Guided Reflection Questions for Medical Case 4: Carl Shapiro
Opening Phase How did the scenario make you feel? This scenario made me feel that I learnt something because I was able to get a better score after my second attempt than my first one.
Scenario Analysis Questions* PCC What could have been the causes of Carl Shapiro's ventricular fibrillation? Smoking a half pack of cigarettes a day, hypertension, obesity, and the probability of heart disease in the family
EBP
When performing CPR for Carl Shapiro, what are quality indicators you are performing resuscitation correctlv? Providing compressions and respirations at a 30:2 ratio, steady slow breaths Look for chest rise and fall when giving respirations Tilt chin up to open up airways Compress chest in at a depth or 2-3 inches Allow for chest recoil Assure elbows stay straight and do not bend them, bend at the hips Assure you are positioned above the level of the patient Compression rate of 100-120/min No excessive ventilation
s
If Carl Shapiro would have had return of spontaneous circulation (ROSC), what would your next interventions be? Assess his pulse If not already on one, hook him up to a heart monitor to see what rhythm he is in Depending on his heart rhythm, possibly administer meds such as epinephrine or Amiodarone
I would optimize oxygenation, treat hypotension, suggest for the provider to order
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another set of labs, and maintain hemodynamic stability I would optimize oxygenation, treat hypotension, suggest for the provider to order another set of labs, and maintain hemodynamic stability
PCC
What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format.
s-
patient Carl Shapiro experienced VFIB while receiving care for chest pain. He became unconscious and the code team was called.Response measures such as cPR and AED
shock were implemented
B-
states began while trying to exercise. He is a smoker and takes blood pressure medication for hypertension. In the ED he was treated with 2 doses of sublingual nitro and stated complete relief
A-
After receiving CPR and electric therapy pt regained consciousness and began breathing spontaneously again. Last VS are BP 123/73 HR 82 RR 12 SpO2 97% and temp of 99 F. He is on 4L of oxygen via NS Close cardiac monitoring and adequate oxygenation
R-
Concluding Questions
what you could have done to support them during this crisis.
I would lead them out of the room because CPR with chest compressions along with the use of the AED can be a traumatic experience for family members to see. I would provide them with a private space to explain to them what is happening and give them updates as soon as I can
What would you do differently if you were to repeat this scenario? How would your patient care change? I would make sure I administer the shock with the AED within 10 seconds of stopping CPR