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S.T.A.B.L.E. – Cardiac Module: Recognition and Stabilization of neonates with severe CHD. By Kristine A. Karlsen, PhD, NNP-BC with cardiology technical advisor Lloyd Y. Tani MD (2003). 1st place winner in the 2004 American Medical Writers Association Book Competition!

The S.T.A.B.L.E. – Cardiac Module provides general guidelines for the assessment and stabilization of neonates with suspected congenital heart disease (CHD). Prompt, effective, and appropriate care of neonates with severe CHD can reduce secondary organ damage, improve short and long-term outcomes, and reduce morbidity and mortality. This information is presented in a highly visual format and divided into three sections. The first section of the module reviews the physical exam of neonates with suspected CHD. The second section details the anatomic features, clinical presentation and initial stabilization of neonates with CHD, and emphasizes differentiation of cardiac from pulmonary disease. Specific heart lesions are covered in detail including those that are cyanotic ductal dependent, cyanotic not-ductal dependent, and left outflow tract obstructed ductal dependent lesions. The final section discusses modifications to the six S.T.A.B.L.E. assessment components that are necessary when caring for neonates with suspected or confirmed CHD.

PART ONE

1. Physical examination and patient assessment for CHD (includes treatment of SVT, assessment of heart sounds and murmurs);
2. Differential diagnosis for CHD.

PART TWO

1. Cyanotic CHD – Not ductal dependent Tetralogy of Fallot* Truncus arteriosus Total anomalous pulmonary venous return (TAPVR) Ebstein’s anomaly* *Extreme forms may be ductal dependent

2. Cyanotic CHD – ductal dependent for pulmonary blood flow The ductus arteriosus – right-to-left and left-to-right shunting Prostaglandin E1 – Indications, Dose, Side Effects, Administration Guidelines Transposition of the great arteries (TGA) Tricuspid atresia Pulmonary atresia (w/intact ventricular septum) Tetralogy with severe PS or atresia Severe Ebstein’s

3. Left Outflow Tract Obstructive Lesions – ductal-dependent for systemic blood flow Coarctation of the aorta Critical aortic stenosis Interrupted aortic arch Hypoplastic left heart syndrome

PART THREE

Sugar – Temperature – Airway – Blood Pressure – Lab Work – Emotional Support Mnemonic-based assessment and care of neonates with suspected or confirmed severe CHD.

Q: Who should take this module? A: Any neonatal or pediatric healthcare provider (physicians, nurses, respiratory therapists) who must identify and care for neonates or infants with congenital heart disease.

Q: Should the S.T.A.B.L.E. Learner course be taken first? A: Although it is recommended that students take the learner course prior to this module, it is not mandatory. We recognize that many pediatric healthcare providers may not have participated in the S.T.A.B.L.E. learner program, yet our expert reviewers felt the Cardiac module would still be very valuable for those caregivers.

Q: How is the module presented? A: As with the S.T.A.B.L.E. Learner course, it is recommended that an expert in neonatal or pediatric (cardiac) care present this material. An animated CD-ROM guides the instructor through the material, while the 125-page full-color manual serves as the student handbook. Some of the material overlaps with the S.T.A.B.L.E. learner course, therefore, it may be best to wait a few months before teaching the cardiac module. This module is not intended for “same day” presentation with the S.T.A.B.L.E. Learner course. There are no pre or post-tests for the Cardiac Module course.

Q: How long does it take to teach the module? A: This didactic/interactive module is presented in 4 to 8 hours, depending on the student’s expertise. If given in 4 hours (excluding breaks), allow 1 hour for the Part 1 – Physical Exam; 2 to 2.5 hours for Part 2 – CHD lesions; and 0.5 to 1 hour for Part 3 – S.T.A.B.L.E. modifications. It is strongly recommended that students read the manual prior to the course.

Q: Do I need to attend a S.T.A.B.L.E.-Sponsored Cardiac Module presentation in order to teach this module? A: No. The most important consideration is that you are an expert in this area. If you are comfortable with teaching concepts of neonatal congenital heart disease, this module should be relatively easy for you to teach. There is no instructor manual for this module.

LDS Hospital Simulation Center 9th Ave N & C Street – Use the North Entrance Salt Lake City, UT 84143

Transportation to and from the LDS Simulation Center is on your own. Please plan ahead to arrive by 0750 as the course begins at 0800.

“The course is very informative and challenging. I like that Kris pushes you to take it further or think in a different way.”

“Very enjoyable and so many great ideas shared! I feel more confident in scenario development.”

“I learned so much! I love all the interaction throughout the course & working in small groups.”

“I am eager to incorporate the lessons learned as I develop a more robust simulation experience for our clinical staff.”

“An excellent course! Looking forward to bringing back what I have learned to my peers and staff! Thank you so much!”

Dr. Kris Karlsen is the author of the S.T.A.B.L.E. Program materials and the Neonatal Stabilization Scenarios resuscitation and post-resuscitation curriculum. Kris is a NNP who works clinically in the Intermountain Healthcare system NICUs in Utah. In 2010, she took a lead role in developing a NICU simulation program at Primary Children’s Hospital. In 2013, she took the lead role in developing a neonatal and pediatric ECMO simulation program at Primary Children’s. She remains actively involved as the Lead Facilitator in both programs. Kris has served as a consultant to Gaumard, Inc. (Miami, FL) a leading manufacturer of high fidelity simulators. In her consultation role, she provided clinical expertise for the development of Gaumard’s neonatal and premature high fidelity mannequins and enhancements to the mannequin software.

Validated    ♦    Interprofessional    ♦    Comprehensive

The Neonatal Stabilization Scenarios – based on the 5th and 6th edition S.T.A.B.L.E. Program curriculum. This is a complete simulation curriculum designed for comprehensive neonatal resuscitation and stabilization care.

The package includes:

• A very detailed and comprehensive scenario guidebook
• Facilitator File documents so you are never without important pages that may become damaged or lost during simulation!
• Videos demonstrating effective and ineffective behavioral aspects of simulation, a mannequin orientation for the newborn Hal® simulator and introductions to simulation and debriefing. Narrated by Kris Karlsen, S.T.A.B.L.E. Program Author and our Medical Director for Simulation, behavioral expert Dr. JoDee Anderson.
• S.T.A.B.L.E. ARAR Model of Care Behavioral Wall Poster. ARAR stands for Anticipate/Recognize/Act/Reassess.

Also available for purchase from Gaumard Scientific, maker of newborn and Premie HAL® mannequins

• 13 (+ 2 mannequin orientation programs) pre-programmed branching scenarios. Please note, one of the patients is a 32-week gestation infant and 3 additional branching scenarios are also provided for the Premie HAL® mannequin.
• You may install these branching scenarios on up to 4 newborn or combination newborn and Premie HAL mannequins if those mannequins are “housed” in the same physical location.

To request a mannequin product demo or to see the Neonatal Stabilization Scenarios package, contact your Gaumard Rep.

Neonatal Stabilization Scenarios PDF product brochure

Order the Neonatal Stabilization Scenarios Guidebook ($1000)

Note: if you purchased the Neonatal Stabilization Scenarios Guidebook (from S.T.A.B.L.E. or Gaumard) and then you would like to purchase the activation code for the Validated Branching Scenarios ($3000) that go with the scenarios in the Guidebook, then contact your Gaumard rep. When you order the branching scenarios from Gaumard, you will need to provide your Unique Reference Number that was included with your Scenario Guidebook.

To view a newborn Hal mannequin orientation, narrated by Kris Karlsen, click on this YouTube link.

Check out the STABLEPROGRAM channel to see our other simulation videos.

Q: Is simulation mandatory for the S.T.A.B.L.E. Program?

A: No, simulation is optional at this time. If you incorporate simulation into your classes, then you will need to add another half or more teaching days as it takes more time to conduct simulation sessions.

Q: Can I use the Neonatal Stabilization Scenarios for S.T.A.B.L.E. course renewal?

A: That is a GREAT and timely question! We are working out the qualification details to permit renewal by simulation. The issues under discussion are as follows:

• How to best achieve a didactic review and testing of the S.T.A.B.L.E. content.
• What simulation qualifications should the S.T.A.B.L.E. instructor possess in order to renew students by simulation?

Q: Do these programmed scenarios work on other mannequins than Gaumard’s?

A: At this time, the programmed scenarios only work with Gaumard’s newborn mannequin products.