Scenario in a Nutshell
Coronary artery dissection presenting to A+E.
Stage 1: Initial assessment of chest pain in 30-week primipara.
Stage 2: Severe chest pain with ST elevation on ECG, commence management for acute coronary syndrome (ACS).
Stage 3: Worsening acute myocardial infarction deteriorating to ventricular fibrillation (VF) arrest. Requiring advanced life support (ALS) and transferred to cardiac catheterisation lab for primary percutaneous coronary intervention (PCI).
Target Learner Groups
Appropriate members of the receiving A+E, cardiology and multidisciplinary obstetric teams.
| Specific learning opportunities |
| Knowledge of differential diagnosis of chest pain in pregnancy |
| Recognition and management of acute myocardial infarction |
| Involve relevant specialities appropriately |
| Appropriate and timely management of VF arrest |
| Rapid decision-making and coordination to arrange transfer to cardiac catheter lab |
| Suggested learners (to represent their normal roles) | In the room from the start | Available when requested |
|---|---|---|
| A+E nurse | √ | |
| A+E ST3+ | √ | |
| Cardiology ST6–7 | √ | |
| Obstetric ST3+/Consultant | √ | |
| Anaesthetic CT2/ST3+ | √ | |
| Other responding members of A+E team | √ | |
| Suggested facilitators | ||
| Faculty to play role of nurse in A+E performing handover on admission of patient to resus bay | √ |
Details for Facilitators
Patient Demographics
Name: Helen Barker Age: 37 Gestation: 30 Booking weight: 78 kg Parity: P0 |
Scenario Summary for Facilitators
37-year-old primipara. (Stopped smoking at start of pregnancy. FH father had myocardial infarction (MI) in 40s. Intermittent cocaine use outside of pregnancy.)
Attends A+E with a 3-hour history of intermittent chest pain and shortness of breath.
Initial ECG unremarkable.
Further pain of greater severity and longer duration.
ECG demonstrates ST elevation.
Given initial treatment for myocardial infarction after discussion with patient.
Constant severe pain with haemodynamic compromise and subsequent VF arrest.
Cardioverts with 1 DC shock, urgent referral and transfer for percutaneous coronary intervention.
Set-up Overview for Facilitators
| Clinical setting | A+E resus bay |
| Patient position | Semi-recumbent on A+E trolley |
| Initial monitoring in place | None – just arrived in resuscitation bay |
| Other equipment | Nil but all equipment available |
| Useful manikin features | Defibrillation |
Medical Equipment
For core equipment checklist see Chapter 9.
| Additional equipment specific to scenario | ||
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Information Given to the Learners
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Scenario Schedule
Figure 30.1 Sinus Tachycardia.
