Patient transfer to CT

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

• 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).

• 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.

Radiographer:

• 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

HiLLO: 5