Outline of simulation scenarios
| Scenario | Curriculum topic | Brief outline of content |
|---|---|---|
| 1 | Opioid toxicity | A patient with bowel cancer has been admitted to the hospice the previous day with abdominal pain and vomiting. She has been found by the nurse unconscious with her son present who is distressed and asking if his Mum is dying. The nurse asks the trainee to assess the patient who should recognise signs of opioid toxicity and appropriately treat this with low doses of Naloxone. The trainee should keep administering this until the respiratory rate is over 8. If the trainee gives a high dose of Naloxone the patient will complain on pain. The candidate needs to recognise the patient is on a syringe driver and make a plan for this. The patient will keep dropping her respiratory rate after Naloxone boluses and the candidate needs to consider an infusion for on-going management. The trainee needs to fully examine the patient and will find a fentanyl patch on their back- this was stopped at home a few days prior to admission but if the patient's son is engaged he will admit that his Mum had pain when he visited last night so he applied a patch from home as he thought it had been left off by accident |
| 2 | Acute left ventricular failure | A patient with metastatic bowel cancer is in the hospice for abdominal pain, which has resolved with treatment of a urinary tract infection. He has developed breathlessness over the course of the day which has acutely worsened with a new chest pain since his son came to visit an hour ago. The nurse will ask the trainee to assess the patient in the presence of his son, and they should recognise by examination and review of the medical notes, that he has developed acute pulmonary oedema. The patient's diuretics had been stopped at admission and an old echo report in the notes shows moderate left ventricular impairment. The candidate should administer intravenous furosemide and a nitrate for his chest pain, and the patient's symptoms will begin to resolve. Any other treatments will cause the patient to continue to deteriorate and his son to get more anxious/ angry. The candidate must address the patient and the relative's concerns |
| 3 | Anaphylaxis | Patient with lung cancer is in the hospice for symptom management and has been started on intravenous antibiotics for pneumonia. He becomes increasingly breathless and the candidate is called to assess the patient by the nurse. They must recognise that he has just started an intravenous meropenum infusion and has developed anaphylaxis. They must appropriately treat this, including addressing the circulatory collapse and stopping the antibiotic infusion. They must make an on-going management plan, including considering whether to transfer the patient. The patient notes record an allergy to Penicillin but he does not have an allergy band |
| 4 | Massive Haemorrhage | Patient with head and neck cancer is in the hospice for pain management. Candidate is asked to speak to him and his son regarding their questions about discharge. Patient develops sudden heavy bleeding from his neck during this discussion and progressively becomes more unresponsive and dies. His son was not aware of this bleed risk and the candidate must address his distress in addition to managing the patient's symptoms |
| 5 | Hypoglycaemia | Patient with pancreatic cancer who took his normal insulin dose despite not having breakfast. Found unresponsive by the nurse. Candidate must recognise hypoglycaemia and appropriately treat with intravenous dextrose. Giving glucagon intramuscular only leads to a partial response due to poor glycogen stores in many palliative care patients and emesis. An explanation to the patient and on-going management plan for review later must be made |