ALS course documents
Jan 2011 – v. 0.1
Cardiac arrest simulation teaching sessions Key learning outcomes To facilitate the application of current guidelines and the skills taught in the workshops / skill stations into the practical management of the patient in cardiac arrest To develop the candidates’ skills, attitudes and knowledge required to function as a member of a resuscitation team To develop the candidates’ skills, attitudes and knowledge required to lead a resuscitation team To develop the candidates’ management of the post resuscitation and stabilisation phase of the care of the arrested patient
Simulation management – instructor guidance The simulations must be run sequentially i.e. CASTeach 1 - simulation 1 should be run first, followed by CASTeach 1 - simulation 2 then CASTeach 2 etc for all groups. The only exceptions are CASTeach 2(2) and 3(2) which may be used interchangeably dependant on faculty preference and the placement of “Decisions relating to resuscitation” discussion on day 1 or day 2 of the course. Each simulation is designed to be completed in 10 minutes. A further 5 minutes is allowed for discussion and feedback. Background information for the candidates should be delivered in an SBAR format (Situation, Background, Assessment, Recommendation); alternatively RSVP (Reasons, Story, Vital signs, Plan) can be used depending on local practice. Use of this format for handover at the end of a simulation should also be encouraged. Information may be delivered directly as written, converted into dialogue or modified to better suit a candidate’s background. Core information should be retained. Please see below for an example ‘dialogue’ presentation of CASTeach 1. The discussion notes are designed to facilitate consistent teaching between stations. Where possible the instructor should try to cover the points contained in the discussion boxes, although it is acknowledged that time may not permit each point to be discussed on every occasion.
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Each simulation will be led by a candidate nominated as the resuscitation team leader supported by other members of the team as required. Candidates should be encouraged to participate in a way that is consistent with their everyday practice whilst allowing them to develop the range of skills required by resuscitation team members. All candidates should undertake the role of team leader on at least two occasions. It is important to facilitate the development of team leadership/team working during these simulations without detracting from the core knowledge and skills of resuscitation. The CASTeach simulation will be used as an opportunity to consolidate skills taught in the workshops such as defibrillation, airway management, chest compressions, ECG and ABG interpretation. Instructors must encourage good practice and monitor/give feedback on performance in these areas as required particularly in relation to the quality of CPR. High quality ventilation and chest compressions should be used. Candidates should be encouraged to identify relevant reversible causes and post arrest investigations rather than relaying a memorised list of inappropriate causes/investigations. CASTeach 5 simulation 3 is written in a similar format to the CASTest and may be used as an illustration of how the testing will be conducted.
Example: CASTeach 1 Guidance:
S
Nurse on acute admissions unit, calling about the patient in side room 6.
B
60-year-old patient admitted with shortness of breath yesterday. Previous history of MI with coronary stenting. Treated with standard medical ACS therapy.
A
Chest pain seems to be increasing, she is becoming more short of breath and her level of consciousness is decreasing.
R
Started high-flow oxygen. Review is requested urgently as she may need further treatment.
Faculty presentation to candidate:
S
‘Hello, this is one of the staff nurses calling from the acute admissions unit. I’m contacting you about the patient in side room 6’
B
‘She’s 60-years-old and was admitted yesterday with shortness of breath. She’s had a previous MI with coronary stenting 2 years ago, and on this occasion been treated with standard medical ACS therapy’.
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A
‘I’m a bit worried about her to be honest – her chest pain seems to be increasing, she is becoming more short of breath and she’s certainly drowsier than this morning’.
R
‘I’ve started high-flow oxygen and told the ward sister about her. I’d be really grateful if you could come and review her urgently as I think she’s deteriorating and may need further treatment’.
Heart rates Where particular heart rates are suggested it is recognised that this may not be possible with all rhythm simulators. The instructor in these situations should pick the nearest appropriate alternative.
Abbreviations
Atrial fibrillation
A
Airway
Asy
Asystole
B
Breathing
CRT
Capillary refill time
C
Circulation
NCT
Narrow complex tachycardia
D
Disability
Sinus rhythm
E
Exposure
AF
SR PEA P RR STach
Pulseless electrical activity
EWS
Early warning score
Pulse Respiratory rate Sinus tachycardia
VF
Ventricular fibrillation
VT
Ventricular tachycardia
SBAR
Situation, Background, Assessment, Recommendation
RSVP
Reasons, Story, Vital signs, Plan
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CASTeach summary
CASTeach
Simulation
Principle content
Defibrillation required?
1
1
VF
Yes
1
2
Pulseless VT
Yes
2
1
Asystole
Yes
2
2
Asystole
No
3
1
PEA
Yes
3
2
PEA
Yes
4
1
Tension pneumothorax
Yes
4
2
Broad complex tachycardia
Yes
4
3
Drowning/hypothermia
Yes
5
1
AF/post resuscitation care
Yes
5
2
Multiple co-morbidities
No
5
3
Narrow complex tachycardia
Yes
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