Code pink – Term Baby
Date:
Location:
Participants/Level:
Interprofessional:
Title:
L&D
Yes
Fetal Maternal Hemorrhage, Acidosis and Anemia
Pre-Brief:
1. Orient to equipment and location
2. We will try to do the megacode in real-time. The scenario will play out on script.
Deviations from the megacode script are acceptable.
3. This scenario and your actions are confidential, privacy needs to be respected.
4. This is a safe place to make mistakes
5. The sim lead or the team has no conflicts of interest
Assumptions:
-Baby is 3.0 kg
-Oral intubation only w (stylet) with 3.0 or 3.5 ETT
(please be careful)
Limitations:
-O2 sat probe must be applied to get reading
-Cardiac leads need to be applied to generate rhythm
-The blood pressure cuff does not actually work but please
have RNs apply it when you wish
-UVC can be inserted and can get blood back, please do not
infuse solutions into the UVC
- Please do not insert PIV’s, do not inject ETT with any fluid
- if you need to use the phone, call using the phone in the
room using the # provided
Allied professionals are clearly part of your team:
o They are NRP certified, can provide B&M ventilation, chest compressions, and
may intubate if within their scope of practice
o Use the phone, send-off bloodwork as you see fit
Sim Team – Special Notes Equipment:
o
o
o
o
o
o
SimNewB + blood moulage + portable baby
Airway Box including working ETCO2 detector
UVC Line kits
Pneumothorax kit
N/S boluses (5 cc preloaded and wrapped)/syringes (1 and 3 cc)
Meds: Ativan, phenobarbital labelled in separate container
Case #1 objectives:
1. Anticipate need for extra resources – staff, blood for transfusion
2. stabilize acutely ill baby using NRP principles
3. organize appropriate health care professionals into functional team,
including designation of roles, promote sharing of information, leadership
skills
Brief:
MD called to delivery by L&D for urgent delivery (You are in a standard delivery
room)
 38 weeks gestation, normal pregnancy, GBS -ve
 26 yo G2P1 comes in to triage in steady labour, but has severe acute
abdominal pain and vaginal bleeding
 Fetal heart tracing is wave-like pattern around 150 bpm, very little
variability and severe late decelerations
 OB team is setting up for c section, you are in the resuscitation area
of the room next door.
You have 2 minutes to prepare in the delivery room.
Obstetrician hands mobile baby to team (approximately 3.5 kg), Pale – Lifeless
– Not breathing-covered in blood - Blanket lifted and Sim NewB is underneath
Case #1 – Fetal-Maternal Hemorrhage
Time
On exam
Vitals
Appropriate action
by team
0 min
Cyanotic
Un-responsive
HR 40
Apneic
SPO2 66%
Dry stimulate warm,
position airway, etc
for 30 sec
Ask re: respiration,
activity, term (no
meconium)
<1 min
Mottled pale,
cyanotic
HR 40
Apneic
B&M ventilation,
1-2 mins
Pale
HR 80
Apneic
SPO2 66%
2-3
minutes
3-4
minutes
Pale
HR 70
Apneic
HR 40
Apneic
SPO2 70%
4-5
miinutes
Pale, cyanotic
HR 50
apneic
Reassess seal and
equipment
MRSOPA
Consider intubation
Intubation
Think about access
Chest
compressions
delivering 100%
oxygen
Give epi by ETT
(3.5 cc)
5-6
minutes
Pale, mottled
CRF 4 sec
HR 80
Apneic
SPO2 70%
6-7
minutes
Pale
perfusion poor
CRF 4-5 sec
Pale but Color
better
CRF 3-4 sec
after bolus
*seizure, or
decreased a/e
to left side if
doing well
HR 160
(BP 48/18)
SpO2 80%
HR 180
(BP 50/24
after 2nd
bolus)
HR 200,
BP not
reading
SPO2 85%
>7
minutes
8 minutes
Pale ,
somewhat
cyanotic
response
Or Epi via
UVC (0.351.0 cc)
Continue to provide
bag and mask
ventilation by ETT
Consider why
baby’s apneic
Check Intubation
IV access, UVC
placement
IV access
N/S bolus #2
Additional D10W
Phenobarbital 20
mg/kg (or 10 x2) IV
push
If …
If ask for glu
4.1
May also
give
diazepam
or ativan
Glucose 3.6
DeBrief:
 Congratulate participants for finishing!
 Remind them of objectives and that debriefing is confidential,
safe environment paramount, for education
 Acknowledge technical limitations and limitations of simulated
resuscitation
Use advocacy inquiry technique if possible (avoid lecturing)
“Eg. I noticed that you ____________, can you tell me why
you did that then?”
If using video play back video in real time, pause if there is a learning
point to be made, or if one of the team members says something.
See debriefing guide for further help.