Critical Care - Lab Exercise

**LAB EXERCISE TITLE & INFORMATION**

Title: Critical Care Simulation Exercise - Assessment of Hemodynamic Monitoring Skills

Duration: 2-3 hours
Group size: 4-6 students
Difficulty level: STEP3

**LEARNING OBJECTIVES**

Upon completion of this lab exercise, students will be able to:

1. Demonstrate the use of hemodynamic monitoring devices (e.g., pulse oximeter, blood pressure cuff)
2. Assess and interpret arterial blood gas (ABG) results
3. Recognize and respond to abnormal hemodynamic parameters (e.g., hypotension, tachycardia)
4. Perform a basic cardiac rhythm interpretation
5. Identify and describe the concept of fluid resuscitation in critical care settings
6. Use a patient simulator model to practice invasive blood sampling techniques
7. Record and analyze vital sign data for a critically ill patient
8. Develop a plan for managing hemodynamic instability

**BACKGROUND & THEORY**

Critical care medicine is a rapidly evolving field that requires the ability to quickly assess and respond to changes in a patient's physiological status. Hemodynamic monitoring is a crucial aspect of critical care, as it allows healthcare providers to evaluate cardiovascular function and make informed decisions about fluid resuscitation, vasopressor administration, and other interventions.

Hemodynamic instability can lead to organ dysfunction, multi-organ failure, and even death if not promptly addressed. Therefore, developing strong hemodynamic monitoring skills is essential for critical care professionals.

**MATERIALS & EQUIPMENT**

* Patient simulator model (e.g., SimMan 3P)
* Hemodynamic monitoring devices:
+ Pulse oximeter
+ Blood pressure cuff
+ Arterial blood gas analyzer
* Vital sign monitors and charting software
* Fluid therapy equipment (e.g., IV pump, infusion bags)
* Medications for use in the simulation (e.g., vasopressors, fluids)
* Safety equipment:
+ Gloves
+ Face shield
+ CPR mask

**PROCEDURE / PROTOCOL**

1. Introduction and patient setup (10 minutes)
* Introduce the patient simulator model and explain its capabilities.
* Set up the hemodynamic monitoring devices and vital sign monitors.
2. Initial assessment and data collection (15 minutes)
* Take initial vital signs (e.g., blood pressure, pulse, respiratory rate).
* Record ABG results.
* Assess cardiac rhythm using a patient simulator model or electrocardiogram (ECG) machine.
3. Hemodynamic monitoring and analysis (20 minutes)
* Use hemodynamic monitoring devices to track changes in cardiovascular parameters (e.g., blood pressure, heart rate, oxygen saturation).
* Analyze ABG results to identify acid-base disturbances.
4. Fluid resuscitation and medication administration (15 minutes)
* Administer fluids or vasopressors as needed based on patient response.
* Monitor for signs of improvement or deterioration.
5. Invasive blood sampling (10 minutes)
* Use a patient simulator model or real patient to practice invasive blood sampling techniques.
6. Review and debriefing (15 minutes)
* Review the patient's progress and discuss any challenges or successes.
* Reflect on the importance of hemodynamic monitoring in critical care settings.

**DATA COLLECTION & ANALYSIS**

* Vital sign data:
+ Blood pressure
+ Pulse
+ Respiratory rate
+ Oxygen saturation
* ABG results:
+ pH
+ PaCO2
+ HCO3-
+ Base deficit
* Hemodynamic monitoring data:
+ Blood pressure readings
+ Heart rate and rhythm
+ Cardiac output and stroke volume
* Fluid therapy data:
+ Volume administered
+ Type of fluid used

**CLINICAL CORRELATIONS**

This lab exercise relates to critical care practice by:

1. Emphasizing the importance of hemodynamic monitoring in critically ill patients.
2. Demonstrating how to use hemodynamic monitoring devices and interpret ABG results.
3. Teaching the concept of fluid resuscitation and its application in critical care settings.

Common errors that may occur during this exercise include:

1. Incorrectly interpreting ABG results or missing a significant acid-base disturbance.
2. Failing to recognize signs of hypovolemia or hypovolemic shock.
3. Administering too much or too little fluid, leading to either dehydration or overhydration.

**POST-LAB QUESTIONS**

1. What is the normal range for blood pressure in an adult patient?
2. How do you interpret ABG results in a patient with respiratory acidosis?
3. What are the signs and symptoms of hypovolemic shock?
4. Why is fluid resuscitation important in critical care settings?
5. What is the difference between isotonic and hypotonic fluids?

**ASSESSMENT CRITERIA**

* Students will be assessed on their ability to:
+ Demonstrate proper use of hemodynamic monitoring devices.
+ Interpret ABG results accurately.
+ Recognize signs of hemodynamic instability.
+ Develop a plan for managing hemodynamic instability.
* Checklist of skills demonstrated will include:

1. Use of hemodynamic monitoring devices
2. Interpretation of ABG results
3. Recognition of signs of hemodynamic instability
4. Fluid resuscitation and medication administration

**REFERENCES & RESOURCES**

* American College of Critical Care Medicine. (2020). Hemodynamic Monitoring in Critical Care.
* Roach, R. R., et al. (2019). Advanced Cardiovascular Life Support: A Guide for Emergency Medical Services Practitioners. 10th ed.
* ASA Practice Guidelines. (2018). Advanced Cardiovascular Life Support.

Video demonstrations of hemodynamic monitoring and ABG interpretation are available online through various medical education websites and YouTube channels.