Dont Bleed out Groin Challenge Escape Room

Are you a groin master?

Dont Bleed out Groin Challenge Escape Room

START

Introduction

"You stumble out of the break room, head pounding from your meal of lukewarm Soylent. You look on the board and see Dr. Will B. Paranoid still has one more case, an ablation on Mr. Jack Smith. Since you still have a job in this crazy world, you decide to head to the supply room and grab what you need to prep the patient."

Explore the Supply Room

You will need to find the proper supplies to prepare Mr. Smith for his procedure.

A rusty old heating unit. It is not working. Would you like to try and repair it?

No

Yes

Do you see any supplies you need?

Everything, surprisingly, is still within their expiration dates!

Appears to be a clipper and fresh bladeWill you take this item?

No

Yes

Your Code for this item is the letter I You should write this down.

Back to Supply Cabinet

Back to Supply Room

Nothing fancy - just a roll of tape and some gloves.Will you take these items?

No

Yes

Your Code for these items is the letter H You should write this down.

Back to Supply Cabinet

Back to Supply Room

Looks like something you can use to clean and prep the patient. Will you take this item?

No

Yes

Your Code for this item is the letter A You should write this down.

Back to Supply Cabinet

Back to Supply Room

Verapamil, Sublingual Nitro and what appears to be some Fentalyal. SCORE! Will you take this item?

No

Yes

This is an unwise choice! Come on, you are better than this...

Old towels and 4 x 4 gauze Will you take either of these item?

No, I do not need any of these items

The gauze

The towel

Your Code for this item is the letter R You should write this down.

Back to Supply Room

Your Code for this item is the letter P You should write this down.

Back to Supply Room

Old towels and 4 x 4 gauze Will you take this item?

No

Yes

This page is password protected

Enter the password

Pre-Op Room 44

This page is password protected

Enter the password

You want to minimize any ____ to the patient?

Skin abrasions

Compassion

Communication

A great tool to have when preping a patient is a roll of ____?

Toilet Paper

Sticky Tape

Quarters

THREE HOURS LATER... Procedure is nearly complete

"Despite the MD best efforts, patient is still very much alive, their procedure is complete, but the sheath remains in place. Their fate is in your hands. Until you properly manage the groin site, they are at risk of bleeding out. To ensure a safe recovery, you must pull the sheath(s) by completing each step, and ensure the patient's vitals remain stable."

Where is the ideal stick location?

Select the location for a good arterial stick to allow for a great manual hold.

This stick is TOO HIGH, what could this lead to?

A Good Time

Retroperitoneal Bleed

Sheath Entrapment

This stick is TOO LOW. While not the end of the world, this prohibits the use of what?

Using a mechanical closure device

The back door

Phoning a friend

Correct! Now assess the patient

Wrong! This patient is not doing well... Try again

All are contraindications of pulling a sheath, EXCEPT:

BP >160/90

Large Hematoma

ACT >180

Before pulling, you should check what?

For zombification

If patient is conscious

For any existing skin damage

Patient has an ACT of 182, BP of 135/90, and a large site hematoma. Can we proceed to pull the sheath?

Not Sure...

No

Yes

NOW, after waiting patiently, and pushing out the existing hematoma, the ACT is 160, BP is 135/90, and a moderate skin tear medial to the access site. Can we proceed to pull the sheath?

Not Sure...

No

Yes

Good job. Now let's pull arterial and venous sheaths

No good, try again...

This is an Arterial Sheath - Where should you apply pressure?

This is an Venous Sheath - Where should you apply pressure?

With an arterial and venous sheath, which one should be pulled first to reduce the risk of creating an AV fistual?

Pull both at the same time

The Venous

The Arterial

Which sheath requires a 20 minute hold?

8fr Arterial

8fr Venous

6fr Arterial

Monitor and hold

When you pull the arterial sheath and apply pressure above the stick site, the distal pulse disappears. Now what should you do??

Shift hold laterally

Release pressure

Nothing, this is normal.

What is common and to be expected when holding manual pressure?

Site pain

Vasovagal response

Hematoma

Are you finished holding...?

Patient is complaining of severe, abdominal and back pain and is becoming hypotensive with an increased HR.What is going one?

Possible Retroperitoneal bleed

Vasovagal Response

Reaction to sedation

We need to get a CT on this patient, STAT. Use the magnifying glass to search for the CT order number, and then type it into the patient's chart

224

This page is password protected

Enter the password

Congratulations

You have completed the procedure and recovered the patient to baseline vitals. He DID NOT BLEED OUT!! You are now free to make your mad dash to the car and escape your eternal (12 hr) shift.

Click Here to complete and receive credit

The doctor is losing patience with your lack of urgency...

At that point, does it really even matter anymore? The undead bleeds no more...

Have you introduced yourself yet? If so, instruct the patient to lie down so you can shave and prep.Password - "what kind of towel?" (all CAPS)

I am beginning to worry about you...

Were you not paying attention to the case? This is not an Arterial stick this time...

Planning to toss this patient to the undead hoard waiting by your car? That's one way to ensure your safe egress from the hospital.

Inventory

♪♬ø

Inventory

♪♬ø

Not even close! Oh man, this patient is in trouble... Try again.

Inventory

Inventory

♪♬ø

This is too high. This may be a successful hold, but you will likely have a hematoma forming. Reposition and try again.

It's Mr. Smith. Though his fangs tell you otherwise, he appears to be harmless in his comfy "jacket." Perhaps he will be more cooperative if you introduce yourself and attempt to establish a little trust.

This is too low. The arteriotomy is above your hold site, and the patient is rapidly losing blood! Adjust and try again...

Inventory

♪♬ø

20 minutes is safe, but likely more time that you need for a venous sheath. 10 min should do the trick

Perhaps you should review and try again

Appears to be some OR towels and old 4x4s. Do these appear to be of use to you?Click here.

This is your idea of an expectation from a good hold? My oh my, I am concerned for your patients. Its a good thing most are already UNdead.

Are you feeling okay? May I remind you this is an arterial sheath...

Inventory

♪♬ø

This BP is too high, you do not want to be pressing against this kind of intraarterial pressure. Some hydralazine would help lower the pressure.

With an acceptable ACT and proper technique, you whould not have to hold more than 15 min.

The undead appear to have given up trying to breach the hospital barricade. ...for now. Care to have a look? Click here.

Inventory

The more unconscious, the better! Who wants to hold pressure on a moaning, squirming patient?

Have you introduced yourself yet? If so, instruct the patient to lie down so you can shave and prep.Password - "what kind of towel?" (all CAPS)

A comfortable chair. Someone must be cleaning out their apartment. Will you take this item? Yes (click in this window)

Really? you will be holding a LONG TIME!! Wait a little longer, or if the patient was given heparin, your could suggest some protamine.

Unless we are leaving in the arterial sheath for hemodynamic pressure monitoring, this one is NOT pulled first.

Shouldn't sedation reduce BP and HR and also relieve excess pain? Think back to your Pharmacology...

The drop in BP is a vagal response, but the back pain and tachycardia are more concerning...

This should NOT be common or expected for a good hold.

It's Mr. Smith. Though his fangs tell you otherwise, he appears to be harmless in his comfy "jacket." Perhaps he will be more cooperative if you introduce yourself and attempt to establish a little trust.