guided)
Hematoma
describe)_____________________________________________
Arterial Catheter (U/S
Pneumothorax
None
Other (please
None
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Improving Perioperative and Anesthesia Care Training in Africa- Simulation Scenario Development
Monitors in use/available (select all applicable):
BP
Cuff
ECG
nerve
Pulse
oximeter
stimulator
Other
ETCO2
(please
specify)___________________________________________________________________________________________________________
Total IV Fluid Given (all types; CC): __________________________________________________________
Types of fluid given (select all that apply):
Lyte
Colloid (albumin, starch)
Normal Saline
Lactated Ringer’s
Plasma-
Blood
Volume Transfused (CC) – Whole Blood: ____________________________________________________
Estimated Blood Loss (CC): ____________________________________________________________________
Please describe the INTRAOPERATIVE Course and events that occur ( such as bronchospasm,
hypotension, arrhythmia, etc.) which will be important aspects for case simulation education
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Please describe the POSTOPERATIVE Course and events that occur ( such as bronchospasm,
hypotension, arrhythmia, etc.) which will be important aspects for case simulation education.
If no abnormal events or complications, indicate “none” in this section.
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Improving Perioperative and Anesthesia Care Training in Africa- Simulation Scenario Development
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Vital Sign Information
Preop HR (bpm)
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Preop_BP (Sys/Dias)
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LOWEST Intra-op HR (bpm)
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HIGHEST Intra-op HR (bpm)
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LOWEST Intra-op BP (Sys/Dias)
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HIGHEST Intra-op BP (Sys/Dias
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Follow-Up & Complications
Postoperative oxygen requirement (within 48 hrs of surgery):
Nasal Cannula
Face mask
No oxygen requirement
Intubation and spontaneous ventilation
Intubation and
controlled ventilation (ventilator)
Surgical or Anesthesia Procedure Complications?
Yes
No
Outcomes – please select all outcomes that occurred for the patient during the hospitalization
after surgery. Next to each one selected, please write which postoperative day (e.g. POD2 for
post-operative day 2):
hrs)
No complications
Nervous system: Stroke
Delerium
Intraoperative Death
Nervous system: Seizure
Nervous system: Peripheral Nerve Injury
Postoperative Death (<24
Nervous system: Postoperative
CV: Cardiac Arrest
Ischemia/Infarction
CV: Congestive Heart Failure
Hypotension (SBP<70)
Resp: Unplanned Respiratory Arrest
CV: Myocardial
Cardiac Dyshrythmia
CV: Sever
Resp: Aspiration
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Improving Perioperative and Anesthesia Care Training in Africa- Simulation Scenario Development
Resp: Pulmonary Edema
Pneumothorax
Resp: Bronchospasm
Airway: Laryngospasm
laryngoscopy/intuation
Misc: Allergic Reaction
Airway: Difficult Mask Ventilation
Airway: Esophageal Intubation
Airway: Unplanned Tracheotomy
Misc: Wrong Site Surgery
Resp: Bronchospasm
Airway: Difficult
Airway: Unplanned Reintubation
Airway: Airway/Dental Injury
Misc: Drug Error
Resp:
Misc: Vascular Injury
Misc: Equipment Problem/Failure
Misc: OTHER
Was the patient alive 2 days after surgery?
Yes
Was the patient alive 1 week (7 days) after surgery?
No
Yes
No
List the three main teaching points for this case or scenario:
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Thank you for your support!
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