Enhancing Registered Nurse Job Readiness and Patient Safety Outcomes Through Clinical
Simulation
Simulation Scenario MULTIPLE PATIENTS TRAUMA
Adaptation of California Simulation Alliance (CSA)
February 24th, 2014
Revised April 2014
University of Ottawa
Algonquin College
Susan Eldred
Heather Macmillan
Shawna Watt
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014-Scenario 24-02-2014
TABLE OF CONTENTS
ii
SECTION I
SCENARIO OVERVIEW
A. Title
B. Summary
C. Evidence Base
SECTION II
CURRICULUM INTEGRATION
A. Learning Objectives
1. Primary
2. Secondary
3. Critical Elements
B. Pre-scenario learner activities
SECTION III SCENARIO SCRIPT
A.
B.
C.
D.
E.
F.
G.
Case Summary
Key Contextual Details
Scenario Cast
Patient/Client Profile
Baseline patient/client simulator state
Environment / equipment / essential props
Case flow /triggers / scenario development
SECTION IV APPENDICES
A. Health Care Provider Orders
B.
B. Digital Images of Manikin / Milieu
C. Debriefing Guide/Patient Scripts
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
1
SECTION I: SCENARIO OVERVIEW
Multi-patient Trauma: Multiple Vehicle Collision
Original Scenario Developer(s):
University of Ottawa
Shelley Clarke, Susan Eldred, Heather Macmillan, Shawna Watt
Date - original scenario
February, 2014
Validation:
Revision Dates:
Pilot testing:
QSEN revision:
Scenario Title:
Estimated Scenario Time: 30-40 min
Debriefing time: 45-60 min
Target group: 4th year students-Complex Care, new grads
Core case: Maternal and fetal assessment & R/O vaginal bleeding, R/O head injury, Splenic laceration
CNO/ CPSI/CIHC:
 Patient Safety
 Teamwork and Collaboration
 Competencies for Entry-level Registered Nurse Practice:
 Knowledge-based Practice
 Competent Application of Knowledge
 Interprofessional Communication
Best Practice Guidelines:
 Client Centered Care
Brief Summary of Case:
This is a multiple patient scenario involving 3 patients in the Observation Unit following an MVC.
Patient A: R/O fetal distress/injury
Patient B: R/O Head Injury
Patient C: Splenic Laceration
Patient A is a 35 y.o. mother, 19 weeks pregnant that was driving herself and her pre-school son to a clinic
appointment when she was in a collision. She has a sprained wrist but otherwise appears to be stable.
There is currently no evidence of vaginal bleeding. She is under observation prior to being cleared for
discharge. Maternal/fetal assessment to R/O fetal distress/injury.
Patient B is Patient A’s 3y.o. son. He was restrained in a child car seat and shows a mild abrasion to his
forehead from the impact during the collision. He is stable and is under observation prior to being cleared
for discharge. R/O head injury.
Patient C is 42 year old man. He was a restrained driver that was struck by another vehicle. The other vehicle struck
the driver’s side door with about 2 feet of intrusion into the passenger compartment. He had a brief loss of
consciousness but is now alert and conversant. He complains of left shoulder and chest pain and left upper quadrant
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
SECTION I
ALL DATA IN THIS SCENARIO IS FICTICIOUS
2
abdominal pain. He is under observation, awaiting results from XRay and CT.
In this scenario learners are to prioritize and organize care in order to manage the various needs of the
patients. They must accurately assess all 3 patients and recognize the signs of hypovolemic shock in Patient
C in order to intervene effectively. Interventions should include:
Patient A: Fetal heart rate monitoring with a Doppler, interpretation of lab results.
Patient B: neurological assessment, orientation to 3 spheres
Patient C: positioning, apply O2, reassessing abdomen and circulatory system, recognizing need for further
orders, communicating with the healthcare team and IV bolus.
EVIDENCE BASE / REFERENCES (APA Format)
American Academy of Pediatrics and Pediatric Orthopedic Society of North America. (2008). Management
of Pediatric Trauma. 121 (4).
Babb, M. et al., January 2010. Treating Pain During Pregnancy. The Hospital for Sick Children-Motherisk.
Retrieved February 14th, 2014, from http://www.motherisk.org/prof/updatesDetail.jsp?content_id=922
College of Nurses of Ontario (2014). Competencies for entry level registered nurse practice (41037).
Retrieved from CNO website: http://www.cno.org/Global/docs/reg/41037_EntryToPracitic_final.pdf
Freiwald, S. (2010). Late presenting complications after splenic injury. The Permanente Journal. 14(2).
Pagana, K. (2011). Mosby's diagnostic and laboratory test reference (10th ed.). St. Louis, MO: Elsevier.
Perinatal Partnership Program of Eastern Ontario. (2007). Care of the pregnant trauma patient. Retrieved
from http://www.cmnrp.ca/en/cmnrp/Obstetrical_p737.html A classic in the field.
Perry, S.E. (2013). Maternal Child Nursing Care in Canada. Toronto: Mosby Canada.
Schulman, C. (2003). A FASTer method of detecting abdominal trauma. Nursing Management. 34 (9). A
classic in the field
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
SECTION I
ALL DATA IN THIS SCENARIO IS FICTICIOUS
3
SECTION II: CURRICULUM INTEGRATION
A. SCENARIO LEARNING OBJECTIVES
Do What
1. Students will perform
With What
focused assessments
2. Students will accurately
interpret
3. Students will respond to
changes in patient status
4. Students will be able to
coordinate the care of the
three patients
assessment findings, patient
history and lab results
by communicating with the
interprofessional team
with other care providers
5. Students will apply
knowledge and skills
acquired from previous
laboratories, theory and clinical
For What
to determine current patient
status.
to organize and prioritize the care
of multiple patients.
in order to intervene effectively.
to ensure the safe and timely
delivery of care.
in order to manage the care of a
pediatric, a pregnant and a trauma
client.
B. Learning Outcome Assessment / Rubric
Competency
(based on “What For”)
1. Students will
appropriately
utilize
assessment
findings, patient
history and lab
Demonstrated
attributes align
with required
competency
Demonstrated
attributes need
some improvement
to align with
required
competency
Demonstrated
attributes need
major
improvement to
align with required
competency
-reviews pt charts, VS,
MARs, Kardex’s lab
results
-seeks out report and
clarifies information as
needed
-reviews MAR and listens
to report but seeks no
further information
-creates shift work-sheet
but key information is not
listed (med times,
-relies on report for all
relevant information
-no shift work-sheet
created
-no identification and/or
assessment of a priority
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
4
results to
organize and
prioritize the care
of multiple
patients.
2. Students will
respond to
changes in
patient status by
communicating
with the
physician in order
to intervene
effectively.
3. Students will be
able to
coordinate the
care of 3 patients
with other care
providers to
ensure the safe
and timely
delivery of care.
-creates shift work-sheet
to organize care
-seeks to identify and
assess priority patient
first
-contacts the MD
-communicates
effectively (SBAR) sharing
all relevant information
and status changes
-transcribe new orders
-implement new orders
needed tests etc)
-priority patient is
eventually identified and
assessed
patient
-contacts the MD
-communication is
disorganized (no SBARR)
but shares relevant
information re: status
change
-implements new orders
but fails to transcribe
-contacts MD
-fails to communicate
relevant information and
communication is
extremely disorganized
-no follow through on
new orders
-tasks, assessments and
interventions are
delegated to appropriate
team members and
completed in an
organized fashion
-effective communication
is established amongst
team members (sharing
of assessment findings,
response to
interventions, patient
concerns etc)
-Effectively
communicates with
patient throughout
simulation to keep
informed, relieve anxiety
and support
active participation in
care as able
-patient safety is
maintained throughout
-delegation of tasks,
assessments and
interventions occurs but
in a disorganized fashion
-communication amongst
team members is
disorganized or
incomplete
-communication with
client(s) is minimal
-overall safety of the
patient is maintained
-little to no delegation
occurs
-lack of communication
-patient safety is of
concern
4. Students will
apply knowledge
and skills
acquired from
previous
laboratories,
theory and
clinical in order
to manage the
-demonstrates accurate
assessment of the patient
(FHR, neuro assessment,
focused abdominal
assessment)
- Identifies and interprets
significant assessment
findings requiring
immediate reporting
-assessments are
completed but are
disorganized
-recognizes abnormal
assessment findings but
fails to communicate
them in an appropriate
period
-struggles with the
-assessments are
incomplete or irrelevant
-fails to recognize
abnormal assessment
findings/changes in
patient status
-little to no organization
or prioritization evident
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
5
care of a
pediatric, a
pregnant and a
trauma patient.
and/or intervention
-Accurately prioritizes
immediate interventions
required for a patient
with an unexpected
change in status.
organization and
prioritization of care
C. PRE-SCENARIO LEARNER ACTIVITIES
Knowledge
Prerequisite Competencies
Skills/ Attitudes
Pathophysiology, risk factors, assessment
techniques and treatment of fetal injury/distress,
head injury and abdominal trauma
Communication with pediatric, acutely ill and/or
anxious patients & members of the healthcare
team
Principles of teamwork and collaboration
Dimensions of patient centered care
Patient safety principles
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Communication with interprofessional team
 Use SBAR method
Strategies for decreasing anxiety & ensuring active
patient participation
Neurological Assessment
 GCS
Check pupils (size, reaction)
Fetal Assessment
fetal heart rate monitoring
pelvic/fetal palpation
Abdominal Assessment
 Auscultate bowel sounds (first)
 Palpate for rigidity, distension (following
auscultation)
Assess for hematuria
Assess Vital Signs
 Complete temperature, pulse, respirations,
blood pressure and oxygen saturation
Recognize abnormal values
Collaborative interventions / changing pt status;
hypovolemic shock
6
SECTION III: SCENARIO SCRIPT
A.
Case summary-Patient A
35 y.o. female; 19 weeks pregnant. Driving to a clinic to have her left wrist examined following a fall this AM.
She was brought in to ER via ambulance following a 2 car collision involving her and her 3 y.o. son and another
vehicle. She reports no pain (other than her wrist) and is in observation to R/O fetal distress and vaginal
bleeding and to monitor FHR. Learners are expected to perform a shift assessment. Upon approaching the
bedside, they find her in another bed with her pre-school son.
Learners are expected to: check VS, O2 sat, FHR via Doppler, ask about any vaginal bleeding, assess for pain
(PQRST), communicate effectively (therapeutic communication), provide support and teaching as well as to
encourage the patient to remain in the assigned bed. Students should also recognize that this patient is stable
and is of lower priority at this point.
B. Key contextual details-Patient A
Scenario takes place on the Observational Unit attached to the ER during day shift. The patient has been
triaged and is being observed prior to being cleared for discharge. The students will receive report from the ER
nurse transferring care to the Observation Unit. X-ray of L wrist shows no fracture and is being treated as a
sprain. Urinalysis results are normal. CBC, K-B assay are all normal as well.
Patient is anxious regarding the status of her unborn fetus and also regarding her 3 y.o. son. She doesn’t want
to be far from her son as he is crying for her and wanting her for comfort.
C. Scenario Cast – Patient A
Patient/ Client
Role
RN 1-Primary Nurse
RN 2-New Grad
Charge Nurse
Documenting Nurse
Pt B and C
High fidelity simulator-Patient B & C
 Mid-level simulator
 Task trainer
 Hybrid (Blended simulator)
 Standardized patient-Patient A
Brief Descriptor
Confederate/Actor (C/A) or Learner (L)
(Optional)
Assessment and delegation;
Learner
communication
Administration of meds, verifies lab
Learner
results, checks orders, follows
direction from RN 1
May be used as a resource
Confederate
Documentation
Learner
Voices of patients
Confederate/Actor

CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
7
D-1.
Last name:
Rodriguez
Gender: F
Age: 35
Spiritual Practice: None identified
Patient/Client Profile-Patient A
First name: Julia
Ht: 167cm Wt: 60kg
Ethnicity: Caucasian
Code Status: Full
Primary Language spoken: English
1. Past history
Patient fell this AM catching herself with her left hand. She had severe pain to wrist and was driving to clinic
appointment when she collided with another vehicle. Her 3 y.o. son was in the car with her. She was brought
in to ER via ambulance and is being observed before being cleared for D/C. X-ray shows no fracture to wrist.
Being treated as a sprain.
G: 2, T: 1, P: 0, A: 0, L: 1. Currently 19 weeks pregnant. No complications to date. No complications with
previous pregnancy. Saw OB earlier in the week.
Primary Medical Diagnosis R/O Vaginal Bleeding & R/O fetal distress
2. Review of Systems
CNS
Cardiovascular
Pulmonary
Renal/Hepatic
Gastrointestinal
Endocrine
Heme/Coag
Musculoskeletal
Integument
Developmental Hx
Psychiatric Hx
Social Hx
Alert & oriented x 3; anxious
WNL
WNL
No complaints of urinary difficulty; no evidence of hematuria
WNL
WNL
No sign indicative of a bleed; Hgb slightly low but in keeping with pregnancy
Normal except swelling/pain in left wrist
WNL
WNL
None shared
Married x 5 years; husband is in the military and is currently away; mother; 2nd
pregnancy; stay at home mom
Alternative/ Complementary Medicine Hx
None shared
3. Current
medications
Medication allergies:
Food/other allergies:
None
None
Reaction:
Reaction:
Drug
Acetaminophen
Ibuprofen
Dose
650mg
200-400mg max
1200mg/day
Route
PO
PO
Frequency
Q4-6h PRN for pain
Q6h PRN for pain
4. Laboratory, Diagnostic Study Results
Na:
Ca:
Hgb: 110g/L
K:
Mg:
Hct: 35%
Cl:
Phos:
Plt:
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
HCO3:
Glucose:
WBC: 7 x 109 /L
BUN:
Cr:
HgA1C:
ABO Blood Type: O+
8
PT:
ABG-pH:
VDRL:
PTT:
paO2:
Kleihauer-Betke
Assay: 0.6%
INR:
paCO2:
Herpes:
Troponin:
HCO3/BE:
HIV:
BNP:
SaO2: 98% R/A
X-ray (wrist):
no fracture
EKG: WNL
E. Baseline Simulator/Standardized Patient State – Patient A
(This may vary from the baseline data provided to learners)
1. Initial physical appearance
Gender: Female
Attire: Street clothes, maternity pants and top
Alterations in appearance (moulage): slight baby bump
X
ID band present, accurate
ID band present, inaccurate
ID band absent or not applicable
Allergy band present, accurate
Allergy band inaccurate
Allergy band absent or N/A
2. Initial Vital Signs Monitor display in simulation action room: Patient A
No monitor display
X
Monitor on, but no data displayed
Monitor on, standard display
Display VS when learner takes them
BP: 138/78
CVP:
AIRWAY:
HR: 96
RR: 14
PAS:
PAD:
ETC0²:
FHR:
Lungs: Left: clear
Right: clear
Sounds/mechanics
Heart: Sounds: S1S2
ECG rhythm: sinus
Other:
Bowel sounds: Present WNL
T: 37.2
PCWP:
SpO²: 98% r/a
CO:
Other:
3. Initial Intravenous line set up
X Saline lock
Site:
R a/c
#1
IV #1
Site:
Fluid type:
Main
Piggyback
IV #2
Site:
Fluid type:
Main
Piggyback
4. Initial Non-invasive monitors set up
Y
Initial rate:
IV patent (Y/N)
Initial rate:
IV patent (Y/N)
NIBP
ECG First lead:
Pulse oximeter
Temp monitor/type
5. Initial Hemodynamic monitors set up
A-line Site:
Catheter/tubing Patency (Y/N)
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
IV patent (Y/N)
ECG Second lead:
Other:
CVP Site:
PAC Site:
9
6. Other monitors/devices
Foley catheter
Amount:
Epidural catheter
X
Appearance of urine:
Infusion pump:
Pump settings:
Doppler at bedside for fetal HR
Internal
External
Environment, Equipment, Essential props - Patient A
Recommend standardized set ups for each commonly simulated environment
1. Scenario setting: (example: patient room, home, ED, lobby)
Observation unit, ED; multi-bed ward. Bed 3.
2. Equipment, supplies, monitors
(In simulation action room or available in adjacent core storage rooms)
Bedpan/ Urinal
IV Infusion pump
Nasogastric tube
Defibrillator
PCA infusion pump
IV fluid
Type:
X
Foley catheter kit
Feeding pump
ETT suction catheters
Code Cart
Epidural infusion
pump
IV fluid additives:
3. Respiratory therapy equipment/devices
Nasal cannula
Face tent
BVM/Ambu bag
Nebulizer tx kit
4. Documentation and Order Forms
X Health Care
X Med Admin
Provider orders
Record
Progress Notes
X Graphic record
X
X
Medication
Transfer orders
reconciliation
Nurses’ Notes
Dx test reports
(blank)
Actual medical record binder, constructed
per institutional guidelines
X
Straight cath. kit
Pressure bag
Oral suction catheters
12-lead ECG
Central line Insertion
Kit
Doppler
Simple Face Mask
Non re-breather mask
Flowmeters (extra supply)
H&P
Anesthesia/PACU
record
Standing (protocol)
orders
Code Record
Revised COUPN January 2014
X Lab Results
ED Record
ICU flow sheet
Prenatal record
Other
Describe:
5. Medications (to be available in sim action room) – Patient A
# Medication
Dosage
Route
#
Medication
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Incentive spirometer
Wall suction
Chest tube kit
Chest tube equip
Dressing ∆
equipment
Blood product
ABO Type:
# of units:
Dosage
Route
10
4
Acetaminophen
650mg
PO
D-2.
Last name:
Rodriguez
Gender: M
Age: 3
Spiritual Practice: None identified
4
200400mg
Ibuprofen
PO
Patient/Client Profile-Patient B
First name: Brendan
Ht: 97 cm
Wt: 14.7kg
Ethnicity: Caucasian
Code Status: Full
Primary Language spoken: English
1. Past history
Patient was restrained in a child seat in the rear seat of the vehicle when it collided with another vehicle. His
mother was the driver. He and his mother were brought in to ER via ambulance. Examination at the scene of
the accident showed an abrasion to the forehead. He is being observed for any changes in status before being
cleared for D/C.
Primary Medical Diagnosis R/O Head Injury
2. Review of Systems
CNS
Cardiovascular
Pulmonary
Renal/Hepatic
Gastrointestinal
Endocrine
Heme/Coag
Musculoskeletal
Integument
Developmental Hx
Psychiatric Hx
Social Hx
Alert & oriented x 3; anxious
WNL
WNL
WNL
WNL
WNL
WNL
Normal except swelling/pain to injured area on forehead
WNL
WNL
None
Lives with parents; father is in the military and is currently away; mother is stay at home
mom
Alternative/ Complementary Medicine Hx
None shared
3. Current
medications
Medication allergies:
Food/other allergies:
None
Strawberries
Drug
Acetaminophen
Reaction:
Reaction:
Dose
220mg
rash
Route
PO
Frequency
Q4-6h PRN for pain
4. Laboratory, Diagnostic Study Results
Na:
Ca:
Hgb:
PT:
K:
Mg:
Hct:
PTT:
Cl:
Phos:
Plt:
INR:
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
HCO3:
Glucose:
WBC:
Troponin:
BUN:
Cr:
HgA1C:
ABO Blood Type:
BNP:
11
ABG-pH:
VDRL:
paO2:
GBS:
paCO2:
Herpes:
HCO3/BE:
HIV:
SaO2:
X-ray:
EKG:
E. Baseline Simulator/Standardized Patient State – Patient B
(This may vary from the baseline data provided to learners)
1. Initial physical appearance
Gender: Male
Attire: Street clothes, pull-ups on under pants
Alterations in appearance (moulage): abrasion to forehead
X
ID band present, accurate
ID band present, inaccurate
ID band absent or not applicable
X
Allergy band present, accurate
Allergy band inaccurate
Allergy band absent or N/A
2. Initial Vital Signs Monitor display in simulation action room: Patient B
No monitor display
X
Monitor on, but no data displayed
Monitor on, standard display
Display VS when learner takes them
BP: 100/66
CVP:
AIRWAY:
HR: 105
RR: 28
PAS:
PAD:
ETC0²:
FHR:
Lungs: Left: clear
Right: clear
Sounds/mechanics
Heart: Sounds: S1S2
ECG rhythm: sinus
Other:
Bowel sounds: Present WNL
T: 37.2
PCWP:
SpO²: 98% r/a
CO:
Other:
3. Initial Intravenous line set up
Saline lock Site:
#1
IV #1
Site:
Fluid type:
Main
Piggyback
IV #2
Site:
Fluid type:
Main
Piggyback
4. Initial Non-invasive monitors set up
IV patent (Y/N)
Initial rate:
IV patent (Y/N)
Initial rate:
IV patent (Y/N)
NIBP
ECG First lead:
Pulse oximeter
Temp monitor/type
5. Initial Hemodynamic monitors set up
A-line Site:
Catheter/tubing Patency (Y/N)
6. Other monitors/devices
Foley catheter
Amount:
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
ECG Second lead:
Other:
CVP Site:
Appearance of urine:
PAC Site:
12
Epidural catheter
Infusion pump:
Pump settings:
Internal
External
Environment, Equipment, Essential props - Patient B
Recommend standardized set ups for each commonly simulated environment
1. Scenario setting: (example: patient room, home, ED, lobby)
Observation unit, ED; multi-bed ward. Bed 5.
2. Equipment, supplies, monitors
(In simulation action room or available in adjacent core storage rooms)
Bedpan/ Urinal
IV Infusion pump
Nasogastric tube
Defibrillator
PCA infusion pump
X
IV fluid
Type:
Foley catheter kit
Feeding pump
ETT suction catheters
Code Cart
Epidural infusion
pump
IV fluid additives:
3. Respiratory therapy equipment/devices
Nasal cannula
Face tent
BVM/Ambu bag
Nebulizer tx kit
4. Documentation and Order Forms
X Health Care
X Med Admin
Provider orders
Record
Progress Notes
X Graphic record
X
X
Medication
Transfer orders
reconciliation
Nurses’ Notes
Dx test reports
(blank)
Actual medical record binder, constructed
per institutional guidelines
Straight cath. kit
Pressure bag
Oral suction catheters
12-lead ECG
Central line Insertion
Kit
Simple Face Mask
Non re-breather mask
Flowmeters (extra supply)
H&P
Lab Results
Anesthesia/PACU
record
Standing (protocol)
orders
Code Record
ED Record
Medication
suspension
D-3.
Patient/Client Profile-Patient C
Henderson
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
ICU flow sheet
Prenatal record
Other
Describe:
5. Medications (to be available in sim action room)
# Medication
Dosage
Route
#
PO
1 Acetaminophen 220mg
Last name:
Incentive spirometer
Wall suction
Chest tube kit
Chest tube equip
Dressing ∆
equipment
Blood product
ABO Type:
# of units:
First name: Troy
Dosage
Route
13
Gender: M
Age: 42
Spiritual Practice: None identified
Ht: 180 cm Wt: 86 kg
Ethnicity: Caucasian
Code Status: Full
Primary Language spoken: English
1. Past history
Mr. Henderson was on his way to work this AM when he was struck by another vehicle. He was wearing his seatbelt but
his vehicle lacked airbags. The other vehicle struck the driver’s side door with about 2 feet of intrusion into the passenger
compartment. He is alert and conversant after a brief loss of consciousness at the scene. He complains of left shoulder and
chest pain and left upper quadrant abdominal pain. He is under observation, awaiting results from XRay and CT.
Primary Medical Diagnosis
R/O Splenic Laceration
2. Review of Systems
CNS
Alert & oriented x 3
Cardiovascular
WNL
Pulmonary
WNL
Renal/Hepatic
Abdominal distension
Gastrointestinal
Abdominal distension; BS x 4 and hypoactive
Endocrine
WNL
Heme/Coag
Awaiting results
Musculoskeletal
c/o L shoulder pain
Integument
Abdominal bruising in keeping with seatbelt injury
Developmental Hx
WNL
Psychiatric Hx
None shared
Social Hx
Smoker 1 pack/day x 15 years; married with 2 school aged children
Alternative/ Complementary Medicine Hx
None shared
3. Current
medications
Medication allergies:
Food/other allergies:
Penicillin
None
Reaction:
Reaction:
Drug
Ringer’s Lactate
Acetaminophen
Morphine
Zofran
Dose
125ml/h
650mg
5-10mg
4-8mg
Rash
Route
IV
PO
IV/SC
IV
Frequency
continuous
Q4-6h PRN
Q2-4h PRN
Q6h PRN
4. Laboratory, Diagnostic Study Results
Na: 141 mmol/L
K: 4.2 mmol/L
Ca:
Hgb: 10.2 mmol/L
PT:
ABG-pH:
VDRL:
Mg:
Hct: 38%
PTT:
paO2:
GBS:
Cl:
102
mmol/L
Phos:
Plt: 163 x 109/L
INR:
paCO2:
Herpes:
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
HCO3:
BUN:
Cr: 56 mcmol/L
Glucose:
WBC: 7.0 x 109/L
Troponin:
HCO3/BE:
HIV:
HgA1C:
ABO Blood Type: A+
BNP:
SaO2:
X-ray:
EKG: WNL
14
E. Baseline Simulator/Standardized Patient State – Patient C
(This may vary from the baseline data provided to learners)
1. Initial physical appearance
Gender: Male
Attire: Street clothes
Alterations in appearance (moulage): abdominal distension, seatbelt bruising, pale, bruising and abrasions to
cheek/chin and hands
X ID band present, accurate
ID band present, inaccurate
ID band absent or not applicable
X
Allergy band present, accurate
Allergy band inaccurate
Allergy band absent or N/A
2. Initial Vital Signs Monitor display in simulation action room: - Patient C
No monitor display
X
Monitor on, but no data displayed
Monitor on, standard display
Display VS when learner takes them
BP: 108/62
CVP:
AIRWAY:
HR: 112
RR: 20
PAS:
PAD:
ETC0²:
FHR:
Lungs: Left: clear
Right: clear
Sounds/mechanics
Heart: Sounds: S1S2
ECG rhythm: sinus tachycardia
Other:
Bowel sounds: Present hypoactive
T: 36.8
PCWP:
SpO²: 95%
CO:
Other:
3. Initial Intravenous line set up
X Saline lock
Site: L fore
#1
arm
Site: R A/C
Fluid type:
X IV #1
RL
Main
Piggyback
IV #2
Site:
Fluid type:
Main
Piggyback
4. Initial Non-invasive monitors set up
Initial rate:
125ml/h
Initial rate:
NIBP
X
ECG First lead:
X Pulse oximeter
Temp monitor/type
5. Initial Hemodynamic monitors set up
A-line Site:
Catheter/tubing Patency (Y/N)
6. Other monitors/devices
Foley catheter
Epidural catheter
Amount:
Infusion pump:
Other:
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Y
IV patent (Y/N)
Y
IV patent (Y/N)
IV patent (Y/N)
ECG Second lead:
Other:
CVP Site:
PAC Site:
Appearance of urine:
Pump settings:
Internal
External
15
Environment, Equipment, Essential props – Patient C
Recommend standardized set ups for each commonly simulated environment
1. Scenario setting: (example: patient room, home, ED, lobby)
Observation unit, ED; multi-bed ward. Bed 6.
2. Equipment, supplies, monitors
(In simulation action room or available in adjacent core storage rooms)
Foley catheter kit
Straight cath. kit
X Bedpan/ Urinal
Feeding pump
Pressure bag
X IV Infusion pump
Nasogastric tube
Defibrillator
PCA infusion pump
X
IV fluid
Type:
1000ml RL
500ml NS
X
ETT suction catheters
Code Cart
Epidural infusion
pump
IV fluid additives:
3. Respiratory therapy equipment/devices
X Nasal cannula
Face tent
X BVM/Ambu bag
Nebulizer tx kit
4. Documentation and Order Forms
X Health Care
X Med Admin
Provider orders
Record
Progress Notes
X Graphic record
X
X
Medication
reconciliation
Nurses’ Notes
(blank)
Transfer orders
X Dx test reports
(CT abd, 12 lead
ECG, CXR)
Actual medical record binder, constructed
per institutional guidelines
Oral suction catheters
12-lead ECG
Central line Insertion
Kit
Simple Face Mask
X Non re-breather mask
Flowmeters (extra supply)
H&P
Anesthesia/PACU
record
Standing (protocol)
orders
Code Record
Revised COUPN January 2014
X Lab Results (CBC and
chem)
ED Record
ICU flow sheet
Prenatal record
Other
Describe:
5. Medications (to be available in sim action room)
# Medication
Dosage
Route
#
PO
2
4 Acetaminophen 325mg
4mg/ml
IV
2 Zofran
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
X
Incentive spirometer
Wall suction
Chest tube kit
Chest tube equip
Dressing ∆
equipment
Blood product
ABO Type:
# of units:
Medication
Dosage
Morphine
10mg/ml
Route
IV/SC
16
CASE FLOW / TRIGGERS/ SCENARIO DEVELOPMENT STATES
Initiation of Scenario :
Patient A:
JR is a 35 year old female under observation following an MVC. She was on her way to a clinic appointment this morning before the
accident to have her left wrist examined following a fall at home. X-ray results indicated there was no fracture. The wrist is being
treated as a sprain. It appears swollen and is tender to the touch. JR rates her pain as being 4-5/10. She had her last dose of Tylenol
1 hour ago and can have ibuprofen if she is still experiencing discomfort. She is 19 weeks pregnant and is being monitored for
vaginal bleeding and for fetal distress prior to being cleared for discharge. Currently, she reports no evidence of bleeding. The
Doppler was just brought to us from the maternity ward. Blood and urine were sent to test for signs of bleeding. Urinalysis was
negative for hematuria and the blood test results are just back. You’ll want to look at them. VS are stable. She’s anxious about the
results and also regarding her son who was in the car with her. He’s also here for observation to rule out a possible head injury.
She’s married but her husband was deployed (military) 3 months ago and won’t be back until mid-summer. She was found in her
son’s bed last time I went to assess her. She was asked to stay in her bed (bed 3) for continued monitoring but if she’s missing just
look for her in bed 5.
Patient B:
BR is a 3 year old male under observation following an MVC in which his mother was the driver. He was restrained in his car seat but
appears to have a mild abrasion to his forehead. He is under observation to rule out the possibility of a head injury prior to being
cleared for discharge. He is ++anxious and is crying for his mom. His last VS and neuro vitals were stable.
Patient C:
TH is 42 year old man. He was a restrained driver that was struck by the vehicle driven by JR. Her vehicle struck the driver’s side door
of his car with about 2 feet of intrusion into the passenger compartment. He is alert and conversant. He complains of left shoulder
and chest pain and left upper quadrant abdominal pain. He is under observation, awaiting results from XRay and CT. Last vital signs
are stable. ECG showed normal sinus tachycardia. He was given 4 mg of IV Morphine by paramedics one hour ago en route to the
hospital.
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
17
STATE / PATIENT STATUS
1. Baseline-Patient A
DESIRED LEARNER ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
Operator
Learner Actions
Display VS on monitor once
Patient found sitting with her completed by learner
1. Introduce self, wash
son in her lap in son’s
hands
assigned bed. Soothing son.
2. Identify patient, request
Responds appropriately to
permission to assess
questions and compliant
Triggers:
3. Check VS
with treatment but unwilling
4. Assess FHR with Doppler
Cues:
I’m
so
worried
about
the
to leave son’s side.
5. Assess pain
baby…when will we know if
HR- 92
6. Administer pain meds as
everything
is
ok?
RR-15
needed
SaO2 -98% r/a
7. Reassure patient with
BP-138/74
clear, calm statements of
action
8. Divide tasks to assure
patient safety
STATE / PATIENT STATUS
1. Baseline-Patient B
Sitting on mother’s lap.
Anxious, draws back from
nursing staff. Crying. Seeking
comfort from mom.
HR-105
RR-28
DESIRED ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
Operator:
Learner Actions:
Shares VS as completed by
learner
Triggers:
Cues: Mom-He’s so upset
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
1.
2.
3.
4.
5.
6.
Introduce self, wash hands.
Identify patient, explain
intended actions.
Use age appropriate language
and explanations; engage
patient with play.
Involve mother in care.
Check VS, neuro vitals
Assess pain
Debriefing Points:
1. Patient Safety Standards to
reduce errors
2. Significance of VS signs,
deviations from normal in
pregnancy
3. Significance of lab results,
deviations from normal in
pregnancy
4. Clear, brief explanations to ↓
anxiety
5. Pathophysiology of placental
abruption
6. Strategies for dividing tasks
so major priorities are
handled initially
7. Strategies for engaging
anxious patients
8. Reassessment requirements
Debriefing Points:
1. Significance of VS in a
pediatric patient
2. Pathophysiology of a head
injury
3. Strategies for engaging a
pediatric patient
4. Reassessment requirements
18
7.
Administer pain meds as
needed
8. Reassure patient with clear,
calm statements as needed.
9. Collaborate with mother to
decrease anxiety
10. Divides tasks to ensure patient
safety.
SaO2 -98% r/a
PERRLA
A&Ox3
GCS-15/15
and really scared with
everything that’s happened.
Is there some way I can
help?
STATE / PATIENT STATUS
1. Baseline-Patient C
DESIRED ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
Operator:
Learner Actions:
Lying on back in bed. Alert,
oriented and conversant.
Display VS on monitor once
completed by learner
HR: 112
RR: 20
BP:108/62
T: 36.8
SaO2: 95%
Triggers:
“I’m feeling a bit woozy and
I am having some pain.”
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
1.
2.
Introduce self, wash hands.
Identify patient, explain
intended actions.
3. Use age appropriate language
and explanations.
4. Check VS, neuro status.
5. Assess pain.
6. Administer pain meds as
needed.
7. Complete abdominal
assessment.
8. Reassure patient with clear,
calm statements as needed.
9. Divides tasks to ensure patient
safety.
Debriefing Points:
1.
2.
3.
4.
5.
Priority assessment in this case
(neuro versus abdominal).
Appropriate techniques for a
focused abdominal assessment.
What constitutes neuro VS.
Assessment and treatment for
shock.
Pain assessment
19
STATE / PATIENT STATUS –
PATIENT C ONLY
2.
After initial assessment
complete, patient starts to
complain of increasing
abdominal pain and nausea.
Now starting to exhibit signs
of hypovolemic shock.
Patient is pale and
increasingly restless.
HR: 128
RR: 26
BP: 98/58
SaO2: 94%
DESIRED ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
Operator:
Learner Actions:
Change VS on monitor to
reflect changing status (you
1. Delegate tasks to
may slowly decrease BP and
secondary nurse.
increase HR).
2. Reassess vital signs.
3. Reassess pain.
After reassessing abdomen,
4. Reassess abdomen for
tell examiner that his
rigidity, bowel sounds,
abdomen is rigid and
tenderness, distension,
further distended.
hematuria.
5. Give patient K basin.
Triggers:
6. Receive and interpret lab
and diagnostic test
Patient is pointing to his left
results.
upper quadrant just under
7. Call MD stat using SBAR
ribcage and moaning.
report.
8. Take telephone order
“My pain is getting worse
from MD for stat bolus
and worse and I feel sick.”
(indicated in MD script).
9. Initiate bolus.
10. Reassure patient.
Debriefing Points
1. Cause of patient’s changing
status. What do they think
is happening?
2. Signs of hypovolemic
shock.
3. Treatment of hypovolemic
shock.
4. Next steps? (e.g. prep for
emergency surgery, fluid
bolus, crash cart close at
hand, ensure patent IV
access x 2, type and
Xmatch if not already
done).
Scenario End Point: Communication with interprofessional team re: change in pt C status; bolus initiated.
Suggestions to decrease complexity:
Patient C is stable with no splenic laceration, only pain and nausea.
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
20
Suggestions to increase complexity:
Patient A has vaginal bleeding/changes in FHR.
Patient B has changes to LOC with deviations from normal re: neuro vitals.
Patient C requires prep for emergency surgery or VS continue to decrease to a cardiac arrest situation.
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
21
APPENDIX A-1: HEALTH CARE PROVIDER ORDERS
Patient Name: JULIA RODRIGUEZ
Diagnosis: R/O VAGINAL BLEEDING
DOB: XX/XX/1978
Age: 35
MR#: 300596812
 No Known Allergies
 Allergies & Sensitivities
Date
Time
TODAY
NOW
HEALTH CARE PROVIDER ORDERS AND SIGNATURE
Transfer to Observational Unit for monitoring x 4h.
1.
VS q1h
2. Send blood for cross and screen, CBC and Kleihauer-Betke Assay
3. Send urine for urinalysis.
4. X-ray L wrist.
5. FHR monitoring via Doppler q1h
6. u/s to check for placental abruption
7. Acetaminophen 650mg PO q4-6h PRN for pain
8.
Ibuprofen 200-400mg PO q6h PRN for pain max 1200mg/day
Notify MD of any abnormal lab/test results. May D/C home after monitoring if results
normal. Provide teaching to patient regarding care and home monitoring.
Signature
Dr. M. Bailey
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
22
APPENDIX A-2: HEALTH CARE PROVIDER ORDERS
Patient Name: BRENDAN RODRIGUEZ
Diagnosis: R/O HEAD INJURY
DOB: XX/XX/2011
Age: 3
MR#: 300596805
 No Known Allergies
 Allergies & Sensitivities
Date
Time
TODAY
NOW
HEALTH CARE PROVIDER ORDERS AND SIGNATURE
Transfer to Observational Unit for monitoring x 4h.
1.
VS q1h with neurovitals
2. Acetaminophen 220mg PO q4-6h for pain.
Notify MD of any abnormal findings. May D/C home after monitoring if VS/neurovitals
remain within normal limits. Provide teaching to parents regarding care.
Signature
Dr. M. Bailey
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
23
APPENDIX A-3: HEALTH CARE PROVIDER ORDERS
Patient Name: Troy Henderson
Diagnosis: R/O SPLENIC LACERATION
DOB: XX/XX/1972
Age: 42
MR#: 300592934
 Allergy: PCN
Date
Time
TODAY
NOW
HEALTH CARE PROVIDER ORDERS AND SIGNATURE
Transfer to Observational Unit for monitoring.
1.
Vital signs and neurovitals q1h until stable.
2. IV Ringers’ Lactate 125ml/hr continuous
3. Morphine 5-10mg IV q2-4h PRN
4. Zofran 4-8mg IV q6h PRN
5. Acetaminophen 650mg po q 4-6h PRN
6. Diet: NPO until CT scan back
7. Notify MD of any abnormal findings
8.
Signature
Notify MD of diagnostic and lab results when available
Dr. M. Bailey
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
24
APPENDIX B
PATIENT A-SCRIPT
NAME: Julia Rodriguez
Script
CNS
Alert and respond appropriately to questions; anxious ask about baby and son
Cardiovascular
No history of heart problems. Some varicose veins that showed up during last
pregnancy.
Your Dad is on heart medication but you don’t know for what exactly. He never
had a heart attack.
Pulmonary
You don’t smoke and neither does your husband. Had bronchitis as a teenager
but nothing since.
Renal/Hepatic
Nothing out of the ordinary. “I pee a lot more than when I’m not pregnant”
Gastrointestinal
You eat fairly healthy other than cravings associated with the pregnancy-chips,
Dairy Queen
Regular BM’s usually every AM
Endocrine
No problems that I know of.
Heme/Coag
You’re last blood work from the obstetrician’s showed your iron to be a little low
but nothing other than that.
Musculoskeletal
Pain in left wrist from your fall this morning. You were on your way to the clinic
to get it looked at when you had the accident.
Integument
Nothing out of the ordinary
Developmental Hx Normal
Psychiatric Hx
Happy and healthy
Social Hx
Married x 5 years; husband is in the military and is currently away; 2 nd
pregnancy; stay at home mom; 1st pregnancy was great-no complications.
Delivered in hospital. Followed by Dr. Labossiere-she’s your obstetrician.
You are worried about the other driver and feeling guilty: “Is he going to be ok? I
feel like I should go over and apologize! I tried to turn but I couldn’t use my left
hand because my wrist hurt so badly.”
You are worried about your unborn baby and your son. You really want to know
that everything will be ok. You ask a lot of questions about your care and your
son’s care. You’re anxious about leaving the hospital: “what if something
happens later? What if I start to bleed? What if my son really does have a
concussion or something wrong?”
You can offer to help nurses with your sons care: “He’s so upset and scared with
everything that’s happened. Is there something I can do to help?”
You refuse to leave your sons side and insist on being treated and assessed at
his bed: “My son needs me. Do whatever you need to but I’m staying here with
him.”
You don’t have anyone close by that can come to the hospital to help out.
Traditional/Alternative/ Complementary
You take your prenatal vitamins and folic acid once
Medicine Hx
per day. You started on them as soon as you and your
husband decided to try for another baby. You have
no allergies to any medications.
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
25
Information about your son
He’s usually a happy boy.
No health concerns. He gets the odd sniffle or cold.
He’s a pretty good eater. He likes what you give him.
He’s allergic to strawberries and gets a rash around
his mouth if he eats them.
He likes to run and play. He’s really good at colouring.
The doctor says he’s developing normally. He’s up to
date on all his immunizations.
Brendan’s never been hospitalized.
You can ask: What should I watch for when we go
home? What if he’s in pain at home?
PATIENT B SCRIPT
NAME: Brendan
Script
Behaviour
Alert and respond to some questions (if worded in a way that is appropriate to
your age); you are extremely anxious and don’t want to be away from your
Mommy
You are shy with the nurses. If they try and assess you without allowing you to
first play with the equipment (stethoscope, thermometer etc) say: “No!” while
hiding against your mom.
If your mom is asked to help, you will allow her and the nurses to assess you.
You will answer your mom’s questions.
Developmental Hx Normal
Psychiatric Hx
Happy and healthy
Social Hx
You are 3. You can use the potty but don’t want to in the hospital. You wear
pull-ups.
Speech is normal for age; short phrases, nothing complex.
You miss your Daddy.
The accident was “scary” and you didn’t like the ambulance ride.
Traditional/Alternative/ Complementary
Spiderman vitamins. “I only get 1 in the morning.”
Medicine Hx
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
26
PATIENT C -SCRIPT
NAME: Troy Henderson
Script
CNS
Alert and respond appropriately to questions. No pain to head.
Cardiovascular
Takes Lipitor for cholesterol. No cardiac history. No further chest pain.
Pulmonary
You smoke 1ppd x 15 years. No history of respiratory problems.
Renal/Hepatic
Nothing out of the ordinary.
Gastrointestinal
You try to eat fairly healthy but I eat a lot of junk food when I watch TV.
Regular BM’s usually every AM.
When the nurses first assess you, you tell them you feel woozy and have some
abdominal pain. After about 5 mins after the completion of their initial
assessment, you start moaning in pain (holding your abdomen) and say you feel
like you are going to throw up. Initial pain rating is 7/10 and progresses to 9/10.
Endocrine
No problems that I know of.
Heme/Coag
No problems.
Musculoskeletal
I feel a bit stiff after the accident and my left shoulder hurts. No neck pain.
Integument
Nothing out of the ordinary
Developmental Hx
Normal
Psychiatric Hx
Happy and healthy
Social Hx
Married x 12 years; 2 boys - 7 and 5 yrs. Wife is a stay at home Mom.
You are worried about the other driver and her child but don’t ask a lot of
questions due to your pain and nausea.
You keep asking if someone has called and heard back from your wife.
Traditional/
Alternative/
Complementary
Medicine Hx
You have no allergies to any medications. No herbal supplements or alternative
medicine use.
Only takes Lipitor every day.
Allergies to Penicillin
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
27
Patient C Script (Dr.Bailey)
The students should call you after completing the assessment.
They should report to you (using SBAR) the following:
 Physical assessment findings
 Patient’s subjective reports
 Blood work
 Diagnostic tests
If their report is incomplete you will need to cue them.
After the report has been provided to you, tell them you will be right over to see the patient
but start:

IV Normal Saline 500ml bolus at 250mls/hour
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
28
APPENDIX C: DEBRIEFING GUIDE
General Debriefing Plan
With Video
Individual
Group
Debriefing Guide
Debriefing Materials
Objectives
Debriefing Points
Culture
2.
3.
4.
5.
QSEN
CPSI Competencies to consider for debriefing scenarios
Teamwork/Collaboration
Identify safety risk
Communication
1.
Without Video
Issues in environment
Respond to safety risk
Sample Questions for Debriefing
One of the goals was prioritization of care. Did you feel you were able to accomplish this
task? Please describe.
Based on your evaluation and the information at hand, which patient was the priority?
What in your mind made that particular patient the priority?
What prior learning were you able to apply to this scenario?
What information or teaching would have been important for patient A and B prior to
D/C?
What do you think was happening with patient C? What do you think would have
happened next?
Interprofessional Competencies to consider for debriefing scenarios
Role Clarification
Interprofessional Teamwork Functioning
Patient/Family /Client centred care
Collaborative Leadership
Interprofessional Communication
Sample Questions for Debriefing
1. Communication was important in this scenario. What went well or created some hurdles
to interprofessional communication in this scenario?
2. Was delegation amongst the “nurses” used appropriately to improve patient care? If yes,
please describe. If no, how might we improve?
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
29
APPENDIX D- Diagnostic
Multiple patients trauma scenario
JULIA RODRIGUEZ
DOB: XX/XX/1978
MR#: 300596812
X-RAY
X-ray of left wrist.
RESULTS: No evidence of fracture. Read by: Dr. P. Laroche Date: today
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
30
Multiples patients’ trauma scenario
JULIA RODRIGUEZ
DOB: XX/XX/1978
MR#: 300596812
ULTRASOUND
Abd. U/S performed to R/O placental abruption.
RESULTS: No evidence of placental abruption.
Read by: Dr. S. Mahz
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
31
Multiple patients trauma scenario
Patient Name: Troy Henderson
DOB: XX/XX/1972
Age: 42
MR#: 300592934
12 Lead ECG
Impression: Normal Sinus Tachycardia
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
32
Patient Name: Troy Henderson
DOB: XX/XX/1972
Age: 42
MR#: 300592934
Chest Xray
Impression: Chest clear no infiltrates
Patient Name: Troy Henderson
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
33
DOB: XX/XX/1972
Age: 42
MR#: 300592934
CT SCAN ABDOMEN
Impression: Splenic laceration
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
34
APPENDIX E- LAB RESULTS
MULTIPLE PATIENTS TRAUMA SCENARIO
JULIA RODRIGUEZ
DOB: XX/XX/1978
MR#: 300596812
HEMATOLOGY LAB
Hgb: 110g/L (pregnant female >110g/L)
Hct: 35% (pregnant female >35%))
WBC: 7 x 109 /L (5-10 x 109 /L)
KB-ASSAY: 0.6% (<1%)
ABO Rh: O+
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
35
Patient Name: Troy Henderson
DOB: XX/XX/1972
Age: 42
MR#: 300592934
HEMATOLOGY
Hgb: 10.2 mmol/L (male 8.7 – 11.2 mmol/L))
Hct: 38% (male 41-50%)
Platelets: 163 (150 to 400 x 109/L)
WBC: 7.0 x 109/L (5-10 x 109 /L)
ABO Rh: A+
CHEMISTRY
Na: 141 mmol/L (135 - 145mmol/L))
K: 4.2 mmol/L (3.5 – 5.0 mmol/L)
Cl: 102 mmol/L (98 – 106 mmol?L)
Cr: 56 mcmol/L (53 – 106 mcmol/L)
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014