Operation HypnoHaven

Operation HypnoHaven Escape Expedition

Crack the Code of Consciousness

start

Introduction

Prepare to be whisked away into the heart-pounding world of Operation HypnoHaven! Today, you're not just participants; you're elite operatives, diving headfirst into the exhilarating role of a veterinary anesthetist!

Meet Kenya, a 5-year-old female intact Labrador Retriever, presented to the UF Soft Tissue Surgery Service for evaluation of right sided facial swelling. Today we are performing head CT with possible fine needle aspirates (FNA) of the mass. Your challenge begins with navigating through the steps to anesthetize Kenya for the procedure. Some experiences will be digital, while others will be hands-on. To successfully escape the room and unveil the password to crack the code, earning you 10% of your final score, you must flawlessly complete each step. But beware, the journey may throw unexpected obstacles your way. Are you ready to immerse yourself in the world of anesthesia and solve the canine medical mystery?

+ info

Tests

Complete each test to beat the game: there is no other way to escape!

Test 1

Test 2

Test 3

Final Test

Test 4

Test 5

Test 1

1/4

🔍 Carefully examine each intricate detail and align the components flawlessly.

Test 1

2/4

You're doing great. ⚙️ Your decision may impact Kenya's escape journey, so analyze the options carefully.

Test 1

3/4

You're almost there!As source of O2 you use an E cylinder. When you check your anesthesia machine you notice that the bourdon pressure gauge on the top of your machine indicates 1000 psi. If you mainatain Kenya with a constant flow of 2 L/min, how long it will take before the cylinder is completely empty?

60 minutes

90 minutes

240 minutes

140 minutes

4/4

Test 1

Last step of this journey. 🔍🏥 The clock is ticking, and Kenya's fate rests on your shoulders. Drag and sort correctly: Associate each number on the picture with its correct name.

A. Oxygen pressure indicator

B Flowmeter

C. Oxygen flush valve

D. Vaporizer

E. Soda sorb canister

Solución

Solution

continue

Gear up for a hands-on experience!

The challenge begins! It's time to put your anesthesia knowledge into action. Head over to the first station and dive into assembling your anesthesia machine. Your mission: select the appropriate circuit and rebreathing bag, then piece them together to ensure Kenya’s safety during anesthesia. Her well-being depends on your precision – can you keep calm under pressure and get everything right? Once you’ve assembled the machine correctly, unlock the next clue by choosing the correct code that appears. Good luck!

134

357

798

Physical examination

At admission 'Kenya' was BAR. T: 102.2F Pulse: 120 bpm Respiration: pant. The mucous membranes were pink and the CRT (capillary refill time) was <2 seconds. She appeared euhydrated. There was a firm swelling over the right caudal ramus of the mandible extending rostrally over the maxilla and ventrally over the mandible and significantly affecting the ventral aspect of the head. In addition, there was a diffuse, flocculent, ventral edema extending from the ramus of mandible to thoracic inlet, and embracing part of the ventral neck. No visible foreign bodies or lacerations were noticed on oral examination. Mandibular, prescapular, and popliteal lymph nodes palpated small, smooth and symmetrical. A II/VI left sided systolic heart murmur with point of maximal intensity over the apex was noted; femoral pulses were strong and synchronous. Clear bronchovesicular sounds were auscultated on all fields. She was soft and non-painful on abdominal palpation. No fluid wave, organomegaly or masses were noticed. There was a mild generalized muscle atrophy, but a full orthopedic exam was not performed. The rest of the physical exam was unremarkable. Blood was submitted for CBC and biochemistry and was unremarkable. A cardiology consult was requested yesterday (see results in Info).

+ info

Tests

Complete each test to beat the game: there is no other way to escape!

Test 2

Test 1

Test 3

Test 5

Final test

Test 4

1/4

Test 2

As you delve into the depths of Kenya's physical examination, a critical decision awaits. Among the premedication options, which one will be your key to ensuring Kenya's comfort and readiness for the anesthesia? Choose the premedication wisely, for the right choice unlocks the path to success.

Dexmedetomidine 10 mcg/kg + butorphanol 0.2 mg/kg IM

Midazolam 0.3 mg/kg + methadone 0.3 mg/kg IV

Acepromazine 0.02 mg/kg + buprenorphine 0.02 mg/kg + butorphanol 0.2 mg/kg IM

2/4

Test 2

Ready for a Visual Challenge? Dive into the next phase by watching the video unfold before your eyes. Now, based on your observation, what do you reckon is the most likely scenario presented in the video?

This is an example of the paradoxical excitatory effects of benzodiazepines

This is an example of the excitatory effects of methadone in dogs

Kenya is a very aggressive dog and should have been premedicated with trazodone before coming to the hospital

3/4

Test 2

Good job anesthetists! the time has come to induce anesthesia. Can you match the molecule to its precise property, understanding the nuances of anesthesia induction? ⚙️ Your choices hold the key to Kenya's destiny, so analyze the options meticulously.

A. Vasodilation and bradycardia can be observed

Ketamine

B. Causes increased heart rate and pressure

Propofol

C. The S group predisposes to arrhythmias

Alfaxalone

Etomidate

D. Can cause acute hemolysis and thrombophlebitis

Thiopental

E. Blood pressures are maintained in dogs and cats

continue

Solución

Solution

4/4

Test 2

Last question of the test:Calculate the fluids rate (drops/seconds) for administering Lactated Ringer's solution at 5 mL/kg/hour, using a drip set that administer 1 mL in 10 drops ( Kenya is 32.6 kg)

45 drops/second

4.5 drops/second

0.45 drops/second

Tests

Complete each test to beat the game: there is no other way to escape!

Test 1

Test 2

Test 3

Test 4

Test 5

Final Test

Test 3

1/2

🔍🏥 The clock is ticking, and the success of Kenya's escape hinges on your skills. Uncover the crucial instruments needed for a successful intubation, and ensure Kenya's safety on this escape adventure.

Test 3

2/2

Drag and sort correctly:Identify the correct sequence of steps required for a successful intubation, and arrange them in the proper order.

A. Perform laryngoscopy to visualize the vocal cords and gently insert the endotracheal tube into the trachea

B. Administer preoxygenation to the patient

C. Induce anesthesia appropriately

D. Secure the endotracheal tube in place

E. Confirm tube placement with capnography

continue

Solución

Solution

The moment has arrived to intubate Kenya.

Now, make your way to the second station and prepare for a high-stakes mission in veterinary care. The pressure is on, and Kenya’s life is in your hands! Can you keep your cool and navigate this adrenaline-fueled challenge? Once you’ve successfully intubated Kenya, start ventilating to reveal the next clue. Remember, every step counts. Good luck on your journey!

Puff

Venti-laughter

Tests

Complete each test to beat the game: there is no other way to escape!

Test 1

Test 2

Test 3

Test 4

Test 5

Final Test

Navigate the next crucial step in your medical mission!

Head over to the third station and take charge of the mannequin's monitoring. Utilize your notes wisely to accurately position the ECG, blood pressure cuff, and pulse oximeter. Every detail matters as you work to ensure the well-being of your patient. Can you master the art of precision and monitoring in this critical phase?

Next

Test 4

1/3

Thirty minutes into the anesthesia, Kenya exhibits a distinct rhythm on the monitor. Your challenge: Identify this arrhythmia and unravel the mystery behind Kenya's vital signs.

Pulseless ventricular tachycardia

Sinus arrythmia

Premature ventricular complexes (VPC)

Test 4

2/3

Engage your diagnostic prowess and untangle the mystery behind Kenya's heartbeat.

Pulseless ventricular tachycardia

Premature atrial complexes (APC)

Premature ventricular complexes (VPC)

Test 4

3/3

Well done! You are almost there.Final question in Test 4.

Premature atrial complexes (VPC)

Pulseless ventricular tachycardia

Supraventricular tachyarrythmia

Tests

Complete each test to beat the game: there is no other way to escape!

Test 1

Test 2

Test 3

Final Test

Test 5

Test 4

1/5

Test 5

Here's a challenge tailor-made for the true anesthesia aficionado! Behold the mysterious waveform on the sidestream capnography during the anesthesia process. Can you unravel the enigma and decipher what's happening in this vital moment?

Leaky tracheal tube cuff

Leaky capnograph sampling line

Expiratory valve stuck open

2/5

Test 5

Sharp observation, Anesthesiologist! While the surgeon wraps up the procedure, take a close look at this image. The capnograph reveals an intriguing clue – the expiratory valve appears stuck open. Could this be the culprit behind the anomaly?

False

True

3/5

Test 5

You're on the brink of mastering the art of capnography! Now, for the final push: Which capnographic wave hints at a leaky tracheal tube cuff? Your sharp senses are the last line of defense in this challenge.

4/5

Test 5

Embark on a journey into the oxygenated unknown! Get ready to unravel the mysteries of pulse oximetry – where each oxygen level holds the key to Kenya's well-being.

5/5

Test 5

Urgent alert! Kenya is in the grips of distress, and the pulse oximeter wails in urgency with an alarming reading of 90%. The room echoes with the pulse of suspense as the numbers reveal a critical moment. Can you swiftly decode the distress signal, navigate the chaos, and restore Kenya's vital balance?

Tests

Complete each test to beat the game: there is no other way to escape!

Test 1

Test 2

Test 3

Final Test

Test 5

Test 4

1/3

Test 6

Step into the realm of blood pressure mastery! Uncover the mysteries of measurement as you embark on the challenge of categorizing elements of direct and indirect pressure readings. Correctly drag and drop each component to its rightful group.

Direct Blood Pressure

Indirect Blood Pressure

1. Non-compliant extension line

2. Blood pressure transducer

3. Sphygmomanometer

4. Heparanized saline

5. Cuff with a width 30-40% of the limb circumeference

6. Doppler

continuE

Solución

SOLUTION

2/3

Test 6

Embark on the blood pressure quest! As you step into the realm of oscillometric monitoring, a crucial challenge awaits. Before you, four statements stand tall.

continuE

3/3

Test 6

Time is of the essence! As Kenya's anesthesia progresses, a peculiar scenario unfolds. Use your expertise to troubleshoot any unexpected events. What corrective actions would you take if the blood pressure drops suddenly during the procedure?

A. Evaluate the depth of anesthesia

B. Give an inotrope (dopamine, dobutamine)

C. Monitor vital signs to assess response to interventions

D. Decrease inhalant anesthetic as needed

E. Give a vasoconstrictor (phenylephrine, vasopressin)

continue

Solución

Solution

Completed

Congratulations, you have successfully completed the escape room!

Click to reveal the Laboratory Attandance Quiz password

Start over?

Oh oh!

That answer is not correct...

But don't lose your balance, continue on your way and try again!

back

'Kenya' initially developed a golf-ball-sized swelling at the caudal aspect of her mandible, evaluated in October by her primary care veterinarian. An inconclusive FNA was performed in-house, and she was prescribed Clavamox 500 mg BID and Rimadyl 75 mg BID. Although the swelling temporarily resolved, it recurred three weeks ago. Revisiting the veterinarian resulted in the same medication, but this time, there was no improvement. Two days ago, 'Kenya' had an episode of gagging and vomiting in the morning followed by inappetence and slightly decreased energy level. She was brought to UF Emergency Service in the evening. Thoracic radiographs were performed at admission and did not show any overt cause for the gagging, but 'Kenya' was found to have an enlarged heart. 'Kenya' had two litters of puppies in the past two years without complications and is fed Purina Pro Plan Grain-Free Food.

genial.ly

1 - B

2- C

3 - A

4 - E

5 - D

Group A lorem ipsum

1 2 4

Group B lorem ipsum

3 5 6

1 - B

2- A

3 - E

4 - D

5 - C

1 - A

2- C

3 - D

4 - B

5 - E

1 - A

2- D

3 - B

4 - E

5 - C

RESULTS OF ECHOCARDIOGRAM: Mild to moderate left atrial and ventricular dilation with moderate decreased systolic function (fractional shortening (FS%) is 26%) and increased end-systolic volume. IMAGING/ OTHER DIAGNOSTICS:

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