Monitor SimulatorSeptic shock simulation scenario
An older patient with a urinary source who looks only a little unwell at first. The numbers tell the story if someone puts them together: a fast heart, a soft pressure and a high respiratory rate.
Brief
- Patient
- Margaret, 74. Two days of burning on urination, confused since this morning according to her daughter.
- Setting
- Emergency department, or a medical ward call.
- History
- Hypertension on ramipril, type 2 diabetes.
- Learners
- Nurses and junior doctors. Two to four people.
- Time
- 15 to 20 minutes plus debrief.
Learning goals
- Spot sepsis from the combination of vital signs, not from any single number.
- Start fluids, take cultures and lactate and give antibiotics without delay.
- Reassess after each bolus and recognise when fluids are no longer enough.
- Call for senior help and discuss vasopressors.
Monitor values
| Phase | Rhythm | HR | SBP | SpO2 | RR | EtCO2 | Change over |
|---|---|---|---|---|---|---|---|
| 1. ArrivalCompensated | Sinus tachycardia | 112 | 98 | 94 | 24 | 30 | Set before the start |
| 2. No fluids yetFrom minute 5 if nothing is given | Sinus tachycardia | 126 | 82 | 92 | 28 | 27 | 10 min trend, turn on Poor perfusion |
| 3. After 1 to 2 L fluidPartial response | Sinus tachycardia | 108 | 96 | 94 | 24 | 31 | 5 min trend, Poor perfusion off |
| 4. Fluid-refractoryOptional, for advanced groups | AF – atrial fibrillation | 138 | 78 | 91 | 30 | 26 | Instant rhythm change, values over 5 min |
SBP is systolic in mmHg; the app sets the diastolic. EtCO2 in mmHg. Use NBP every 5 minutes if there is no arterial line in your setting, and switch the ABP toggle off.
Running it in the app
- Before the learners come in, set phase 1 with HR, ABP, SpO2, RR and EtCO2 switched on and tap Send to monitor. Set NBP to cycle every 5 minutes on the monitor.
- If the team has not started fluids by minute 5, set phase 2, pick 10 minutes with the Instant button and tap Send to monitor. Switch perfusion to Poor. The pleth gets weak and the saturation reading drops, which often prompts someone to look at the probe instead of the patient. That is worth talking about later.
- Once fluids are running, set phase 3 over 5 minutes. A partial response is more realistic, and more useful, than a full recovery.
- For a group that handles the basics well, switch to AF with a fast rate and let the pressure fall again. New AF in sepsis is common and changes the conversation about fluids.
What learners tend to miss
- A respiratory rate of 24 is the earliest warning on the screen and the one most often skipped.
- A systolic of 98 looks acceptable until someone remembers she takes ramipril for high blood pressure.
- Low EtCO2 here reflects poor perfusion and a fast breathing rate, not a ventilation problem.
Debrief questions
- Which number made you think of sepsis first, and when?
- How long did it take from arrival to the first dose of antibiotics?
- What told you that the fluids were working, and what would have told you they were not?
- When would you call for help with vasopressors in your own unit?
Questions
What vital signs does septic shock show on a monitor?
Typically a fast heart rate, a high respiratory rate and a falling blood pressure, often with a narrowing MAP below 65. SpO2 may be normal early on. EtCO2 tends to be low because of fast breathing and poor perfusion, and the pleth trace weakens as the patient clamps down peripherally.
How long should a sepsis simulation take?
About 15 to 20 minutes for the scenario itself, and at least as long for the debrief. That gives time for recognition, a first fluid bolus, antibiotics and one reassessment.
How do I make the sepsis scenario harder?
Use phase 4: new atrial fibrillation with a fast rate and a pressure that does not respond to fluids. It forces the team to think about vasopressors and who to call.