|
Ambiance:
|
| - Adult hospital bed (bed, bedside table, armchair) |
| - Bench with sink and drawer for storing materials |
|
Materials used:
|
- Stethoscope
- Gauze packs
- Tray
- Micropore
- Protective goggles
- Procedure gloves
- Bottle of alcohol gel
- Sterile gloves
- Sachets of alcohol swabs
- Indwelling bladder catheterization kit
- Bottle of standard disinfectant
- Indwelling bladder catheter |
- Paper towel
- Catheters for venipuncture
- 3ml, 5ml and 10ml syringes
- Catheter protection film
- 40x12 aspiration needles
- Macrodrip IV administration set
- 20ml bottles of distilled water
- Valved connector for venous access
- 10ml bottles of saline solution
- Blood collection vials
- Saline solution bottles (100ml and 250ml)
- Sample Collection Vials |
|
Fictitious documents:
|
- Medical record
- C-reactive protein report
- ID bracelet - Urea report |
- CBC report
- Abdominal ultrasound report
- Lactate report
- Abdominal X-ray report
- Creatinine report |
|
Fictitious medications:
|
- Anidulafungin
- Dipyrone |
- Cefepime
- Xylocaine gel
- Metronidazole
- Ringer’s lactate |
Specific items:
Whitish solution to simulate purulent secretion from the surgical wound |
|
Simulation dynamics
|
|
Participant's conduct: |
Manikin actions:
|
| If verbal contact with the patient is attempted |
Moaning, says he/she feels a lot of pain |
| If questions are asked about diuresis |
Says he/she hasn't urinated for more than 8 hours |
| If vital signs are checked (available on multiparameter monitor) |
Vital signs parameters*:
Sa.O2: 98%
HR: 92 bpm
RR: 22 rpm
AT: 39ºC
BP: 120x80mmHg |
| If abdominal palpation or inspection of the surgical wound is performed |
Acute pain reaction to palpation.
Decreased level of consciousness.
Vital signs parameters*:
Sa.O2: 95%
HR: 105 bpm
RR: 23 rpm
AT:40ºC
BP: 100x60mmHg |
| If laboratory or imaging tests are requested |
Vital signs parameters remain altered.
Reports with results compatible with sepsis will be made available on the computer. |
| If an evaluation is requested from the surgical team |
Vital signs parameters remain altered.
The participant will receive a notice that the team is in surgery and will only be available in a few hours. |
| If an institutional sepsis protocol is initiated, but antimicrobial therapy is not initiated. |
Vital sign parameters remain altered.
End of scenario. |
| If an institutional sepsis protocol is initiated and antimicrobial therapy is started |
New vital signs parameters*:
Sa.O2: 99%
HR: 73 bpm
RR: 20 rpm
AT:37.2ºC
BP: 120x80mmHg
End of scenario |
|
Actions expected within the simulation
|
|
Participant doctor:
|
- Opening of the sepsis protocol;
- Evaluate the surgical wound and identify the drainage of purulent secretion;
- Request blood cultures from two different sites, complete blood count, lactate, C-reactive protein and creatinine;
- Request abdominal imaging tests;
- Determine treatment for nosocomial sepsis and prescribe antibiotic therapy according to institutional protocol: vancomycin (20-25mg/kg) + Meropenem (1mg to 2mg), preferably associated with Anidulafungin (200mg - attack). |
|
Participant nurse:
|
- Identify the drainage of purulent secretion from the surgical wound;
- Identify vital sign parameters compatible with Systemic Inflammatory Response Syndrome (SIRS);
- Identify symptoms of organic dysfunction (oliguria and decreased level of consciousness) and contact the medical team;
- Immediately start the treatment prescribed by the medical team. |
Construction and validation of an interprofessional simulated scenario for the identification and management of sepsis