Simulations by

Recognize Cues

lrehak — 2024-09-15 13:27:32 UTC

BP: 79/53, HR: 112, Dizziness, Abd pain (7/10), ecchymosis, oliguria (<30cc), concentrated/amber urine, tender/firm/distended/guarded

Hgb: 6.2, Hct: 18.4, RBC: 3.3, Cr: 1.6, BG: 135, ALT: 57

Prioritize Hypotheses

lrehak — 2024-09-15 13:28:06 UTC

Hypovolemia/Fluid volume deficit AEB low BP, decreased UO, dizziness

Decreased renal perfusion AEB AKI, low BP

Acute pain AEB bruising/distention/tenderness/pain 7/10

Generate Solutions and Take Actions

lrehak — 2024-09-15 13:28:48 UTC

Notified Provider

Informed Patient

1L NS bolus STAT

Obtained UA

Labs: CBC, CMP, lactic, myoglobin, CK

Prep for Renal Ultrasound

Q15 vital signs

Evaluate Outcomes

lrehak — 2024-09-15 13:29:22 UTC

Deteriorating: Decreased BP, tachycardia, disorientation, lightheaded/dizziness, unconscious, anuric, labs trend in the wrong direction, increased pain, have to call RRT/code

Improving: Increased BP, decreased pain/HR, no more dizziness, labs trend in the right direction, increased UO, vital signs stabilize, bleeding stops

Recognize Cues

2024-09-24 12:36:21 UTC

Crushing CHEST PAIN/angina, HR 120s, 10/10 pain, RR 20s, SpO2 93% on 3LNC, ST elevation on EKG, elevated/critical troponin, BNP, BUN/Cr, myoglobin, sodium/glucose, EF 20%, low RBC, edema, delayed cap refill, BLL consolidation, crackles, diaphoresis

Non-compliance with coumadin = normal coags

Analyze Cues/Prioritize Hypotheses

2024-09-24 12:36:46 UTC

Impaired coronary perfusion

Decreased cardiac output

Acute pain

Generate Solutions/Take Actions

2024-09-24 12:39:53 UTC

Elevated HOB

Focused CV, resp, skin assessment

SBAR to provider

Heparin infusion, 12 lead EKG, nitroglycerin, STAT labs (PTT, CKMB, trop, myoglobin), VS q5 min

Evaluate Outcomes

2024-09-24 12:41:57 UTC

Improving: Chest pain alleviated, decreased HR/BP, RR, labs stabilize, coags in therapeutic ranges, cardiology consult with cath lab, stent placed/grafted vessel, return to baseline weight, downgrade to telemetry, transition to cardiac rehab, then home

Deteriorating: Upgraded to ICU, chest pain not alleviated, increased HR, Afib with RVR/lethal rhythm, cardiogenic shock, loss of consciousness, code and death

Recognize Cues

kwalker311 — 2024-10-01 12:54:21 UTC

Coughing, crackles/wheezing, SOB/dyspnea, SpO2 70-80s, elevated RR, use of accessory muscles, temp 39

Elevated WBC and RBC, FEV1 40%, CXR: hyperinflation and RLL PNA

Analyze Cues/Prioritize Hypotheses:

kwalker311 — 2024-10-01 12:54:29 UTC

Impaired gas exchange

Ineffective airway clearance

Acute infection

Insecure r/t trach

Ineffective health maintenance

Generate Solutions/ Take Actions

kwalker311 — 2024-10-01 12:54:50 UTC

Raised HOB, suctioning, admin albuterol, sputum culture, vital signs, SBAR to provider, consulted RT, focused respiratory assessment, CV, neuro

lrehak — 2025-07-24 11:04:42 UTC

Recognize Cues

lrehak — 2025-07-24 11:04:48 UTC

Recognize Cues

lrehak — 2026-01-29 16:24:38 UTC

BP: 80/53

HR: 115

Abdominal pain: 7/10, diffuse, sharp, hypoactive/absent bowel sounds, medications helped

Dizziness

UO concentrated, <30mL

Analyze Cues/Prioritize Hypotheses

lrehak — 2026-01-29 16:24:45 UTC

Hypovolemia/Fluid volume deficit AEB hypotension/tachycardia, low UO, dizziness

Impaired renal perfusion AEB low UO, concentrated urine, hypotension, BUN/Cr

Acute pain AEB pain score 7/10, ecchymosis, guarding/tenderness

Generate Solutions/Take Actions

lrehak — 2026-01-29 16:24:54 UTC

IV fluid bolus

Collected UA and blood samples (CBC, CMP, CK, myoglobin, lactic acid)

Q15 min vitals

Prep for renal ultrasound

SBAR to provider

Focused assessment/I & O

Evaluate Outcomes

lrehak — 2026-01-29 16:25:01 UTC

Deteriorating: Lower BP, elevated HR, unconscious, anuria, labs become increasingly abnormal, death

Improving: Increased BP, HR normalizes, increased UO, dizziness resolves, BUN/Cr return to baseline, pain improves

Recognize Cues

lrehak — 2026-02-05 13:40:35 UTC

Crushing Chest pain/Angina, HR 120s, dyspnea, diaphoresis, BLL crackles, BLE edema, hypertension, 12 lb weight gain/FVE

Labs: BUN/Cr elevated, myoglobin, troponin, CKMB, BNP, EF 20%

noncompliance with coumadin

Analyze Cues/Prioritize Hypotheses

lrehak — 2026-02-05 13:40:45 UTC

Impaired coronary perfusion

Acute pain

Fluid volume excess

Decreased cardiac output

Generate Solutions/Take Actions

lrehak — 2026-02-05 13:40:53 UTC

Assessment and Vitals q5 min

SBAR provider

Nitroglycerin 1 tab sublingual q5min up to 3 doses

Heparin gtt IV 12 units/kg/hr

EKG

CKMB, troponin, myoglobin, PTT

elevated HOB, IS

Evaluate Outcomes

lrehak — 2026-02-05 13:41:08 UTC

Improving: Alleviation of chest pain, lungs CTA, HR, BP, RR return to baseline, weight return to baseline, successful cardiac cath/CABG, PACU to tele floor, cardiac rehabilitation

Deteriorating: Diminished/absent lung sounds/pulmonary edema, weight gain, cardiogenic shock, fatal arrhythmia, loss of consciousness, death

Evaluate Outcomes

lrehak — 2026-02-05 13:42:14 UTC

Improving: SpO2 increases to 88-93%, HR/RR/BP/temp WNL, lungs CTA, WBC WNL, improved FEV

Deteriorating: Decreased SpO2, HR/RR/BP increases/decreases, AMS/lethargy, diminished/absent lung sounds, worsening cough/wheeze, cor pulmonale, respiratory failure, sepsis, death

Generate Solutions/Take Actions

lrehak — 2026-02-05 13:42:25 UTC

Raised HOB, suctioning, albuterol nebulizer, focused respiratory, CV, neuro/orientation assessment, vital signs, SBAR to provider, teaching on trach care, medications, suctioning

Analyze Cues/Prioritize Hypotheses

lrehak — 2026-02-05 13:42:39 UTC

Impaired oxygenation/gas exchange

Ineffective airway clearance

Acute infection

Altered self-image

Ineffective health maintenance

Recognize Cues

lrehak — 2026-02-05 13:42:47 UTC

Productive cough, elevated HR, RR, BP, febrile, low SpO2 70-80s, elevated WBC, RBC, accessory muscle use, hyperinflation of lungs on CXR w/ RLL PNA, FEV1 45%