How to use the Emergency Case Simulator

As a veterinary surgeon some of the most challenging cases are those that present as clinical emergencies.

Time is of the essence. The decisions you take and the amount of time it takes to make them will mean the difference between life and death. Cases need to be carefully but rapidly assessed to prioritise life threatening problems. Interventions should not destabilise the patient or obscure the clinical picture.

This simulation will permit some mistakes … but you will be penalised for them. As in life there is no way back after a decision is taken … your patient has to live with - or die because of - your mistakes.

How can I diagnose and treat the patient?

To assist you in the management of these cases you have at your disposal an armoury of diagnostic tests and facilities as well as a pharmacy and options for surgical intervention. These options are grouped into 14 procedures.

	ECG - Record an ECG After recording an ECG you will be asked to identify any abnormalities present. If you get the question wrong you will lose one life point, however the correct answers will be given to you.
	Full history - Obtain a detailed history from the owner Taking a full history will take time … Be sure you patient can wait before sitting down with the client to hear about Rover's every move since he was a pup! As with all histories, be sure to take care not to be led astray…
	Imaging - Take an ultrasound or radiograph Radiographs or ultrasound (including colour flow Doppler where appropriate) images will be displayed. You may be asked to interpret the images displayed…
	IV access - Insert a catheter for IV access Choose the most appropriate catheter size for your patient and then a suitable site for venous access.
	ABC - Rapidly assess: Airway, Breathing, Circulation In an emergency it is essential to be able to satisfy the baseline information needs in as little time as possible. ABC is a quick assessment of the cardiovascular and respiratory systems. Comments on the mental status many be given at this time where pertinent.
	Analgesia and anaesthesia - Choose agents to provide analgesia, sedation or induce anaesthesia Devise an anaesthetic protocol before moving on to invasive procedures, or simply provide pain relief for your patients from the wide range of analgesics available.
	Blood analysis - Baseline bloods, full H + B profile or further tests Three options are available to you. Baseline bloods (PVC, TP and BUN, electrolytes and venous blood gas analysis), run patient-side and available in a couple of minutes, a full haematology and biochemistry profile which take a much longer time to complete and further tests - the results of some of these will take days.
	Full physical exam - Carry out a full physical examination Like a full history, a complete and thorough physical examination will take time … is that time you patient has? … you must be sure.
	Pulse oximetry - Pulse oximetry Pulse oximetry can give useful, non invasive information about the oxygenation of the haemoglobin in the blood. Take care though not to over-interpret the results…
	Emergency procedures - Carry out further diagnostic procedures or perform surgery From endoscopy to thoracocentesis and exploratory surgery there are no limits to what can be done … but what should you do?
	Oxygen - Provide supplemental oxygen Oxygen is essential for life. Many patients will benefit from being given supplemental oxygen. In fact it may save their lives.
	Fluids - Choose your fluid (including blood and products) Fluid therapy can be the key to saving many emergency cases. But what to choose? There is such a range …
	Medical therapy - Choose therapeutic agents from our pharmacy Although not endless there is an extensive range of therapeutic agents available in the pharmacy. Like in life no one will stop you from lifting the wrong bottle by accident … though your patient may not live to regret your decisions.
	Euthanasia - Administer euthanasia A very final decision, but in some cases and in some situations this may be the most appropriate decision to take.

How do I monitor the health of my patient?

The life meter is your indicator of success … or failure. Life is lost though making inappropriate choices of either diagnostic tests or therapeutic interventions. The more significant the mistake, the greater the harm to the patient and therefore the further the life meter will fall….. and once zero is reached your patient will die. Many appropriate tests will cause no change to the life meter …. But just occasionally there will be a life lost, just to reflect the change in your patient's status that would occur in life because of the physical time taken to carry out the investigation … so make sure you they are fit enough before you start…

Life points are gained when appropriate therapy is given. Sometimes one point …. sometimes three or more. Again it all depends on the significance to the patient of the therapy you give.

How do I keep track of what I have done?

Accurate care records are an essential part of the management of any case. The computer will keep these for you in the form of case notes. This will help you to keep track of the management of your case.

How do I complete a case?

There are set criteria built into each case which must be met to gain a successful outcome. These generally include one or more diagnostic steps and one or more treatment steps which will prove you can effectively manage the patient. However, if you do not complete the case quickly enough nature may win and the patient could still die!

At the end of each case you will have the option to work through the case again. Feedback and links to clinical notes will also be provided.

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