Do you plan to utilize cognitive aids in your own anesthetic practice in the OR setting?

a. Yes I do b. No I don’t

APPENDIX C – PRE-SIMULATION BRIEFING Simulation Plan

• Bob is a 25-year-old male undergoing a laparoscopic cholecystectomy that weighs 70kg. He has no surgical history, and has no known allergies. The surgery has been in progress for about 10 minutes (prior to the beginning of the simulation). The surgical team is working on the patient. After 1-2 minutes the patient will exhibit signs of malignant hyperthermia

• Progressive complexity

o Maintenance of anesthesia o Signs of MH

o Physiological system failure

Sequence of Events • 1 minute into the scenario:

o Temperature increase to 39 C o ETCO2 increases

o BP drops to 70/30 o HR 95

o PVC’s noted on EKG • 2 minutes into the scenario:

o BP 65/30

o Temperature 41 C ETCO2 increases

• Simulation will Continue for 5 minutes or until all of the following treatments are completed.

o Team member calls for MH cart and Code cart into the room and determines team leader

o Stops triggering agent, hyperventilate with 100% O2, draw ABG, announce for team member to call MH Hotline, start arterial line or any other needed IV lines, treat hyperkalemia, give Na+ bicarbonate if metabolic acidosis is present (1-2 mEq/kg), Treat dysrhythmia, place NG tube

o Retrieve MH cart. (use cognitive aid if in interventional group)

o Start dilution of dantrolene of 9-12 vials and reconstitute with 60ml of sterile water to yield 20mg per vial. (2.5mg/kg dosing)

o Call for OR nurse or team members to apply cooling measures, insert foley, insert rectal tube, cool IV fluids.

Pre-Simulation Participant Briefing • Scenario

o Setting: Operating room/Simulation Lab o Pre-brief: 10-15min

o Time: Simulation 5-10mins o Debrief: 15-20mins

o Roles:

▪ CRNA ▪ Circulating RN ▪ Surgeon

▪ OR tech

o Patient Hx and Procedure • Objective of the simulation

o The team will properly act during the crisis following the MH management checklist.

o The CRNA and SRNA will properly communicate with members of the perioperative team during a MH crisis.

o The CRNA or SRNA will demonstrate correct treatment of MH o Team members will correctly complete steps for treatment of MH

APPENDIX D – POST-SIMULATION DEBRIEFING Standardized Debrief Questions

• How did the simulation experience make you feel about your ability to care for a malignant hyperthermia patient?

• Where you able to meet the clinical objectives of this simulation experience? What areas did you identify in your knowledge that might be weak in regard to caring for a malignant hyperthermia patient?

• If given a second chance to complete the scenario, how would you handle the patient’s care differently?

• What do you think that you performed well on during the simulation? • How well did the two of you work together within your roles?

Debrief Questions for Observers • What were the positives that you noticed during the simulation? • What were the negatives that you noticed during the simulation?

• Are there any other points that you would like to cover with the participants about the scenario?

MH Specific Debrief Questions

• Do you feel like the cognitive aid would’ve helped or hurt your performance in this simulation?

• During the MH scenario how did you decide which team member would assume which role during the simulation?

• What do you think could’ve helped the team’s performance in dealing with the MH patient?

Review learning objectives.

Review participants, roles and team expectations. Review of communication expectations

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