We have simulation today. Well, two really. Simulation is this lovely thing where we are rushed in like cattle, given 2 seconds to look at a chart and orders and meds, and then pushed into a room with our patient and then we are supposed to make magical things happen. No matter how much you prepare, you could have memorized every med, every symptom that you are supposed to see, and KNOW exactly what you are supposed to do....
Then we FREEZE.
Your patient starts asking you for mimosas to take their medication with. The monitors in our life-like simulation hospital don't work, you are supposed to be able to hear the heart beat and lung sounds on our "patient" but we can't....it's not working. All of these things just make you freeze. You aren't dealing with a real actual patient, and the interaction is just not a natural one, no matter what you do. It is supposed to be a learning experience, but you walk out feeling like the only thing you learned was how much of an idiot you are. The best simulation I had was our Peds sim, but the worst thing the kid was doing was doing was being a picky eater and wanting twinkies for his meal....different story from mimosa dude.
So, we have one simulation with a partner (sometimes this goes great, sometimes it goes wrong,VERY wrong) where our patient was admitted to rule out myocardial infarction. We have a website where it gives us a mock up patient chart, and she has elevated troponin levels, elevated ST segment on EKG, elevated CK-MB levels. Lady had a heart attack. We could go in and she's totally fine, but she's having back pain, so something is still going on. We may just need to give her nitro, or we will be adjusting her Heparin drip, who the eff knows.
Then we have a group simulation for code management. We had a really crappy boot camp run through of a code management. This I believe deserves a lil mini bootcamp of its own, in my opinion. We assess the patient, they aren't responsive, no pulse.....call for help, press code button and start chest compressions. Someone brings in the crash cart, we put a back board under the patient, make sure we have IV access, do an EKG.....we are only shocking for certain heart rhythms. We may need to administer epinephrine, dopamine, etc. Someone needs to run the code, someone needs to record the cycles, the shocks, the meds given. One person does compressions, one person does breaths with the bag, and they need to be relieved after so many cycles. Hopefully, the person will come out of VT or VF, and return to sinus tachy or sinus rhythm.
Luckily, the code management is a larger group, so they tend to go better. But the one person or partner sims are usually a crap shoot. You just have to go in and do the best that you can. I have learaned to not over prepare, because it doesn't mean that you will do any better. I just try to make sure I know some things I should do, or what the meds do, but I can't get all worked up about it. It is what it is!
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