Resus Drills: Adults Upper GI Bleed
Drill pre-brief (instructor to read out)
“Welcome to this Resus Drill. Drills are for situations which are not common, and need a time-critical response. This is not a Simulation. Drills are a rehearsal for practising teamwork and speed.
We will run a scenario for 5 minutes, chat and reflect on it, then run the same scenario again for another 5 minutes.”
Assurances
Learning, NOT assessment: drills are for practice and for learning. We’re concentrating on how fast you can think, and how well you work as a team.
Safe zone: lessons are shared here, not judged, not told as tales.
5-min reflection rules: please use the debrief to be positive about what you can all do better on the re-run. These are deliberately tough scenarios. That’s the point of a drill.
Pretend it’s real: although it’s not real, we need you to help us by acting as you’d do in real life, in your normal role, and we’ll try to run it in real time.
Take-away pack: there is some information that you can take away for further learning. We recommend “spaced repetition” for the best learning!
Make some reflective notes while it’s fresh in your mind
Make yourself read them again in a couple of weeks
How does it work?
Each Resus Drill pack follows a standard format.
The drill packs are laminated and available for teaching purposes. Printable copies can be downloaded HERE.
Our drills can also be EDITED to suit your local hospital needs (Google account required).
S.E.T.U.P. (before patient arrives)
SELF… physical readiness (stay calm) & cognitive readiness (accept the challenge)
ENVIRONMENT… lighting, crowd control, appropriate equipment?
TEAM… initial briefing, identify Team Leader, allocate team roles
UPDATE… if possible, recap for the team (and yourself) before patient’s arrival
PATIENT… the patient arrives
Location of Equipment
BloodTrack® devices (or similar) needed for requesting emergency bloods
A rapid fluid infuser will be needed for delivering requested blood products
Major Upper GI Bleed Decision Algorithm
Red Call Sheet & Venous Blood Gas Results
Scenario Script
“The red phone has just rung with a 3-minute warning of a 52-year old male found on the bathroom floor by his daughter vomiting copious red blood. Here is the red call sheet…” (give Red Call sheet to Team Leader)
Minute One
Gloves, aprons, suction, Upper GI Bleed SOP.
Team Leader designates team members and uses S.E.T.U.P (Self, Environment, Team, Update, Patient arrives).
Minutes Two & Three
Patient arrives, obs unchanged (ambulance handover) and patient is semi-conscious, actively vomiting red blood, pale, mottled lips and peripheries.
Team Leader to ask for two large IVs, rapid infuser, MHP activation, ED consultant, ITU Reg (use phone in cubicle). Someone watching airway / suctioning, supporting patient.
Minute Four
Nursing staff setting up rapid infuser rapidly. Aim for systolic blood pressure of 85-100 mmHg. Team Leader to verbalise ideal target BP. “Your VBG result is available” (show results above). Repeat obs show no change, if requested.
Ongoing haematemesis. Team Leader to ensure ITU support, ED consultant alerted that gastro team is contacted and MHP products are definitely en route. If TXA suggested, remind learners of the HALT-IT trial. No evidence of benefit for the average patient, so do not use up nurse time getting it.
Minute Five
Start variceal bundle. Reassess patient. Team Leader should update team and prepare to transfer to definitive care.
Debrief and Feedback
You should aim to cover the following points within 5 minutes, then re-run the scenario:
Did the Team Leader allocate roles and tasks in a way
that was clearly understood? Was S.E.T.U.P utilised?Did team members do as allocated?
On arrival of patient did Team Leader ensure a
good pre-hospital handover?Did Team Leader show calm and clear speech? Body language?
Did Team Leader maintain good team control and communication?
Closed loop communication when tasking?
Was the IV access and rapid infuser prioritised?
Did Team Leader accurately interpret gravity of situation and convey that?
Did these things happen? ED consultant, ITU, gastro, massive haemorrhage protocol all called correctly?
How did team members help the team pull together?
Were there any instances of:
Equipment issues?
Human factors negatively impacting communication or patient care?
