Initial Resuscitation of a Multisystem Trauma Patient Following a Fall From Height: A Complete Simulation Scenario for Medical Students

Abstract

Management of a complex trauma patient is a critical skill for medical students, particularly during a general surgery or emergency medicine clerkship. However, gaining proficiency with this skillset may be challenging without prior medical or simulation experience. The aim of this technical report is to present a comprehensive high-fidelity medical simulation of a polytraumatized patient with numerous injuries sustained from a 20-foot fall. As the scenario unfolds, students identify multisystem injuries including acute hemorrhage, femur fracture, tension pneumothorax, and traumatic brain injury. The case was designed as an assessment tool to evaluate the knowledge of preclinical medical students obtained through a one-day workshop on the primary survey. This technical report provides simulation designers with a premade script, flowchart, labs, images, and supplies needed to successfully recreate the case.

Keywords: emergency medicine resuscitation; femur and fracture; life-threatening bleeding; medical education; pneumothorax (ptx); simulation design; simulation in medical education; trauma management; traumatic injury.

Figure 1. Simulation props

(A) The black arrow highlights dark makeup which was applied behind the ears to mimic retroauricular ecchymosis. (B) Silicone prosthetic was applied to the thigh of the SP to simulate a compound femur fracture. (C) At the beginning of the scenario, students encounter a human SP (or high-fidelity simulator) fully dressed in a hospital bed with cervical collar in place. The yellow arrow is pointing to the location of the cervical collar in the image. The light blue arrow highlights the pre-cut clothing to facilitate easy exposure of the patient. SP, Standardized patient.

Figure 2. X-ray showing open displaced femur fracture

Case courtesy of Prof. Cláudio Souza, Radiopaedia.org, rID: 13772.

Figure 3. Chest x-ray showing tension pneumothorax

Case courtesy of Dr. Ana Brusic, Radiopaedia.org, rID: 60551.

Figure 4. Epidural hematoma underlying a depressed skull fracture

Case courtesy of Dr. Michael P Hartung, Radiopaedia.org, rID: 74815.

Figure 5. Script Page 1

Figure 6. Script Page 2

Figure 7. Script Page 3

Figure 8. Script Page 4

Figure 9. Script Page 5

Figure 10. Simulation case flow

Figure 11. Laboratory results

Figure 12. Bleeding wound set-up

The image shows the use of a soda can and nylon stockings to fabricate a bleeding laceration that can be applied to a SP. A soda can is inserted into the nylon stockings as a placeholder as adhesive binds a silicone laceration injury to the stockings. Intravenous tubing ran through the inside of the nylon material and is connected to a bag of prop blood and fashioned to the silicone piece. The soda can then be removed, and the nylon apparatus can be applied to the extremity of a SP. SP, Standardized patient.