SimFridays - fever and shortness of breath

For October the sim theme is “breathing”. This blog covers some of the learning points from 16/10/20. We will be aiming to run simulations weekly - mostly Fridays but not always - see the gmail calendar.
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The simulated case: 
Adam is in his 70s and has presented with shortness of breath, fever and productive cough. He has been brought to the Plym (?COVID) area of the emergency department. 

What considerations are there in where and how we care for patients like this? What is helpful to prepare before the patient's arrival?​
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What happened?
We ran this simulation with a nurse, HCA and student nurse in the resus area of Plym. A history was taken, observations recorded and appropriate oxygen delivered. The scenario made use of a runner to collect resources and to collect samples to avoid contamination of the area. 

This simulated patient had community acquired bacterial pneumonia however was also correctly treated as potentially having a contagious viral disease like COVID19.

I plan to run this simulation again in the future - I will post on the facebook page.
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What did we think? 
In debrief we discussed:

Differences in the environment of Plym theatres to be aware of e.g. how to attach oxygen and how to access help. In particular we noted that the tannoy is different to the one for the rest of the department. To seek help one needs to use the white tannoy on the wall to tannoy to the “green desk” of Plym where they can relay the tannoy to the rest of the department if required. Reflecting on the sim perhaps walkie-talkies to facilitate two-way communications between those in resus and those in the green areas would be helpful, especially if the potential runner might be moving around and completing other tasks. It was noted that often the staffing level does not allow for an additional person to be a runner, so perhaps a walkie-talkie worn by a designated person would aid in making sure someone is available when needed. 

We discussed the difficulty of requesting a doctor to Plym if there is not someone already present. It is generally done through tannoying for “a doctor”. Perhaps if there was a named person each day that can be tannoyed they would be more likely to respond promptly. 

In terms of collecting samples like the throat swab or blood bottles, we talked about double bag techniques to pass the samples to the green runner. In this case resus was an amber area as was the nearby corridor so a VBG could have been taken directly to the machine still within amber, however blood tests would have needed ICM stickers applied within the area before they were bagged once, and dropped into a second bag held by someone in the green area.

We reviewed the geography of Plym including where to don and doff. 

The guidelines:
The choice of antibiotic in potential community acquired pneumonia can be found on our “RxGuidelines” mobile app. 

See last week’s blog post for the criteria that determine the need for a patient to go to Plym rather than the main ED. 

To do:
Consider going to Plym and conducting a mental run-through of how you would act with a patient in Plym area if you needed to don PPE/collect samples/call specialties/doff without contaminating clean areas  [  ]

Have a look at the tannoys on the wall of Plym resus and make sure you know how you would access help from there if you needed it  [  ]

If you took part in the sim, you can use this blog as a starter to reflect on your own experience of it   [  ]


James Keitley - ED Sim Fellow

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For clinical decisions please refer directly to the guidance. This blog may not be updated.