Patient transfer to CT
RIJ CVC & left radial arterial line
1L crystalloid at 100ml/hr
FM, FiO2 0.4, RR 25, SpO2 94%, crackles bibasally
Transfer monitor, transfer bag
I: You are the ICU registrar transferring the patient for a CT scan of his abdomen
S: You have just arrived at CT
B: 70M was admitted to HDU post Hartman’s procedure for acute large bowl obstruction (2o probable new colonic mass), 5 days ago. He continues to have abdominal pain and persistent inflammatory markers, so the ICU consultant on duty decided he will have a CT CAP to assess the source of ongoing infection. PMHx T2DM, HTN. NKDA Abx to Tazocin. SHx: Independent of ADLs, with ex-tolerance up to 1 mile twice weekly. TEP: Full escalation
A: You are there to as support for the transfer
R: Called for help
Potential Clinical Course
- Initially A own, B SpO2 94% on FiO2 0.4 FM, crackles bibasally C HR 120 bpm SR, BP 110/60, CVP 16, D GCS 15/15
- Patient starts having a tonic-clonic seizure
- The seizure self-terminates; however, patient’s GCS remains E1V1M4, with airway compromise.
- SpO2 drop 95%->75%->35% and progresses to respiratory arrest if emergency intubation is delayed.
- (The scenario can be run as a full transfer or as “just arrived in CT” based in a sim suite).
Info Sheet For Faculty
- Initial settings:
- SpO2 94% on FiO2 0.4 FM
- RR 25/min
- Bilateral air entry, crackles bi-basally
- HR 120bpm, SR
- BP 110/60, CVP 16,
- T 38.8
- Progress to:
- SpO2 75% on FiO2 0.4 FM
- (post-seizure) Obstructing airway
- HR 130 bpm
- BP 111/57, CVP 18
- If not intubated:
- SpO2 35%
- Absent breath sounds
- Increase HR to 80 bpm SR
- Progressing to cardiac arrest
- If intubated:
- SpO2 97% on FiO2 1.0
- HR 110bpm SR
- BP 90/60.
Bedside Nurse 1:
- You are a senior ITU nurse
- You are looking after a 70M post Hartman’s procedure for acute large bowl obstruction 5 days ago. He continues to spike temperatures and has abdominal pain. You have come on the transfer to CT for him to have an CT abdo.
- When you are at CT patient has a tonic-clonic seizure and drops his GCS following it.
- You take direction well, and can perform tasks asked of you in a timely fashion.
- You wonder if CT is the most appropriate place to intubate someone.
- You can put out calls if asked
- Beyond that you do not know how to help
Anaesthetic SpR if called:
- You are experienced, but let the ITU team lead on the situation
- If scenario is not progressing you wonder if intubation needs to happen quicker
- You wonder if CT is the safest place to intubate or perhaps moving to a place of safety is more appropriate