A time nobody can supply
Educational use only. Not clinically reviewed76-year-old woman for calm timeline recording, uncertainty preservation, activation, and handoff practice. About 7 simulated minutes.
What you will practise
- Record last known well as a bound.
- Keep an uncertain account uncertain.
- Activate on the deficit, not the clock.
- State what the unknown does and does not change.
- Review the boundaries and their certainty.
- Hand over the empty field as empty.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-guided thrombolysis for stroke with unknown time of onset (WAKE-UP). N Engl J Med. 2018;379(7):611-622. doi:10.1056/NEJMoa1804355. Randomised trial in 503 of a planned 800 patients with stroke of unknown onset, stopped when funding ended; favourable outcome 53.3% versus 41.8%, adjusted odds ratio 1.61 (95% CI 1.09-2.36), P=0.02; death 4.1% versus 1.2% (P=0.07) and parenchymal haematoma 4.0% versus 0.4% (adjusted OR 10.46, 95% CI 1.32-82.77, P=0.03). Eligibility rested on imaging as a surrogate for lesion age rather than on a remembered time of onset, and the trial was never powered to measure harm.
- Difonzo M. Performance of the Afferent Limb of Rapid Response Systems in Managing Deteriorating Patients: A Systematic Review. Crit Care Res Pract. 2019;2019:6902420. At least one vital sign was missing in 77% of patients with adverse events, supporting the general finding that gaps in observation precede unrecognised deterioration.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.