Scenario Template

BRIEF DESCRIPTION:

You are called to attend an emergency C-section of a 38 week infant with an estimated fetal weight of 3000 grams (3 kg). The mother is a G1 P1, 38 years old with a history of poorly controlled DM (diabetes mellitus). The mother was seen in Labor and Delivery triage due to report of decreased fetal movement. The fetal HR (heart rate) on doppler was 40. Amniotic fluid is clear. At delivery, the infant is noted to have tight nuchal cord x 2 requiring surgical reduction.

LEARNING OBJECTIVES: (Fill in the blank). _________________________

PERTINENT HISTORY FOR LEARNERS: (pertinent information gathered from the scenario brief description)

Mother: 38 years old
G 1 P 1
Gestational Age (GA): 38 weeks
Delivery: Cesarean section
OTHER RISK FACTORS (prenatal history, labs, ultrasound results, pertinent maternal and social history, antepartum complications):

Fill in the blank. __________________________________
SCENARIO LOCATION:

Labor and Delivery OR
NECESSARY EQUIPMENT AND SUPPLIES:

Complete resuscitation set-up
Variance in set-up (list additional supplies or equipment required): None
MANNEQUIN PREPARATION:

blood and vernix
INITIAL CONDITION OF NEONATE:

The baby is delivered to the warmer limp, cyanotic, and apneic.
EXPECTED INTERVENTIONS DURING SCENARIO:

(Fill in the blank). _________________________________
SKILLS DEMONSTRATED:

Cognitive: (Fill in the blank). _________________________________
Technical: (Fill in the blank). _________________________________
Behavioral: (Fill in the blank). _________________________________

Source: All rights reserved. Copyright 2010 American Academy of Pediatrics – Revised 11/11/2010

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Sample Scenario Template from American Academy of Pediatrics

BRIEF DESCRIPTION:

You are called to attend an emergency C-section of a 38 week infant with an estimated fetal weight of 3000 grams (3 kg). The mother is a G1 P1, 38 years old with a history of poorly controlled DM (diabetes mellitus). The mother was seen in Labor and Delivery triage due to report of decreased fetal movement. The fetal HR (heart rate) on doppler was 40. Amniotic fluid is clear. At delivery, the infant is noted to have tight nuchal cord x 2 requiring surgical reduction.

LEARNING OBJECTIVES (cognitive, technical, and behavioral):

1. Identify the newborn who requires positive pressure ventilation (PPV).
2. Demonstrate correct technique for positive ventilation, including placement of mask on the newborn’s face, rate and pressure, and corrective actions (MR. SOPA) for ineffective PPV
3. Demonstrate correct placement and interpretations of pulse oximetry.
4. Recognize improvement during PPV by noting improvement in increasing heart rate, color, and oxygen saturation, muscle tone, and spontaneous breathing.
5. Demonstrate pertinent key behavioral skills to optimize team performance.

PERTINENT HISTORY FOR LEARNERS:

•  Mother: 38 years old
• G 1 P 1
• Gestational Age (GA): 38 weeks
• Delivery: Cesarean section

You have 60 seconds to check and set-up all of your equipment.

OTHER (prenatal history, labs, ultrasound results, pertinent maternal and social history, antepartum complications):

• None to discuss

SCENARIO LOCATION:

• Labor and Delivery OR

NECESSARY EQUIPMENT AND SUPPLIES:

• Complete resuscitation set-up
  • Variance in set-up (list additional supplies or equipment required): None

MANNEQUIN PREPARATION:

• blood and vernix

INITIAL CONDITION OF NEONATE:

• The baby is delivered to the warmer limp, cyanotic, and apneic.

EXPECTED INTERVENTIONS DURING SCENARIO:

• equipment check including presence and function of PPV device
• initial steps
• assessment of heart rate and breathing
• call for assistance
• initiation of PPV
• pulse oximetry
• assessment of effectiveness of PPV
• corrective steps
• 30 seconds of effective PPV
• recognition of improving heart rate, tone, pulse oximetry
• cessation of PPV
• administration of free flow oxygen
• assessment of need for post-resuscitation care

SKILLS DEMONSTRATED: 

• Cognitive
  1. Recognize the infant who requires PPV
  2. Recall indications for  effective ventilation (rising HR, rising oxygen saturation, bilateral breath sounds, chest movement).
  3. Interpret pulse oximetry and adjust oxygen concentration according to the infant’s age and SpO2 target range.
• Technical
  • Equipment check
  • Initial steps
  • Positive pressure ventilation
    • Self-inflating bag
    • Flow-inflating bag
    • T-piece resuscitator
    • Management of oxygen concentration
    • Rate and pressure
    • MR. SOPA
    • Assessment of heart rate
    • Assessment of breath sounds
    • Use of pulse oximetry
    • Administration of free flow oxygen
    • Use of OG tube as necessary
    • Assessment of need for post-resuscitation care
  • Chest compressions
  • Endotracheal intubation (or assistance with intubation)
  • Emergency UVC placement (or assistance with placement)
  • Epinephrine administration (drawing up, routes, and dosages)
  • laryngeal mask airway placement
• Behavioral
  • Know your environment
  • Anticipate the plan
  • Assume leadership role
  • Communicate effectively
  • Delegate workload optimally
  • Allocate attention wisely
  • Use all available information
  • Use all available resources
  • Call for help when needed
  • Maintain professional behavior

 Source: Copyright 2010 American Academy of Pediatrics – Revised 11/11/2010