The Simulation Experience
Goal: The goals of a simulation experience include teamwork, communication, critical decision-making, and establishing roles among team members. This is the opportunity to put all your knowledge and skill together in one place.
Settings: You will be working in a simulated environment. We make every effort to replicate the actual surroundings you might encounter in the hospital. You will generally find ‘staff’ members milling about in and out of the room as you would in a real setting. These ‘staff’ members are very knowledgeable and are there to assist you within their specific role. You may notice specific sounds and/or smells similar to those you would find in a real situation.
Person: The patients you encounter will be different individuals although they look very similar because their roles are played by sophisticated computer-controlled mannequins. Each patient has a name, age, medical and social history and a unique personality. Depending on the situation, all, some, or none of this information may be available. All responsive patients have a voice and will be able to converse with you in a normal fashion although the mouth does not move when the patient speaks. Responses may be delayed 2-3 seconds, so give the patients time to answer your questions.
Eyes: The patients’ eyes do not open and close and the pupils do not dilate and constrict. You may have to ask a staff member for results on these types of tests.
Airway: Patient airways are anatomically correct. You can use oropharyngeal airways, nasopharyngeal airways, and LMA’s. Patients can be intubated and you can perform a Cricothyroidotomy if necessary. A patient may have a ‘difficult’ airway. Difficult airways can include trismus, swollen tongue, decreased cervical range of motion, pharyngeal obstruction, etc.
Breathing: Your patient can breath (if not in respiratory arrest). When you patient breaths, the chest will rise and fall and the rate will be accurate for the situation. Lung sounds can only be heard anterior and may be different on each side. If you are not sure what you are hearing, make an educated guess and ask a “staff” member to confirm your findings; they will provide reliable information. Pneumo decompression can be performed on either side and a chest tube may be placed on the left side when necessary. There will be no anatomical changes regardless of the situation even though the information provided may steer you in that direction.
Abdomen: The patient will develop gastric distention if ventilations are too vigorous or if the endotracheal tube is misplaced.
Sounds: The patients have heart, breath, and bowel sounds that can be auscultated using a stethoscope. The quality of the sounds is poor and they can easily be missed or misinterpreted. In addition they are binary. That is, the sounds are “absent” or “present” – it is difficult to distinguish “diminished”. Also, when the sounds are supposed to be abnormal they are decidedly so – there is just normal or abnormal – nothing in between. If you determine abnormal sounds but are not sure exactly what you are hearing, you can state what you believe you hear clearly and a staff member or the patient will be able to confirm what the sounds are.
Pulses: Patients may have carotid, L brachial, L radial, femoral and pedal pulses. If you press too hard trying to palpate a pulse, you may occlude the artery and not feel the pulse. Be gentle! The pulse will be strong, weak or absent depending on the situation. For example, a patient with a low blood pressure will have weak or absent distal pulses based on what the blood pressure reads.
Vital Signs: There are some things your patient just can’t do in simulation. For example, your patient cannot have diaphoresis or a change in color or temperature. A ‘staff’ member will be happy to assist you with that type of information. You can auscultate a blood pressure in the left arm or ask that the patient be put on an automatic BP machine (you will have to ask for the blood pressure when you want it, but the machine will take the pressure for you), you can check pulses and place the pulse oximeter on the patients’ finger. Once you have the monitor cables on the patient (they snap on), you can use the touch screen monitor to bring up the rhythm. If you need to cardiovert or defibrillate, you must use the hands-free pads (which also have snaps that must be on securely for the energy to transmit). REAL ENERGY IS USED FOR DEFIBRILLATION, CARDIOVERSION, AND PACING – BE CAREFUL!!!
IV Access: IV’s can be placed in the Right hand/arm. Often you will find that someone has already started an IV for you. Tubing is needleless making administration of drugs safer.
Headwall: The headwall has functioning Oxygen and Suction. Any adjuncts needed should be asked for and a staff member will be happy to find them for you. If the headwall fails to function, you may need to ask a staff member for assistance.
Medications: When administering medications, they must actually be given to elicit a response from the patient. When giving medications, you MUST clearly verbalize what you are giving AND the dose given. When appropriate, medications may be given SL, ET, Nebulizer, etc. as necessary. A reasonable amount of time must be given for a response to medications administered.
Additional Information: As with treatment of any patient in a hospital setting, you may ask for any equipment you need. As in a real situation, you may or may not get it in a reasonable amount of time. Treat malfunctions of equipment as you would in a real-life situation. Some patients will have EKG, X-Ray, and/or Lab results; some may not have anything available for a while. You can check these with the touch screen monitor.
*Acknowledgement to CMS at Harvard
**The SimMan Video contains two errors: Chest tubes can be placed on the Left side only, and you cannot simulate drawing of arterial blood gasses in this model.
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