Neonatal Self-Evaluation Clinical Simulations
- Each Neonatal Self-Evaluation Clinical Simulation features the following:
- Format closely follows the actual credentialing simulations in content and difficulty. For teaching purposes, each simulation is slightly longer in length (7 – 10 sections on the optimal path).
- New for 2020 – Responses are presented in a random order.
- New for 2020 – Each simulation may be set for timed mode (15 minutes) or untimed mode (no time limit).
- The score report section is fashioned in a similar manner as the actual credentialing examination and presents the IG score, DM score, and IG + DM score. Additionally, the total, proficiency, efficiency, errors of omission, errors of commission, and overall competence scores are reported.
- While viewing responses, the user is provided an explanation that identifies the rationale behind the correct response(s).
- Use the Respiratory Administrator to set teach/test mode, timed/untimed mode, passwords, student assignments, and view users' scores.
Note: The Respiratory Software Programs are for institutional purchase only.
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ISG-01: Apnea of Prematurity - This clinical simulation evolves around the management of a neonate, born at 30 weeks' gestation, who develops periodic episodes of apnea and then sustained apnea. Decisions relative to clinical and laboratory assessment, pathophysiology, performing a polysomnography study and interpreting the results, implementing neonatal care procedures to lessen the apneic episodes, initiating bag and mask ventilation for sustained apnea, selecting an appropriately sized endotracheal tube, initiating mechanical ventilation and setting initial ventilator parameters, and adjusting ventilator parameters are required.
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ISG-02: Aspiration Pneumonitis - This clinical simulation evolves around the management of a 2-day-old female infant who presents with cyanosis after vomiting her feeding. Decisions relative to clinical and laboratory assessment, initiation of NCPAP therapy, initiation of bag and mask ventilation for respiratory distress, selecting supplies and equipment required for endotracheal intubation, selecting an appropriately sized endotracheal tube, determining appropriate intervention for a failed intubation attempt, and initiation of mechanical ventilation are required.
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ISG-03: Chronic Lung Disease of Prematurity - This clinical simulation evolves around the management of a 26 weeks' gestation male neonate who requires increasing ventilatory support with HFOV and is subsequently diagnosed with chronic lung disease (bronchopulmonary dysplasia). Decisions relative to clinical and laboratory assessment, chest x-ray interpretation, repositioning a mal-positioned endotracheal tube, adjusting HFOV settings, weaning from HFOV, extubating, and initiating NCPAP are required.
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ISG-04: Cardiopulmonary Resuscitation - This clinical simulation evolves around the management of a 12-hour-old neonate who becomes lethargic and unresponsive. Decisions relative to clinical assessment, initiating bag and mask ventilation via flow-inflating bag, determining appropriate bag compression rate and inspiratory pressure during manual ventilation, troubleshooting the flow-inflating bag, initiating chest compressions, performing endotracheal intubation and administering epinephrine through the endotracheal tube, assessment following epinephrine administration, discontinuing chest compressions and initiating mechanical ventilation are required.
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ISG-05: Congenital Diaphragmatic Hernia - This clinical simulation evolves around the management of a 5-hour-old female neonate who develops poor chest excursions with respiratory distress. Decisions relative to clinical and laboratory assessment, pathophysiology, intubation and manual ventilation, post-operative assessment, insertion of a right-sided chest tube, initiation of mechanical ventilation, determining the inspiratory time and flow rate required to obtain volume-targeted ventilation with a pressure-controlled ventilator, and ventilator waveform interpretation are required.
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ISG-06: Congenital Lobar Emphysema - This clinical simulation evolves around the post-operative management of a two-week old infant following surgical resection of the right upper lobe. Decisions relative to clinical and laboratory assessment, initiation of mechanical ventilation and setting initial ventilator parameters, adjustment of ventilator parameters, ventilator waveform interpretation, corrective action for waveform abnormality, assessment for post-operative infection, and appropriate therapeutic intervention are required.
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ISG-07: Delivery Room Management - This clinical simulation evolves around the management of a 24 weeks' gestation neonate who presents limp and cyanotic with minimal respiratory effort at birth. Decisions relative to ensuring that the delivery room is adequately stocked with various neonatal resuscitation supplies and equipment, ensuring that the appropriate medications and resuscitative fluids are readily available, administering supplemental oxygen to the mother due to the onset of fetal late decelerations, providing free-flow oxygen to the neonate immediately after birth, assessing the neonate to determine if resuscitative actions are indicated, initiating positive pressure ventilation via bag and mask, determining the cause for the chest not rising during manual ventilation, recommending endotracheal intubation, assessing the neonate following intubation, and initiating chest compressions are required.
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ISG-08: Extreme Prematurity/RDS - This clinical simulation evolves around the management of a 25 weeks' gestation neonate who is depressed and apneic at birth. Decisions relative to clinical and laboratory assessment, patient/ventilator assessment, interpreting the ventilator waveform and taking corrective action for the abnormality, adjusting ventilator support parameters, manually ventilating and performing transillumination of the chest for a suspected pneumothorax, performing needle thoracentesis with subsequent insertion of a chest tube, obtaining a follow-up chest x-ray and arterial blood gases with interpretation of the results, pathophysiology, and recommending switching to high frequency oscillatory ventilation (HFOV) are required.
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ISG-09: Meconium Aspiration Syndrome - This clinical simulation evolves around the management of a 42 weeks' gestation neonate who presents meconium-stained at birth. Decisions relative to maternal and fetal assessment, pathophysiology, assessing the neonate post-delivery, determining the Apgar score, administering free-flow oxygen, transferring to the NICU and initiating NCPAP and setting initial CPAP pressure, adjusting the CPAP level, performing clinical and laboratory assessment relative to a distressed neonate, manually ventilating and performing endotracheal intubation, and extubating and re-intubating with a larger-sized endotracheal tube when faced with significant leaks in the infant/ventilator system are required.
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ISG-10: Neonatal Transport - This clinical simulation evolves around the management of a neonate who requires transport to a tertiary care center. Decisions relative to performing a clinical assessment, endotracheal intubation and initiating mechanical ventilation, setting inspiratory and expiratory controls on the transport ventilator, determining the ventilatory I:E ratio, adjusting ventilator parameters, monitoring and assessing the neonate while in transport, and extubating and re-intubating in response to an occluded ETT are required.
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ISG-11: Patent Ductus Arteriosus - This clinical simulation evolves around the management of an intubated and mechanically ventilated neonate. Decisions relative to clinical and laboratory assessment, repositioning the endotracheal tube, inserting a left-sided chest tube for a left-sided pneumothorax, troubleshooting the transcutaneous PO2 electrode, interpreting clinical findings of a patent ductus arteriosus (PDA), recommending diagnostic studies that would confirm the clinical findings, and evaluating arterial blood gas results following extubation are required.
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ISG-12: Persistent Pulmonary Hypertension - This clinical simulation evolves around the management of a neonate who presents meconium-stained at delivery. Decisions relative to clinical and laboratory assessment, initiation of NCPAP therapy, intubation and initiation of mechanical ventilation, setting initial ventilator parameters, calculation of the oxygenation index (OI), initiation of HFOV, setting initial HFOV parameters, and nitric oxide administration are required.
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ISG-13: Pulmonary Interstitial Emphysema - This clinical simulation evolves around the management of an intubated and mechanically ventilated premature neonate. Decisions relative to clinical and laboratory assessment, ventilator waveform interpretation, adjustment of ventilator parameters, assessing the patient/ventilator system, endotracheal tube positioning, initiation of high frequency ventilation, and pathophysiology are required.
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ISG-14: Respiratory Distress Syndrome - This clinical simulation evolves around the management of a preterm neonate who develops respiratory distress syndrome and subsequently requires increasing ventilatory support. Decisions relative to clinical and laboratory assessment, initiating mechanical ventilation and setting initial parameters, repositioning a mal-positioned endotracheal tube, pathophysiology, titrating the FIO2 to maintain adequate oxygen saturations, performing endotracheal suctioning, switching to HFOV and then switching to HFJV when no improvement is noted with HFOV, and adjusting HFJV parameters are required.
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ISG-15: Transient Tachypnea of the Newborn - This clinical simulation evolves around the management of a neonate delivered via emergency cesarean section who subsequently develops respiratory distress. Decisions relative to pre-delivery assessment, delivery room management, post-delivery assessment, assigning an Apgar score, providing ongoing care and transferring the infant to the newborn nursery, assessment for agitation and respiratory distress, initiating HFNC, and pathophysiology are required.
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