463 APPENDIX D Appendix D Scenario Name: Unstable Supraventricular Tachycardia Requiring Cardioversion Learning Objectives Cognitive Technical Behavioral 1. Recognize SVT rhythm. 2. Recognize vital sign changes associated with SVT. 3. Identify treatment of SVT, including vagal stimulation (application of ice), medication administration, and cardioversion. 4. Verbalize the appropriate dose of adenosine. 5. Verbalize the correct technique and the number of joules required for cardioversion. 1. Demonstrate correct operation of defibrillator, including the correct number of joules. 2. Perform correct airway management. 3. Demonstrate correct administration of adenosine. 1. Call for help in a timely manner. 2. Demonstrate effective, clear, concise team communication, including Directed communication Closed-loop communication Staff handoffs 3. Assign roles and delegate responsibilities. 4. Demonstrate effective resource allocation. 5. Maintain situational awareness. Abbreviation: SVT, supraventricular tachycardia. Simulation Roles 1. Registered nurse (embedded participant): provides handoff of the patient to the team 2. Attending physician 3. Trainees (eg, residents, fellows) 4. Neonatal registered nurse 5. Neonatal respiratory therapists 6. Neonatal nurse practitioners 7. Pharmacist Note: An embedded participant is person who is coached or scripted to play a role in the simulation, the goal of which is to help guide the scenario.1 Registered Nurse to Registered Nurse Report “This is a 2-day-old neonate born at 37 weeks’ gestational age, via cesarean delivery. Birth weight was 3.75 kg [3,750 g]. The neonate was admitted to the mother-baby unit and had been well until this morning, when he did not feed as well as he had been and was noted to be irritable. On assessment, the mother-baby nurse noticed that the neonate’s heart rate was 230 beats/min. The episode lasted approximately 90 seconds, and the neonate’s condition was otherwise stable. The pediatrician ordered a blood culture and a complete blood cell count and started antibiotics. Staff were unable to achieve intravenous access, so the pediatrician placed an umbilical venous catheter, secured at 10 cm at the skin. The neonate was transferred to the NICU [neonatal intensive care unit] for further observation. He is currently breastfeeding well.” Laboratory Results (if asked) WBC count, 12.5 K/uni03BCL 27% neutrophils, 1% band cells, 10% monocytes Hct, 42% Hgb, 14 g/dL Platelet count, 275 K/uni03BCL Sodium level, 141 mmol/L Potassium level, 3.7 mmol/L Chloride level, 100 mmol/L Bicarbonate level, 27 mmol/L Calcium level, 12 mg/dL BD/BE, 0.6 mmol/L Glucose level, 75 mg/dL Abbreviations: BD/BE, base deficit/base excess Hct, hematocrit Hgb, hemoglobin WBC, white blood cell. NeoSim.indb 463 2/21/21 12:13 PM
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