SimulationInterestGroupScenarioTemplate-EMEDU.org.docVIP

Neuroleptic Malignant Syndrome Simulation Case Title: Neuroleptic Malignant Syndrome II. Target Audience: EM residents Learning Objectives or Assessment Objectives Primary Develop and demonstrate an approach to the adult patient with hyperthermia and altered mental status Demonstrate an understanding of the diagnosis and treatment of neuroleptic malignant syndrome Secondary Demonstrate an understanding of appropriate cooling methods for hyperthermia Demonstrate the appropriate treatment of rhabdomyolysis Develop a differential diagnosis for hyperthermia with AMS Utilize closed loop communication Critical actions checklist (attached) Obtain a temperature reading in the altered mental status patient Institute external cooling measures for severe hyperthermia Obtain the medication history from the patient’s family member Recognize the potential for neuroleptic malignant syndrome Administer benzodiazepines for agitation Do not administer succinylcholine for paralysis Administer bromocriptine (or amantadine) dantrolene for NMS Evaluate the patient for other causes of hyperthermia and AMS (infection, thyrotoxicosis, OD, substance intoxication / withdrawl) Treat hypovolemia with crystalloid resuscitation Treat rhabdomyolysis and ARF with crystalloid resuscitation (+/- urine alkalinization and mannitol) Admit patient to the ICU Environment Lab Set Up – ED critical care room Manikin Set Up – type of simulator, moulage, lines needed, drugs needed High Fidelity Simulator Moulage: Wig and street clothes for 24 y/o F Lines: 2 peripheral IVs IVFs: NS Drugs Needed: code blue cart assumed Dantrolene Bromocriptine, amantadine Versed, Ativan Haldol, Droperidol Cyproheptadine, Chlorpromazine Paralytics: succinylcholine, vecuronium, atracurium Sedatives: etomidate, ketamine Props EKG: Sinus Tachycardia CXR: Normal US: Cardiac US – hyperdynamic IVC US – collapsible Labs: CBC, BMP, LFTs, Coags, CK, Upt, UA, UTox, TSH, VBG, Lactate, Mag, Phos, APAP, ASA 12.8 CBC 19.7 490