The Johns Hopkins Medicine Simulation Center Scenario Planning Worksheet

Step 1: General Scenario Information

Developer Name: Department: Case Name: Date: Target Duration (min): Intended Learners:

Case Description (describe your patient as a case presentation-Information for Facilitator ONLY):

Step 2: Learning Objectives At the end of this scenario, participants will be able to: 1) 2) 3) 4) 5)

Step 3: Patient Information

Patient Name: Gender: Weight: Height: Clinical Setting: Case Description for Participants: (SBAR)

Complaint: Allergies: Medications: Past Medical History: Social History: Events Leading to Current Condition: Temperature: Labs:

Step 4: Scenario Algorithm

Manikin Capabilities/Features/Options

Airway Options Vocal Sounds: Breath Sounds: Circulation: Heart Sounds: Bowel Sounds:  Normal Airway The manikins have the  Normal breathing  Normal  Describe types of  Normal Bowel  Tongue Edema, capability to replicate vocal  Abnormal BrS Circulation heart sounds, and Sounds  Cervical Range sounds. There are preloaded  Differential sounds  Weak Pulses, location (if  Hypoactive, sounds, but if you want of Motion R vs L, apices vs.  Absent important)  Hyperactive, specific statements please bases, posterior vs. Pulses (PEA)  Trismus type them below and we will  Borborygmus anterior  Pharyngeal simulate and upload them i.e. Obstruction coughing or my chest hurts…  Laryngospasm

Manikin Initial Peripherals (Please BOLD Your Answer)

IV placed? YES NO Arterial Line Currently placed? YES NO ECG placed on the patient? YES NO Patient currently placed on O2? YES NO Is the patient on a ventilator? YES NO Does the patient have an NG tube? YES NO

Describe any other pertinent initial set ups for manikin (type of bed, location in room, moulage, any other important information)-A photo would be ideal

Scenario Stage Pati Simulator Expected Interventions (Participant Simulator Scripted Participant ent Parameters Actions) Response (Confederate) Response Con (Bold which to ditio display on Monitor) n Initial Stage Gen: Vitals: Airwa ECG: y: HR: Breat hing: BP: Circul RR: ation: SpO2: Disab ETCO2: ility: Temp: Expo sure: Pt Condition: Other: Stage 2 Chan Vitals: ge in Cond ECG: ition: HR: Labs: BP: X- RR: rays, other SpO2: Diag ETCO2: nosti cs: Temp: Pt Condition: Other: Stage 3 Vitals: ECG: HR: BP: RR: SpO2: ETCO2: Temp: Pt Condition: Other: Stage 4 Vitals: ECG: HR: BP: RR: SpO2: ETCO2: Temp: Pt Condition: Other: Stage 5 Vitals: ECG: HR: BP: RR: SpO2: ETCO2: Temp: Pt Condition: Other:

Step 5: Additional Manikin Capabilities (BOLD if requesting or need additional information—a simulation staff member will contact you.)

 Intubation (oral/nasal)  Supplemental O2  needle decompression  chest tube placement  IV placement (one side vs. two sided)  Arterial line moulage (does it need to work?)  Foley catheter placement  Surgical cricothyrotomy  Wounds/injury simulation  Profuse bleeding simulations  Blood pressure cuff monitoring  SpO2 monitoring cable  NG tube placement  Tracheotomy placement  Ability to electronically post ECG, Chest X-ray, Lab Values and other media upon request  Seizure  Intraosseus needle placement (and location)

Key Debriefing Points