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Sepsis Scenerio

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Submitted By cheekyy
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Patient Data | Patient Name | Age | Gender | DOB | Medical Record # | Lenny Xigris | 49 | M | 8/13/1964 | 1819 | Chief Complaint | History of Present Illness | slipped in BR and shattered R patella and associated ligament tear | S/P (Status/Post) Right total knee replacement | Past Medical History | appendectomy at age 13, HTN | Current Medications | 1. lisinopril 10mg QD 2. HCTZ 12.5mg QD | Allergies | Height | Weight | Levels of End of Life Care | NKDA | 5”3” | 64kg (141 lbs) | Full Code | Admission Date | Admission Diagnosis | Admitting Physicians | Today | S/P (Status/Post) R total knee replacement | McNasty Ortho surgeon |

Scenario Data | Learning Objectives | Note: This simulation is part of a Microbiology course (MICRO 290). The main learning objective is to use a simulation of sepsis to facilitate student visualization and understanding of the mechanisms of key chemical and biochemical events in the human body during a human pathological scenarioBy the end of this scenario, the participant will be able to: 1. Observes and discusses the use of patient history and assessment data in the early identification and management of patients at risk for or with sepsis, septic shock and multi-system organ dysfunction (ANALYSIS). 2. Observes and discusses the possible diagnostic orders and therapies including medications for the management of patients with sepsis, septic shock and multi-system organ dysfunction. Uses factor analysis to calculate doses of medication (COMPREHENSION, APPLICATION). 3. Applies the microbiology concepts learned throughout the course to explain the physiological outcomes involved in sepsis (COMPREHENSION, APPLICATION, ANALYSIS). The microbiology concepts are the following: a. Sepsis and the immune system – Relate the signs (including labs) and symptoms to the processes in the immune system - Ex. What is the portal of entry and what are the first responders of the immune system? How does the organism evade and/or confuse the immune system and how does, this, along with the immune system in high gear, result in signs and symptoms observed (temp, pH, bicarbonate, local inflammation, signs specific to sepsis)b. Most likely cause of sepsis – understand how infection by a surgical procedure can lead to sepsis. Provide possible organisms that contaminated instruments or improper disinfection of site. Be able to describe the process of infectionc. What would be the preferred antimicrobial and why? d. Create a novel super drug that could address every aspect of sepsis at once. Judge its efficacy relative to current drugs. (SYNTHESIS, EVALUATION) | Scenario Location Setting | ICU, PCU, or Med Surg | Summary of Scenario State by State | 1. ???? I’ll let you figure this out 2. VSS NAD S/P Right TKR boarding in the ICU. Surgery done on Left knee 3. 24 hours later: previously stable man s/p TKR is tachy, tachpnea, hypotensive, low sat, and hyperthermic, if student asks skin is warm and flushed, this is very different from baseline. Needs sepsis screening and initial resuscitation 4. Initiation of Severe Sepsis Resuscitation Bundle Order 5. Severe Sepsis Resuscitation Bundle (Goal Directed Therapy): initiating first 6 hours GDT – obtaining parameters/values, Assisting with Line insertions, Hyperdynamic phase of septic shock 6. Patient is intubated and placed on Ventilator 7. Severe Sepsis Resuscitation Bundle (Goal Directed Therapy): initiating first 6 hours GDT (continued), Hypodynamic phase of septic shock 8. Code Blue, MODS, Death. Will progress rapidly to VF > asystole regardless of intervention. No response to painful stimuli. Daughter was contacted and has arrived to the unit | Paperwork Needed For Scenario | Admission Orders | Subsequent Orders | Lab Reports | X-Ray Reports | ECG Reports | Blank MD Orders | Physician Admission/Progress Notes | Consent Forms 1. | Other Forms 1. |

Mock Medications Required For Scenario | 1. Dopamine 400mg/250ml 2. Dobutamine 500mg/250ml 3. Levophed 8mg/250ml 4. Hydrocortisone 100mg /10ml 5. Vancomyocin 1 gm /250ml 6. Zosyn 4.5 gm IV 7. ACLS meds 8. Vasopressin 40u /250ml 9. PRBC 10. Albumin 250ML 5% 11. Hespan 500ml 12. Heparin 5000U/ 10ml 13. Pepcid 20mg/10ml 14. Dipravan 1gm /100ml | Equipment Required For Scenario | 1. 2 peripheral IVs 2. Pumps 3. Vent 4. CVP with SaO2 sensor (Prescep catheter) 5. A line with Flow Track and transducer for pressure monitoring 6. NC 7. Suction 8. NGT >suction canister 9. Foley 10. NRM 11. Intubation set 12. Crash cart 13. SCD machine 14. AE hose |

Supplies Required For Scenario | 1. Lots of IVF 2. Tubing primary and 2nd 3. CVP and A-line pressure tubing 4. Blood consents 5. Clipboard with forms 6. Blood tubing 7. Test tubes 8. Culture tubes | Props Required For Scenario | 1. 2. | Actors (Roles) Required For Scenario | 1. Surgeon (on phone) 2. Brother |

References:

American Heart Association (2010, November 2). 2010 American Heart Association Guidelines For Cardiopulmonary Resuscitation And Emergency Cardiovascular Care. Supplement to Circulation: Journal of the American Heart Association, 112(18).

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