Monitor SimulatorHemorrhagic (hypovolemic) shock trauma scenario
A young patient bleeding into the abdomen and pelvis holds the blood pressure for a long time. The heart rate climbs first. The scenario is built around that gap, and around a positive eFAST that the team has to act on.
Brief
- Patient
- Male, about 25, motorcycle against a car at around 60 km/h. Pain in the lower abdomen and pelvis.
- Setting
- Trauma room, prehospital pre-alert received five minutes ago.
- Prehospital
- Pelvic binder applied, one large-bore IV, 500 ml crystalloid given.
- Learners
- Trauma team: team leader, airway, two for circulation, nurse.
- Time
- About 15 minutes plus debrief.
Learning goals
- Treat a rising heart rate with a normal pressure as shock until proven otherwise.
- Do the eFAST early, call the result clearly and act on it.
- Activate the massive transfusion protocol, give tranexamic acid and limit crystalloid.
- Decide on the route to bleeding control: theatre, angiography or both.
Monitor values
| Phase | Rhythm | HR | SBP | SpO2 | RR | EtCO2 | Change over |
|---|---|---|---|---|---|---|---|
| 1. ArrivalCompensated | Sinus tachycardia | 118 | 112 | 97 | 24 | 32 | Set before the start |
| 2. Ongoing bleedingNo blood products by minute 5 | Sinus tachycardia | 138 | 82 | 95 | 30 | 25 | 10 min trend, Poor perfusion on |
| 3. Blood runningBleeding not yet controlled | Sinus tachycardia | 116 | 94 | 97 | 24 | 30 | 5 min trend |
| 4. Too much crystalloid, no bloodOptional | Sinus tachycardia | 150 | 62 | 93 | 34 | 20 | 5 min trend, then PEA if nothing changes |
SBP is systolic in mmHg; the app sets the diastolic. EtCO2 in mmHg. Without a trend, the app moves the heart rate faster than the pressure, the way a bleeding patient compensates. A trend moves all values together at an even pace.
eFAST findings
Press eFAST on the controller and pick a view when the learner places the probe. The loop covers the monitor numbers while it is shown, and the patient is paused until you go back to the monitor.
- RUQ: pathological. Free fluid in Morison's pouch.
- Pelvis, long and transverse: pathological.
- LUQ and subxiphoid: normal.
- Both thoraces and lung sliding: normal.
Nothing on the screen says which view is pathological. The learner has to read the image, which is the point.
Running it in the app
- Set phase 1 and start the NBP cycling every 3 minutes. Leave the ABP toggle off until someone places an arterial line, then switch it on.
- If no blood is running by minute 5, apply phase 2 with a 10 minute trend. Turn on Poor perfusion when the pressure passes 90.
- Once blood products are going in, apply phase 3. Keep the patient tachycardic. The bleeding is still there until someone stops it.
- If the team gives litre after litre of crystalloid instead, phase 4 shows where that leads.
Debrief questions
- At what point did you call this shock, and which number decided it?
- How was the eFAST result communicated to the team leader?
- How long from arrival to the first unit of blood, and to tranexamic acid?
- What was the plan for bleeding control, and who made the call?
Questions
What are the vital signs in hemorrhagic shock?
The heart rate rises first, along with the respiratory rate. The systolic pressure often holds until a large share of the blood volume is lost, especially in young patients, and then falls quickly. The pleth weakens and EtCO2 drops as cardiac output falls.
Can I show a positive FAST scan in the simulation?
Yes. The eFAST menu on the controller puts real ultrasound loops on the monitor, both normal and pathological, including free fluid in the right upper quadrant and the pelvis.
Why does the blood pressure stay normal at first?
Compensation. Vasoconstriction and a faster heart keep the pressure up until the reserve runs out. A normal pressure with a rising heart rate is the warning sign this scenario is built to teach.