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198.174.110.146 - 8590103622523334148PEAdraft1
198.174.110.146 - 8590103622523334148PEAdraft1
198.174.110.146 - 8590103622523334148PEAdraft1
‘Shortness of Breath/PEA’
-2005 Model of the Clinical Practice of Emergency Medicine 1.1 Chest: Shortness
of Breath, critical. 3.1 Cardiopulmonary Arrest, critical. 16.2 Disorders of the
pleura, mediastinum and chest wall, tension pneumothorax, critical.
-Appendix 1: Airway Techniques, Intubation. Resuscitation, CPR. Thoracic,
thoracostomy.
B. Secondary
1. Describe the differential diagnosis for PEA (MEDICAL
KNOWLEDGE)
Obtain IV access
Provide oxygen
Place patient on monitor
Order appropriate labs and tests—Labs: CBC, chemistry panel (can
request iSTAT), Tests: EKG, CXR
Perform physical examination
Manage patient’s respiratory distress
Establish definitive airway
Recognize PEA
Treat PEA
Coordinate final disposition for patient
IV. Environment
A. Lab Set Up – Emergency Department Critical Care with necessary
equipment/supplies for airway management, needle thoracostomy
B. Manikin Set Up – METI HPS (for program attached using Standard Man
as patient), certainly would work well with ECS or SimMan.
Moulage: None
Clothing: Wig, any other dress to make patient seem like elderly male.
C. Props:
• IV lines with mock fluid
• Oxygen mask, have nasal cannula available as well as nebulizer
• BiPAP machine/ventilator optional
• Drugs: Albuterol/atrovent, steroids (PO/IV), magnesium, induction
agents, paralytics
• Labs/Studies: Optional—can add basic labs (attached), CXR with L
sided pneumothorax, negative cardiac US picture.
V. Actors
A. Roles: Nurse, RT
B. Who may play them: Usually actors, could be other participants
C. Action Role – Nurse to assist with IV, monitor/vitals, and drug
administration. RT to assist with oxygen/nebs, BiPAP, bagging
Scene: Rural Hospital, single RN, lab tech and radiology tech busy in the hospital
-Worsening Status (time 3:00): HR 110, BP 130/800, Sat 90% (on oxygen), RR 40
-physiologic changes include:
Left interpleural volume to 1000
Rhythm change to sinus with PVCs
Blink/eyes to ‘closed’
-PEA-Tension PTX
-HR 110, BP 40 (PEA), RR bagged
-physiologic changes include:
Left lung compliance factor 0.15
Rhythm: PEA
Needle Decompression
-HR 110, BP 130/80, Sat 97%, RR bagged
-physiologic changes include:
Rhythm to sinus
I to E ratio to 2:1
RR factor to 1
HR factor to 0.8
Shunt fraction to 0.1
Left lung compliance factor to 1.0
Left interpleural volume to 0
Stabilized
-HR 90, BP 140/90, Sat 97%, RR bagged
-physiologic changes include:
HR factor 0.5
Packed RBC infusion 400
Bolus: Nitroglycerine 200mcg
Case concludes after final disposition for patient has been coordinated.
*NOTE: Stop AV equipment if taping for debriefing
(see final attachment, METI program coding for more details about case program)
Critical Actions Checklist
Obtain IV access
Provide oxygen
Place patient on monitor
Order appropriate labs and tests—
Labs: CBC, chemistry panel (can
request iSTAT), Tests: EKG, CXR
Perform physical examination
Manage patient’s respiratory
distress
Establish definitive airway
Recognize PEA
Treat PEA
Coordinate final disposition for
patient
09/14/2007 Rurual Hospital AUT O RES ULT
He m o gra m + Platelets
WBC 12.5
HGB 11.1
PLTS 355
Debriefing guidelines: