Your First Sedation Simulator Case
1. We suggest you run case 1 first. If you already opened a different case, click New Case and select case 1 to get started.
2. You can control a number of personalized settings for the application in the Settings menu. Many users enable or disable the pulse oximeter sound depending on your preference.
3. The simulator initially presents the patient in the procedure room. The patient already has a running IV and is connected to routine monitors including ECG, non-invasive blood pressure, and pulse oximeter.
4. The preop evaluation is presented. You can review the preop evaluation again anytime during the simulation by clicking the Preop button. Make note of the patient’s weight in the Physical Exam section of the preop evaluation since you will need that to calculate drug dosages.
5. Take a few minutes to familiarize yourself with the main simulator screen. The simulation clock is located in the upper left hand corner of the display. You can click on the clock to pause the simulation.
6. The Help menu provides suggestions about what to do next during the case scenario. Use the What Now help feature frequently to keep you on track. Learning objectives with a suggested management plan for each case are available. In addition a glossary of abbreviations used in the application, and normal values are also provided in the Help option.
7. Examine the patient with the Patient menu.
8. Use the Monitor menu to control monitors for the case. Routine monitors, including ECG, non-invasive blood pressure (NBP), pulse oximeter are automatically placed. The capnogram will be activated when the patient is connected to the breathing circuit. You can also use invasive arterial pressure, a central venous line, and a pulmonary artery catheter as required by the clinical situation.
9. The patient comes to the procedure room with one IV running. You control the type of IV fluid and rate of administration with the Fluids menu. You can run up to two intravenous lines. Select the type of fluid in the content field and adjust the infusion rate. You can also administer a fluid bolus if desired.
10. Select the Airway menu to place an oxygen mask on the patient. It is assumed that the oxygen flow is appropriately set. Notice that the capnogram is activated when the patient has a maskin place. If you use a bag-valve mask, positive pressure ventilation will automatically be applied.
11. The Airway menu also allows you to administer several airway maneuvers including insertion of an oropharyngeal and/or nasopharyngeal airway, or apply a jaw lift maneuver.
12. Sedate the patient prior to the procedure. If you can’t remember the patient’s weight, you will find it in the Physical Exam section of the Preop Evaluation.
13. There are many possible combinations of medications for procedural sedation. Midazolam + Fentanyl is a popular combination. In some places, propofol infusion can be added. The most important consideration for sedation is to be vigilant for airway obstruction or decreased ventilation, and properly trained and prepared to manage the airway and breathing in case of severe respiratory depression.
14. Inject midazolam by selecting it from the Drugs list, then a bolus of 2mg. Select Administer to give the drug. You can review dosing and other information about the selected drug by clicking Display Drug Info after selecting the drug.
15. Then administer fentanyl 50mcg. Notice the change in respiratory rate shown in the capnogram.
16. Give the medications a couple minutes to reach peak effect. Then you can assess the patient’s condition by clicking the Patient menu.
16. If desired, you can add an infusion of propofol. Start at 10-20 mcg/kg/min and increase as needed.
17. If you are not using propofol, you can administer more fentanyl and midazolam to achieve the desired level of sedation. Midazolam causes sedation and amnesia, and fentanyl causes sedation and analgesia. Remember these drugs will be synergistic in causing respiratory depression.
18. When you think the patient is ready, tell the cardiologist to prep the patient using the Cardiologist menu. After a couple minutes the cardiologist will request permission to start the procedure.
19. Administer additional medications to achieve the proper level of sedation for the stimulation.
20. In these simulations it is not necessary to have the cardiologist complete the entire procedure. A heart icon will appear when you have successfully completed the learning objectives for the simulated case. A ghost indicates the patient has died and you should try the case again. A broken heart means the patient survived but you could have managed the case better. It is not necessary to obtain a perfect score for the simulation. The heart icon indicates you managed the case well.
21. You can review the case record using the Case Log option. In addition to a record of the simulated patient’s condition and your management throughout the simulated scenario, you will receive a debrifing of your management.
22. Select New Case to start another simulation. Before you exit the current case, you may want to save the record of your case management.
23. You can review previously saved case logs in My Account > View My Cases.