Hospital Stroke Module

Scene C

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• Run CT Angiogram

EMRProtocol Doctor Notes

1. Perform CT angiogram

2. Determine course of treatment

Description/Actions:

Student clicks on “Run CT Angiogram” and video pops up, showing a patient having a CT angiogram scan. Move to Act 2.

EMR:

Description of how and why CT Angiograms are done.

Scene C, Act 1

Patient History

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Choose a course of treatment:1. Clip the aneurysm (Learn more about this procedure in the EMR)2. Coil the aneurysm (Learn more about this procedure in the EMR)

Description/Actions:CT angiogram results

show that the patient has an aneurysm in the anterior communicating artery. Student must choose to either clip or coil the artery.

Electronic Medical Record:Brain blood vessel anatomyInformation about clipping aneurysmsInformation about coiling aneurysms

Scene C, Act 2

1. Perform CT angiogram

2. Determine course of treatment

Protocol EMR Patient HistoryProtocol

Doctor Notes Patient History

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Insert a coil into the aneurysm.

EMRProtocol Doctor Notes

1. Perform embolization (coiling) on the aneurysm.

2. Send patient to ICU

Electronic Medical Record:

Video of emoblization

(coiling) process.

Scene C, Act 3

Patient History

Description/Actions:

A. Student clicks on “coil the aneurysm”.

B. Coiling procedure video or simulation is shown.

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1. Perform embolization (coiling) on the aneurysm.

2. Send patient to ICU.

EMRProtocol Doctor Notes

EMR:HHH therapyVasospasms (causes and treatments)

Scene C, Act 4

Patient History

Coiling of aneurysm was successful.

Send patient to ICU with orders for HHH therapy and vasospasm monitoring

Student clicks on “Send patient to ICU”

EMR Scene C – Act 1

• Description of how/why CT Angiograms are performed.

• Return to ER

Dr. _______’s Notes

• CT Angiogram shows aneurysm in the anterior communicating artery

• Aneurysm in Anterior Communicating Artery

• Have decided to coil/embolyze the aneurysm due to the patient’s age and lack of invasiveness of this procedure.

Return to ER

EMR – Scene C, Act 2

• Brain Blood Vessel Anatomy

• Information about Clipping Aneurysms

• Information about Coiling Aneurysms

• Return to ER

Coiling Aneurysms

• Return to ER

Clipping Aneurysms

• Return to ER

EMR – Scene B, Act 3

• Insert a coil into the aneurysm.

• Return to ER

Dr. _____’s Notes

• Aneurysm successfully coiled.

• Sent patient to ICU for recovery. Ordered HHH therapy and monitoring for vasospasms.

Congratulations!

• You have successfully treated Mr. Jones within the necessary 3 hour time window! If you have scored a ___ or higher, you are still in the running to become Chief of Staff – great job! If you have scored lower than a ___, perhaps the next stroke patient to come through the doors of St. Normal Hospital will have better results. Also, please realize that Mr. Jones’ journey is not over. He will have a 10-14 day stay in the ICU (where the rate of mortality from strokes is very high 2-12 days following the initial stroke) and then undergo physical therapy.

EMR – Scene C Act 4

• HHH Therapy

• Vasospasms

Clip the Aneurysm

• This procedure is highly invasive and should only be done when the aneurysm is located close to the surface of the brain and on younger patients. Please think carefully before proceeding with this procedure on this patient.

Return to Patient

Coil the Aneurysm

• Correct! This procedure is much less invasive and a better choice for this patient. Go forward with your treatment of this patient.

• Return to patient