Table 3 Curriculum-mapped scenarios and learning objectives

Untreated hypertension

45 year old man admitted to HASU with dysphasia and seizures. CT showed Intracerebral Haemorrhage. The patient has become increasingly restless and the staff over night had difficulty controlling his blood pressure. He is to be rescanned.

Basic

Initial management of hypertensive patient; recognition of acute deterioration; call for help early and appropriately with appropriate tools; equipment required for transfer; appropriate treatment; awareness of complications

Post-stroke seizure

Patient admitted 2 days ago with a haemorrhagic stroke. While nurse is taking a telephone handover about another patient, she is called by a healthcare assistant who has noticed that the patient appears to be twitching

Basic

Recognition of acute deterioration; initial management of seizure; maintains patent airway and administers high flow oxygen; call for help early and appropriately; identifies causes and treatment of a seizure

Hyperacute stroke

73 year old man admitted to HASU at 18:00 last night with fully resolved TIA. Noted by student nurse that patient has new facial weakness. Band 6, Registrar and Consultant available by phone if required.

Basic

Recognition, assessment and management of acute neurological deterioration; call for help early and appropriately with appropriate tools; understanding the importance of urgent escalation

Intracerebral haemorrhage post-thrombolysis

Patient admitted with expressive dysphasia and right sided weakness, National Institutes of Health Stroke Scale (NIHSS) 14. CT scan normal. Thrombolysed (total 76 mg) with good effect. NIHSS at 2 h = 0. The patient appears to have become more confused. Glasgow Coma Score (GCS) deteriorates because of intracranial haemorrhage and oedema

Both

Common presenting symptoms and signs including: nausea, vomiting, headache, altered conscious level, altered pupil reaction, focal deficits of vision, speech, power, sensation; recognition of acute deterioration; understanding of the importance of urgent escalation; appropriate treatment and management of blood pressure

Post-thrombolysis anaphylaxis

Woman admitted to A&E with slurred speech and left sided weakness. Was thrombolysed and transferred to the ward. The band 6 nurse has commenced the altepase infusion and handed the patient over to the ward staff. The patient begins to develop an allergic reaction to the altepase

Both

Calls for help early; administers oxygen and uses bag and mask ventilation safely; monitors; identifies and tries to correct circulatory failure appropriately; identifies potential causes; interprets abnormal vital signs correctly in context; anticipates and prevents deterioration in vital signs

Consent for thrombolysis or breaking bad news using patient actor

45 year old man admitted to A&E FAST positive. For randomisation to new thrombolysis trial, team to gain consent from the patient.

Advanced

Sympathetic, patient-centred approach; discussion of treatment options, complications and side-effects; awareness of consent procedures; assessment of mental capacity; sharing information with patient; breaking bad news

TIA/Stroke examination using patient actor

Received a call from cardiac cath labs at 10:05; patient noted to have new onset of left sided weakness post angiogram at 10:00. Transferred to recovery.

Advanced

Uses NIHSS competently

Thrombolysis for acute ischaemic stroke; patient arriving through A&E

45 year old man admitted to A&E FAST positive. For NIHSS assessment as potential thrombolysis candidate.

Advanced

Assessment of acute focal neurological deficits; use of NIHSS; importance of rapid clinical and radiological assessment; appropriate use of stroke pathway/protocol; appropriate treatment and management of blood pressure/glucose; consent for thrombolysis