Transcript Slide 1

Stroke Module
Scene A – Trauma Room
Scene A Introduction
In this module, you are role playing a physician in the
Emergency room at St. Normal Hospital. Your specialty is
radiology. You are the doctor who reads CT scans, MRI’s,
PET scans, angiograms. You have been a doctor for some
time now, and are interested in becoming chief of staff at
the hospital. Your “performance” here may help determine
whether or not you get this prestigious role.
The POINTS that you gain in each scene will help the
selection committee decide whether or not you are a good
person for the job! The way to gain the most points is to
get the correct answer on the first try. To do this, you’ll
need to do a bit research before submitting a response.
(not sure if we’re still doing the points)
Note to computer programmers & animators: Underlined words should
be links to the specific part of the EMR.
St. Normal hospital has all its patient files (vitals, history, test results) and
protocol (the order in which certain tests should be done when) located
on a local intranet. A computer on a rolling stand is located by each
patient bed where you, the patient’s doctor, can access the information
at any time. Here is a
Dr. Notes: Results from procedures will be
sample of what that
computer screen looks located here along with your explanation for how
you came to that conclusion. Use Dr. Notes to
like. Mouse over
different portions of the review records of procedures done, the results,
your diagnoses and your suggested treatments.
screen to learn how
each section will help
you.
The protocol: This gives you stepby-step directions on what to do
throughout your experience.
EMR: (Electronic Medical Record): Refer to
this if you need clarification of something in
the protocol. Additional points are added to
your score for accessing this information!
Patient History: Gives patient
history and test results
Protocol
E
M
R
Note to computer programmers & animators: The buttons should be mouse overs
so participants can learn how each part of the screen will function.
Dr.’s
Notes
Patient
History
Click Here
to Begin!
Beep! Beep! Beep!
Your pager goes off and indicates
that you are being called to a
suspected stroke case that is
coming into the Emergency Room
(ER) from an ambulance. You will
meet the neurosurgeon, as well as
the ER doctor in the Trauma room
to assess the situation as soon as
the ambulance arrives. So quickly
make your way to the trauma room.
Note to computer programmers & animators: This could be its own
screen maybe in a bubble that pops up after the participant has clicked
on the Ready to Begin link on the previous slide.
Click Protocol to begin.
This is the text box that should pop up when participant clicks
on patient history.
Protocol:
1. Check
patient vitals,
symptoms and
history (Click on
patient history.)
Protocol
E
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This is the text box that should pop up when participant clicks
on protocol.
Dr.’s
Notes
Patient
History
Patient name: Shawn Idieh Jones
Patient age: 45
Medications patient has taken in the last 2 weeks:
(blood pressure medicine)
Misc. Behaviors: smoker, non-drinker, lifts weights
three times a week.
Family history of:
Heart disease
Cancer
Diabetes
Symptoms: (compare to symptoms listed in the EMR)
When Shawn, a farm mechanic, was working on a
combine, he suddenly got the most severe headache he
had ever had. He began throwing up and sweating
profusely. He was able to call his wife, who in turn
called an ambulance and met him at the hospital. He is
unconscious as he arrives in the ER.
Vitals:
Blood Pressure: 149/90
Pulse: 98 beats per minute
Close/Next
Once participant hits the close/next button on the patient
history pop up, the second set of directions should appear in
the protocol box.
This sentence should be a link to the text box below. When the
participant clicks on # 2 in the protocol box, this is what they
should see.
#2: Risk Factors for stroke that Shawn Jones has: (click all that
apply then click submit: you receive the most points if you get it right on
the first submission!)
Protocol:
1.
High blood pressure (if doesn’t check: “See what medications the
patient is taking.”)
Check patient vitals, symptoms and history (Click
on patient history.)
2. Determine which high risk factors
the patient has for stroke. (Hint: go
to the EMR and read about stroke
risk factors and re-read patient
history. When ready to submit
your answer, click on the link
above.)
Heart disease (if doesn’t check: “Check family history”)
Protocol
E
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Dr.’s
Notes
Patient
History
Inactive-little exercise (shouldn’t be checked, if it is “Check Misc.
behaviors.”)
Smoking (if doesn’t check: “Check Misc. Behaviors”)
Diabetes (if doesn’t check: “Check family history”)
Radio buttons
Once a participant has completed previous protocol directions,
they can stay on the screen, but make them smaller or a
different color. When there are too many, a scroll bar should
allow the participant to go back and see them all.
High cholesterol (if doesn’t check: “See what medications the patient is
taking.”)
Submit answer
Correct Answer: All should be selected EXCEPT answer C
What is in parenthesis is the feedback the participant should
receive.
Add this to the Dr.’s Notes once participant answers #2 correctly.
Patient has many of the risk factors associated with stroke: high blood
pressure, heart disease, smoking, diabetes, and high cholesterol.
When they get it correct the feedback should be “Great job!
You understand Shawn’s risk factors for stroke. Remember,
this information will be stored in your Dr.’s notes if you need to
read this again in the future.”
This sentence should be a link to the text box below. When the
participant clicks on # 3 in the protocol box, this is what they
should see.
The NIH Stroke Scale Score is 17. What do you think Dr.
(participant name entered here), should we treat this patient
or not?” Hint: The EMR will help you decipher the NIH
Score.
Protocol:
2.
Determine which high risk factors the patient has for
stroke.
3. Determine whether or not
treatment will help or hinder the
patient by reading the NIH stroke
scale score. (Hint: go to the EMR.
When ready to submit your
answer, click on the link above.)
No, give no treatment: patient will recover without
intervention
Protocol
E
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Dr.’s
Notes
Yes, give treatment: patient will benefit from intervention
Patient
History
No, give no treatment: patient is too severe for treatment
Once a participant has completed previous protocol directions,
they can stay on the screen, but make them smaller or a
different color. When there are too many, a scroll bar should
allow the participant to go back and see them all.
Add to EMR: Info on NIH stroke scale
and how it is interpreted
Submit answer
Correct Answer: B
Correct answer feedback:
“Correct: The NIH score was 17, which is in between 422. This makes the patient a perfect candidate for
treatment.”
Add this to the Dr.’s Notes once participant answers #3
correctly.
NIH Stroke Scale Score Results: NIH score was 17, which is in
between 4-22. This makes the patient a perfect candidate for treatment.
Wrong answer feedback:
“Be sure to read in the EMR, how to decipher the NIH
Stroke Scale score.”
This sentence should be a link to the text box below. When the
participant clicks on # 4 in the protocol box, this is what they
should see.
What type of stroke do you think Shawn Jones has had?
(Hint: visit the EMR.)
Protocol:
2.
3.
Determine which high risk factors the patient has for
stroke.
Ischemic
Determine whether or not treatment will help or
hinder the patient by reading the NIH stroke scale
score.
4. Make an initial diagnosis on the
type of stroke based on patient
history & symptoms.
Hemorrhagic (correct)
Protocol
E
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Dr.’s
Notes
Patient
History
Once a participant has completed previous protocol directions,
they can stay on the screen, but make them smaller or a
different color. When there are too many, a scroll bar should
allow the participant to go back and see them all.
Submit answer
In the EMR:
Correct Answer: B (hemorrhagic)
Ischemic stroke symptoms: (83% of all strokes): Occurs when a blood
vessel contains a clot
•Sudden severe headache
•Sudden weakness or numbness of the face and extremities (usually to
one side)
•Loss of speech or difficulty understanding speech
•Sudden dimness or loss of vision
•Unexplained dizziness or sudden falls, particularly if accompanied with
the above symptoms.
Correct answer feedback:
“Correct: Mr. Jones most likely had a hemorrhagic
stroke because the stroke symptoms did NOT include
weakness or numbness of the face, but DID include
nausea, vomiting, and loss of consciousness.”
Incorrect answer:
“Compare the stroke symptoms of Ischemic and
Hemorrhagic stroke in the EMR.”
Hemorrhagic stroke symptoms: (only 17% of all strokes): Occurs when a
blood vessel ruptures causing blood to leak into the brain.
•Sudden severe headache
•Nausea
•Vision impairment
•Vomiting
•Loss of consciousness
Add this to the Dr.’s Notes once participant answers #4
correctly.
Mr. Jones most likely had a hemorrhagic stroke because the stroke
symptoms did NOT include weakness or numbness of the face, but DID
include nausea, vomiting, and loss of consciousness.
This sentence should be a link to the text box below. When the
participant clicks on # 4 in the protocol box, this is what they
should see.
Primary diagnostic test:
What test should be ordered first? (Be sure to visit the EMR to
read about the tests suggestions.)
Protocol:
2.
Determine which high risk factors the patient has for
stroke.
3.
Determine whether or not treatment will help or
hinder the patient by reading the NIH stroke scale
score.
4.
Make an initial diagnosis on the type of stroke
based on patient history & symptoms.
5. Order primary diagnostic test.
What test should be done first?
(Hint: in the EMR read about the
different types of diagnostic tests)
MRI scan (Feedback: It takes a long time to get MRI results,
our patient doesn’t have time to wait. Read the EMR to get
some help.)
Protocol
E
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Dr.’s
Notes
Patient
History
CT scan (Feedback: Good job, a CT will get us results quickly
and will let us know where the bleed is located so we can order
a secondary test. Lets take him to the CT!”)
PET scan (Feedback: Read the EMR to get some help.)
CT Angiogram (Feedback: This might be good for a secondary
test. Read the EMR to get some help.)
Once a participant has completed previous protocol directions,
they can stay on the screen, but make them smaller or a
different color. When there are too many, a scroll bar should
allow the participant to go back and see them all.
Submit answer
In the EMR:
Correct Answer: B (CT scan)
MRI:
Brief description of the test:
What the test results are helpful in showing:
Helpful in diagnosing stroke because:
The feedback is located in parenthesis.
CT:
Brief description of the test:
What the test results are helpful in showing:
Helpful in diagnosing stroke because:
PET:
Brief description of the test:
What the test results are helpful in showing:
Helpful in diagnosing stroke because:
After the participant gets the correct answer, the
following screen should be visible.
Scene A conclusion:
Great job Dr. ________.
Angiogram:
Brief description of the test:
What the test results are helpful in showing:
Helpful in diagnosing stroke because:
Add this to the Dr.’s Notes once participant answers #5
correctly.
Primary test ordered: CT because the results come back
quickly and will show where the bleed is located.