# need some help coming up with a good scenario



## Keep Dreaming (May 4, 2013)

Hi, im helping teach some uni students skills and procedures for the first time. I have been asked to organise a scenario for the lectures/mentors (all are at least qualified paramedics and we should have two intensive care paramedics there as well) to demo to our students. Basically it will be all of the mentors and lectures available (about 10 people) we have one person willing to be the patient so far, we were hoping one would be enough but if needed we can get some more. 

We need some ideas for a good scenario of a call out to use for this demo, something relatively full on. We have access to everything an ambulance would include including the ambulance itself. They have done car crashes alot already and are trying to mix it up a bit. We have access to basicaly anything you would need to make the scenario work. We would like to use skills such as IV, spinal immobilization, extrication etc, splints, basically anything we can cram into one massive scenario. Any ideas?
A massive thanks in advance  If you need more info just ask.


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## NomadicMedic (May 4, 2013)

A roofer, working on a second story building, has a medical emergency (MI/CVA/hypoglycemic event) and falls off the roof. 

Boom. You can demo medical, trauma and how to pronounce a PT on scene.


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## Handsome Robb (May 4, 2013)

DEmedic said:


> A roofer, working on a second story building, has a medical emergency (MI/CVA/hypoglycemic event) and falls off the roof.
> 
> Boom. You can demo medical, trauma and how to pronounce a PT on scene.



Hook, line and sinker.

I was gonna say the low speed MVA that was caused by a syncopal episode secondary to señor's massive inferior AMI + RVI. The kicker is he's altered and + airbag deployment so they're forced to board and collar him but you said no car accidents :-/


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## Keep Dreaming (May 4, 2013)

DEmedic said:


> A roofer, working on a second story building, has a medical emergency (MI/CVA/hypoglycemic event) and falls off the roof.
> 
> Boom. You can demo medical, trauma and how to pronounce a PT on scene.



Nice, although I'm not quite sure how to simulate that with a real person but i guess we do have the simulators for a reason.
The low speed MVA might work.

I go this crazy idea a few hours ago. We have two wreckers cars we use for scenario's both are structurally sound but i believe the engines and all fuel oil, and everything like that's been completely cleared. Do you think it would work if we took a car put the nose in front of a tree, got some chains and winches and stuff, winched the nose up high enough so we can fit the other car under it and chain it to the tree, so it doesn't move. Put the other car under it, then stuck our patient (shes a second year student but i know her personally outside of work) in the drivers side of the car that's half up the tree? Have you guys ever had to attend an MVA like that or similar, and would it be to dangerous for everyone involved?


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## mycrofft (May 4, 2013)

Drowning, near drowning, electrocution and chlorine or bromine exposure at a pool, maybe woith a fire.


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## Handsome Robb (May 4, 2013)

mycrofft said:


> Drowning, near drowning, electrocution and chlorine or bromine exposure at a pool, maybe woith a fire.



I like it. The few drownings/near-drownings I've had the FD has deferred everything to me including how to remove the pt from the water because most know I've had a lot more training on it and done it A LOT more than any of them in my previous jobs. 

Requires full spinal motion restriction, and aggressive ALS airway control and auctioning if you want to have any chance of resuscitating that patient.

If you really wanted to add a twist do a cold water submersion with a severely hypothermic patient in full arrest. See how they handle it in regards to meds, defibrillation attempts, pt handling/packaging, warming techniques, things that they don't do every day.


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## Keep Dreaming (May 5, 2013)

These are all good ideas, thanks heaps. 

This scenario is for the lectures and mentors to do, with the students watching because some of them are having problems with how to approach a scenario, we want to use a real person as the patient because the simulators, even though they come close, you cant use them for extrication, and they just aren't as good as a real person, especially since they need to be plugged in to work. We will use what has already been suggested in classes though.

We are happy to do a car crash if its a good one. We want to use a real person. We can do every skill you would be able to do on a conscious patient, apart from administer real drugs (probably use fluids to mimic it) and the patients only rule is no IO's, not that i blame her for making that call


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## Melclin (May 5, 2013)

I had a great job relatively recently that involved a few different procedures as well a some good thought provoking moments. 

70year old female, hx of spontaneous SAH, starts acting strangely after returning from toilet. Dysphasia, difficult speaking at all, speaks only single words every now and then, L sided inattention, nystagmus, SpO2 84%, nil other of significance. Interesting differential here. 

Pops into a borderline wide complex, regular tachycardia from a narrow sins rhythm of 90. Nil change in obs, asymptomatic. Interesting in considering the relationship between arrhythmia and SAH, and what consitutes VT and when to be calling for backup and to be doing things like putting a second line in in potentially sick pts and preparing drugs and fluids. On further inspection the VT was sinus tach with new LBBB. But it was quite hard to see initially. Interesting discussion available here about treating/diagnosing these kinds of arrythmias.

Pt had tonic clonic seizure, terminated. GCS 3, intubated via RSI, one of lines clotted occluded during. Persistently hypotensive after intubation, so there is that whole deal of working out whats causing the that. Eventually came to the point of decompressing her chest, with the only indication being hypotension, which was brave decision by the ICP in my opinion. Successful in correcting her BP.

Follow up in ICU a week later, nobody has any idea what caused the presentation. No stroke. No deficits. Pt being discharged with neuro follow up ?seizure.


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## SpecialK (May 5, 2013)

Oh my goodness that patient sounds like something from an ambo's nightmare.

On calling for backup, all patients in a wide complex tachycardia attended by those under ALS level should have backup called for, because a wide complex rhythm is VT until proven otherwise.  However having said that, all clinical people should be able to cardiovert (be it in automatic mode for those who cannot use a manual defibrillator) but still ...


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## Melclin (May 5, 2013)

SpecialK said:


> Oh my goodness that patient sounds like something from an ambo's nightmare.
> 
> On calling for backup, all patients in a wide complex tachycardia attended by those under ALS level should have backup called for, because a wide complex rhythm is VT until proven otherwise.  However having said that, all clinical people should be able to cardiovert (be it in automatic mode for those who cannot use a manual defibrillator) but still ...



Actually it was awesome. Best job I did in months. Everything went really smoothly despite the decline of the patient. Not a single raised voice or second of indecision either; a credit to the Intensive Care paramedic running the second act. We were discussing decompression and I confidently stated that it didn't feel right. I didn't think that was the issue. I was happily proven wrong 

On the topic of VT. 1) It was a reminder of the wide, fast, regular is VT until proven otherwise rule. 2) Was an interesting case of 'is this rhythm a symptom or the problem' In retrospect, its fairly clear, but at the time when we were first looking at the rhythm and starting to draw up drugs, it didn't seem that clear and it was a fun process figuring it out in tandem with managing a dynamic pt.  

We can manually defib, but we don't sedate to sync cardiovert. That is Intensive care territory.


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## Squad-6 (Jul 8, 2013)

DEmedic said:


> A roofer, working on a second story building, has a medical emergency (MI/CVA/hypoglycemic event) and falls off the roof.
> 
> Boom. You can demo medical, trauma and how to pronounce a PT on scene.



Have the patient land in a wheel barrel  and ask a team of 2 to remove the patient from the wheel barrel while holding c-spine.


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## Fortion (Aug 26, 2013)

mycrofft said:


> Drowning, near drowning, electrocution and chlorine or bromine exposure at a pool, maybe woith a fire.



how a pool and fire will be a good scenerio?


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