Respiratory Software
Adult Self-Evaluation Clinical Simulations
Adult Self-Evaluation Clinical Simulations

Each Adult 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.

The Adult Simulations are divided into 5 categories:

  • Adult Chronic Airways Disease Simulations (ISA)
  • Adult Trauma Simulations (ISB)
  • Adult Cardiovascular Simulations (ISC)
  • Adult Neurological or Neuromuscular Simulations (ISD)
  • Adult Medical or Surgical Simulations (ISE)

Note: The Respiratory Software Programs are for institutional purchase only.


ISA-01: Bronchiectasis/Diagnosis - This clinical simulation evolves around the evaluation of a 42-year-old male who presents to the respiratory clinic with chief complaints of shortness of breath, persistent cough, and hemoptysis. Decisions relative to obtaining a medical history, performing a physical examination, obtaining and evaluating arterial blood gases and a chest x-ray, obtaining and evaluating a CT scan of the chest, and diagnosis of the disease condition are required.

ISA-02: Chronic Bronchitis/Diagnosis - This clinical simulation evolves around the management of a 56-year-old male who presents with increasing dyspnea and hemoptysis. Decisions relative to clinical and laboratory assessment, chest x-ray interpretation, recommending bronchoscopy, patient assessment following bronchoscopy, albuterol and PEP therapy, pulmonary function interpretation, and final diagnosis are required.

ISA-03: COPD/Invasive - This clinical simulation evolves around the management of a 64-year-old female with COPD who presents for follow-up care after completing a 2-week course of oral antibiotics for community acquired pneumonia. Decisions relative to clinical and laboratory assessment, adjustment of oxygen therapy, chest x-ray interpretation, recommending thoracentesis for a massive left-side pleural effusion, assisting with the thoracentesis procedure, initiation of NPPV, intubation and initiation of mechanical ventilation for deteriorating status are required.

ISA-04: COPD/Outpatient - This clinical simulation evolves around the management of a 72-year-old male with COPD experiencing complications secondary to severe influenza. Decisions relative to clinical and laboratory assessment, discharge planning regarding home oxygen and bronchodilator therapy, educating the patient on correct use of oxygen, transtracheal oxygen initiation due to noncompliance of wearing nasal prongs, x-ray interpretation of correct placement of the transtracheal catheter, educating the patient in the care and cleaning of the catheter, and precautions of use of the transtracheal catheter are required.

ISA-05: COPD/Infection Control - This clinical simulation evolves around the management of a 69-year-old female with a long history of COPD who presents to the ED complaining of a fever, weakness, chest pain and a cough. Decisions relative to clinical and laboratory assessment, initiation of oxygen therapy, chest x-ray interpretation, discharge planning with infection control instructions, hand washing advise, instructing the patient regarding the warning signs of infection, and instructing the patient on common irritants and avoidance of irritants are required.

ISA-06: COPD/Invasive - This clinical simulation evolves around the management of a 59-year-old male who is admitted to the ICU with acute respiratory failure secondary to COPD, CHF, and lipoid pneumonia. Decisions relative to clinical and laboratory assessment, initiation of mechanical ventilation and setting initial ventilator parameters, adjustment of ventilator parameters, recognition and correction of auto-PEEP, administering a bronchodilator and performing endotracheal suctioning, and correction of a high pressure alarm situation are required.

ISA-07: COPD/Noninvasive - This clinical simulation evolves around the management of a 66-year-old male with severe COPD who is scheduled to have lung volume reduction surgery (LVRS). The patient requires pre-operative assessment and post-operative management. Decisions relative to clinical and laboratory assessment, pulmonary function testing, arterial blood gas analysis, chest x-ray interpretation, recommendations for pre-operative management and rehabilitation, initiation and adjustment of oxygen therapy following surgery, initiation of and setting initial parameters for noninvasive positive pressure ventilation (NPPV), and troubleshooting patient dyssynchrony with the NPPV are required.

ISA-08: COPD/Diagnosis - This clinical simulation evolves around the management of a 55-year-old male who presents to the ED with complaints of acute dyspnea and chest tightness. Decisions relative to assessing the patient following initiation of NPPV, adjusting NPPV parameters, obtaining pulmonary function and exercise tolerance tests after the patient's condition improves, and interpreting the results of the tests are required.

ISA-09: COPD/Outpatient - This clinical simulation evolves around the management of a 74-year-old retired shipyard laborer with a 50+ pack-year smoking history who presents with a chronic cough and increasing dyspnea during exertion. Decisions relative to pulmonary function interpretation, chest x-ray interpretation, obtaining and assessing pulmonary history and clinical data, performing a 6-minute walking test, implementing a pulmonary rehabilitation and home care program, and recommending components to include in the pulmonary rehabilitation program are required.

ISA-10: Asthma/Diagnosis – This clinical simulation evolves around the management of a 27-year-old female who develops occupational asthma secondary to employment at a spray paint factory. Decisions relative to clinical and laboratory assessment, pulmonary function and methacholine challenge testing and interpretation, pathophysiology, asthma action plan, and patient education are required.

ISA-11: Asthma/Outpatient - This clinical simulation evolves around the management of a 42-year-old asthmatic male with obstructive sleep apnea (OSA) secondary to weight gain and enlarged nasal turbinates. Decisions relative to clinical assessment, monitored overnight sleep study via polysomnography (PSG), interpretation of PSG results, second overnight sleep study via PSG with CPAP titration, setting optimal CPAP pressure during CPAP titration, strategies utilized in encouraging the patient to comply with CPAP therapy, and pharmacological agents used to promote daytime wakefulness are required.

ISA-12: Asthma/Invasive – This clinical simulation evolves around the management of a 34-year-old female with a known history of asthma who has just been admitted to the ICU. Decisions relative to clinical and laboratory assessment, oxygen and bronchodilator management, patient assessment during a trial of NPPV, endotracheal intubation and initiation of mechanical ventilation when the patient’s condition deteriorates are required.

ISA-13: Asthma/Noninvasive - This clinical simulation evolves around the management of a 28-year-old asthmatic female who presents to the ED in moderate respiratory distress. Decisions relative to clinical and laboratory assessment, classification of asthma severity, recommending a change in albuterol delivery, physical assessment following the change in therapy, initiation of NPPV, and interpretation of arterial blood gas results following the initiation of NPPV are required.

ISA-14: Asthma/Outpatient - This clinical simulation evolves around the management of a 35-year-old female who presents to the asthma clinic for a review of her asthma following an acute exacerbation. Decisions relative to clinical assessment, classification of asthma control, classification of asthma severity, recommending a change in asthma medication, developing a personal asthma action plan (PAAP), providing self-management education, and recommending medication change based on continuing symptoms are required.

ISA-15: Asthma/Invasive - This clinical simulation evolves around the management of a 26-year-old female who is intubated and receiving mechanical ventilation following respiratory failure secondary to acute asthma exacerbation. Decisions relative to clinical and laboratory assessment, implementation of a plateau pressure-based strategy with permissive hypercapnia, adjustment of ventilator parameters, ECG rhythm interpretation, ventilator graphics interpretation, and weaning from mechanical ventilation are required.

ISB-01: Adult Transport - This clinical simulation evolves around the management of a 60-year-old female who was involved in a motor vehicle accident. The patient requires air transport from a suburban hospital to a Level I trauma center. Decisions relative to clinical and laboratory assessment, ensuring appropriate flight equipment is functioning and available, while en route initiating manual ventilation, troubleshooting the oxygen delivery system, attempting endotracheal intubation, performing an emergency cricothyrotomy with insertion of an endotracheal tube into the opening, and repositioning the endotracheal tube are required.

ISB-02: MVA/CPR - This clinical simulation evolves around the management of a 30-year-old male following a motor vehicle accident. Decisions relative to clinical and laboratory assessment, administering whole blood, initiating manual ventilation and external cardiac compressions, selecting an appropriately sized endotracheal tube, ECG rhythm interpretation, and medication recommendation are required.

ISB-03: Chest Trauma/Diaphragmatic Rupture - This clinical simulation evolves around the management of a 67-year-old female who sustains a diaphragmatic rupture following a fall down a flight of stairs. Decisions relative to clinical and laboratory assessment, oxygen administration, initiation of mechanical ventilation, setting and changing ventilator parameters, ventilator troubleshooting, adjustment of PEEP and titration of FIO2 are required.

ISB-04: Chest Trauma/Double Lumen ETT - This clinical simulation evolves around the management of a 35-year-old male who sustains left-sided lung injury following a 30-foot fall. Decisions relative to clinical and laboratory assessment, chest x-ray interpretation of a pneumothorax, chest tube insertion, endotracheal intubation and initiation of mechanical ventilation, setting initial ventilator parameters, recommending placement of a double lumen endotracheal tube with differential lung ventilation due to deteriorating gas exchange and persistent air loss from the left chest, and recommending dual capnography are required.

ISB-05: Chest Trauma/Flail Chest - This clinical simulation evolves around the management of a 42-year-old male who sustains severe trauma to the left side of his chest following a bicycling accident. Decisions relative to clinical and laboratory assessment, fluid resuscitation, chest drain insertion, intubation and setting initial ventilator parameters, and low pressure alarm troubleshooting are required.

ISB-06: Chest Trauma/Gunshot Wound - This clinical simulation evolves around the management of an intubated and mechanically ventilated 23-year-old female who sustained a gunshot wound to the chest. Decisions relative to clinical and laboratory assessment, bronchodilator therapy, ventilatory parameter adjustments, initiation of inverse ratio ventilation, assessment of tolerance to ventilator changes, and discontinuance of inverse ratio ventilation once the patient’s condition improves are required.

ISB-07: Blunt Chest Trauma - This clinical simulation evolves around the management of a 62-year-old male who sustains blunt chest trauma after being thrown from his horse. Decisions relative to clinical and laboratory assessment, recommending placement of a right-sided chest drain for a right-sided hemothorax, recommending intubation, interpreting the results of an esophageal detector device, assessment following the initiation of mechanical ventilation, and recommending decelerating waveform are required.

ISB-08: Hypothermia - This clinical simulation evolves around the management of an intubated and mechanically ventilated 22-year-old male with severe hypothermia and frostbite. Decisions relative to clinical and laboratory assessment, adjustment of ventilator parameters, recognition of asystole and taking corrective action, administering CPR drugs, reinstituting mechanical ventilation following ECG rhythm conversion, weaning from mechanical ventilation and evaluating weaning parameters, extubating and administering supplemental oxygen are required.

ISB-09: Thermal Burns - This clinical simulation evolves around the management of a 24-year-old female admitted to the trauma center after being trapped in a burning building at her place of work. Decisions relative to clinical and laboratory assessment, intubation and initiation of pressure-control ventilation, assessment and adjustment of the ventilator parameters, diagnostic bronchoscopy to assess the severity of thermal burns to the lungs, assessment and treatment for pulmonary infection, and recommending a tracheotomy with insertion of a tracheostomy tube for long-term mechanical ventilation are required.

ISB-10: Traumatic Asphyxia - This clinical simulation evolves around the management of a 29-year-old male who sustained a crushing neck injury. Decisions relative to clinical and laboratory assessment, securing an airway via emergent cricothyroidotomy, initiation of mechanical ventilation, administering fluid and vasopressor support, ventilator parameter adjustments, and ventilator waveform interpretation are required.

ISB-11: Organ Donor - This clinical simulation evolves around the management of an intubated and mechanically ventilated 31-year-old female admitted with massive head injuries and a broken neck following a fall from a ladder, who subsequently becomes an organ donor following brain death. Decisions relative to clinical and laboratory assessment, head injury precautions, patient/ventilator evaluation, troubleshooting and correcting an endotracheal tube cuff leak, evaluating confirmatory tests for brain death, performing an apnea test, monitoring and evaluation during the apnea test, reporting the results of the apnea test, and maintaining full supportive care and mechanical ventilation while waiting for organ procurement are required.

ISB-12: Hemorrhagic Shock - This clinical simulation evolves around the management of an intubated and mechanically ventilated 33-year-old male who sustained multiple traumatic injuries with copious blood loss following a bomb explosion at his place of residence. Decisions relative to clinical and laboratory assessment, patient-ventilator system assessment, ventilatory parameter changes, initiation of a spontaneous breathing trial (SBT), re-instituting mechanical ventilation due to a failed SBT attempt, and re-attempting the SBT when the patient’s condition improves are required.

ISB-13: Bilateral Diaphragmatic Paralysis (BDP) - This clinical simulation evolves around the management of an intubated and mechanically ventilated 39-year-old male who is diagnosed with acute respiratory failure secondary to bilateral diaphragmatic paralysis (BDP) following a traumatic injury to the back of his neck. Decisions relative to clinical and laboratory assessment, patient-ventilator system assessment, initiation of a spontaneous breathing trial (SBT), patient assessment during the SBT and adjustment of the FIO2, extubation and initiation of supplemental oxygen, initiation of NPPV for alveolar hypoventilation following extubation and setting initial NPPV parameters, and adjustment of NPPV parameters are required.

ISC-01: Cardiac Tamponade - This clinical simulation evolves around the management of a 65-year-old female who develops cardiac tamponade following CABG surgery. Decisions relative to clinical and laboratory assessment, oxygen therapy, diagnosis of cardiac tamponade, recommending pericardiocentesis, patient stabilization, manual ventilation, rapid sequence intubation, and re-positioning the endotracheal tube following intubation are required.

ISC-02: CHF/Diagnosis - This clinical simulation evolves around the management of a 78-year-old male who presents with increasing breathlessness. Decisions relative to clinical and laboratory assessment, diagnosis of CHF, initiation of oxygen therapy, initiating NPPV and setting initial parameters, adjusting NPPV parameters, troubleshooting NPPV due to eye irritation, and recommending corrective therapy for nose redness and irritation are required.

ISC-03: Coronary Artery Disease (CAD)- This clinical simulation evolves around the management of a 71-year-old male with a history of coronary artery disease who is admitted to the ED with complaints of dyspnea, palpitations, and nonspecific chest tightness. Decisions relative to clinical and laboratory assessment, initiation of oxygen therapy, administration of IV fluids and vasopressors for hypotension, recognizing the signs of pulmonary air embolism and taking corrective action, intubation and manual ventilation, interpreting the indicator color of a colorimetric end-tidal carbon dioxide detector, initiation of mechanical ventilation and setting initial ventilator parameters are required.

ISC-04: Postoperative Cardiac Surgery - This clinical simulation evolves around the management of a 72-year-old male following CABG surgery. Decisions relative to clinical and laboratory assessment, suggesting ventilator parameter changes when faced with inappropriate physician orders, titrating the FIO2, performing endotracheal suctioning, initiating weaning from mechanical ventilation, recognition and treatment of cardiac tamponade, re-instituting weaning when the patient's condition stabilizes, assessing tolerance to weaning, extubating and initiating supplemental oxygen are required.

ISC-05: Right Atrial Septal Defect - This clinical simulation evolves around the management of a 36-year-old female with a history of right atrial septal defect who presents with increasing cyanosis, edema of the legs, and dyspnea on exertion. Decisions relative to clinical and laboratory assessment, diagnosis of pulmonary hypertension with right-to-left shunting, intubation and initiation of mechanical ventilation, adjustment of ventilator parameters, troubleshooting the cause for the high pressure alarm activation, and administration of inhaled nitric oxide are required.

ISC-06: Pulmonary Embolism - This clinical simulation evolves around the management of a 60-year-old intubated and mechanically ventilated male following aortic valve surgery. Decisions relative to clinical and laboratory assessment, ventilator parameter adjustment, ECG rhythm interpretation and recommending medication delivery for the rhythm disturbance, weaning from mechanical ventilation and extubating, recognizing the signs and symptoms of pulmonary embolism and suggesting a diagnosis of pulmonary embolism as the cause for the patient’s symptoms, recommending CT pulmonary angiography, and initiating high-flow nasal cannula therapy are required.

ISC-07: Congestive Cardiomyopathy - This clinical simulation evolves around the management of a 29-year-old male who presents with increasing dyspnea, lower extremity edema, palpitations, and chest discomfort. Decisions relative to clinical and laboratory assessment, initiation of oxygen therapy, initiation of mask CPAP, interpretation of an ECG rhythm disturbance, recommending electrical cardioversion when pharmacological cardioversion fails, and recommending an energy level change during cardioversion are required.

ISC-08: CHF/Pulmonary Edema - This clinical simulation evolves around the management of a 78-year-old male with pulmonary edema secondary to acute exacerbation of CHF who is receiving mask CPAP therapy. Decisions relative to clinical and laboratory assessment, CPAP parameter adjustment, titration of FIO2, discontinuing CPAP and switching to low-flow oxygen, adjustment of oxygen liter flow, recommending nasotracheal suctioning for a weak, ineffective cough, insertion of a nasopharyngeal airway, and troubleshooting an occluded nasopharyngeal airway are required.

ISC-09: AMI/CPR - This clinical simulation evolves around the management of a 58-year-old male who was brought to the ED by the paramedics following a suspected myocardial infarction. Decisions relative to performing CPR and recommending CPR medications, initiation of mechanical ventilation and adjustment of ventilator parameters following CPR, troubleshooting a low pressure alarm activation, initiating CPR in response to cardiac asystole, recommending defibrillation in response to V-fib, assessing tolerance to weaning from mechanical ventilation once the patient’s clinical condition improves, and recommending extubation are required.

ISC-10: Post CPR Management - This clinical simulation evolves around the management of a 69-year-old male who sustained an in-hospital cardiac arrest and was successfully resuscitated, but remained apneic and hemodynamically compromised post CPR. Decisions relative to adjusting ventilator parameters, administering IV fluids, assessment of clinical condition to determine the cause for asynchronous breathing with the ventilator, manual ventilation and troubleshooting the endotracheal tube, and extubating when faced with an obstructed tube are required.

ISC-11: Ischemic Heart Disease (IHD) – This clinical simulation evolves around the management of an 82-year-old female with a history of ischemic heart disease who is status post coronary angioplasty with stent implantation. Decisions relative to clinical and laboratory assessment, patient assessment to determine the cause of respiratory distress, manual ventilation and troubleshooting an issue with bag compression, intubation and initiation of mechanical ventilation, recommending initial ventilator settings, troubleshooting an I:E ratio alarm and high pressure limit alarm activation, and recommending medication to alleviate severe hypotension are required.

ISC-12: Atrial Fibrillation/Synchronized Cardioversion - This clinical simulation evolves around the management of a 67-year-old male who presents to the ED with complaints of palpitations and dyspnea. Decisions relative to clinical assessment, recommending synchronized cardioversion for atrial fibrillation with a rapid ventricular rate, selecting supplies/equipment needed for the cardioversion procedure, recommending a sedative agent prior to the procedure, recommending an analgesic agent prior to the procedure, placing the adhesive pads in the appropriate position on the chest, ECG waveform interpretation following an initial synchronized shock, and initiating manual ventilation with chest compressions for asystole are required.

ISC-13: Pulmonary Hypertension – This clinical simulation evolves around the management of a 43-year-old male who presents with complaints of weakness, fatigue and worsening dyspnea on exertion. Decisions relative to clinical and laboratory assessment, diagnosis of pulmonary hypertension, initiation of mask CPAP, intubation and manual ventilation due to sporadic respirations and periods of apnea, recommending initial ventilator settings, and ECG rhythm interpretation with therapeutic intervention for unifocal PVCs are required.

ISD-01: Drug Overdose - This clinical simulation evolves around the management of a 31-year-old female who has overdosed on prescription medications. Decisions relative to clinical and laboratory assessment, intubation and initiation of mechanical ventilation, assessing for the cause of a fever and elevated white blood cell count, diagnosing pneumonia, interpretation of a ventilator graphic waveform abnormality, and taking corrective action are required.

ISD-02: Guillain-Barre Syndrome - This clinical simulation evolves around the management of a 27-year-old pregnant female admitted with a diagnosis of pneumonia, upper respiratory infection, and progressive lower extremity weakness. Decisions relative to clinical and laboratory assessment, diagnosis of Guillain-Barre Syndrome, spontaneous ventilatory parameter monitoring, supportive care and respiratory therapeutic intervention, intubation and mechanical ventilation, adjustment of sensitivity to correct ventilator auto-cycling, insertion of an arterial line, and tracheotomy with insertion of a tracheostomy tube are required.

ISD-03: Traumatic Brain Injury (TBI) - This clinical simulation evolves around the management of a 32-year-old female who was swimming at the local quarry when she did a forward flip into the water, striking her head on some submerged rocks. Decisions relative to chest x-ray interpretation of a mal-positioned endotracheal tube, repositioning the endotracheal tube, initiation of mechanical ventilation, ventilator graphic waveform interpretation, recommending sedation, ECG rhythm interpretation and corrective action for the ECG disturbance, obtaining weaning parameters, and recommending a spontaneous breathing trial are required.

ISD-04: Muscular Dystrophy - This clinical simulation evolves around the management of a 61-year-old female with adult-onset of muscular dystrophy who presents with generalized muscle weakness and lethargy. Decisions relative to clinical and laboratory assessment, intubation and manual ventilation, assessment of the endotracheal tube cuff pressure, setting initial ventilator parameters, adjustment of ventilator parameters, chest x-ray interpretation of a right-sided pneumothorax, placement of a right-sided chest tube, and diagnosis of aspiration pneumonia are required.

ISD-05: Myasthenia Gravis - This clinical simulation evolves around the management of a 39-year-old male with ventilatory failure secondary to acute exacerbation of myasthenia gravis. Decisions relative to clinical and laboratory assessment, patient/tracheostomy/ventilator assessment, initiation of weaning from mechanical ventilation, ventilator mode and parameter adjustments, attempting a T-piece trial, switching to a trach collar, oxygen concentration adjustments, tracheal suctioning, and initiating intrapulmonary percussive ventilation (IPV) are required.

ISD-06: Cervical Spinal Cord Injury - This clinical simulation evolves around the management of a 28-year-old male who exhibits respiratory failure following a cervical spinal cord injury. Decisions relative to clinical and laboratory assessment, patient/ventilator troubleshooting, assessment for respiratory distress, chest x-ray interpretation, fiberoptic bronchoscopy with removal of an impacted mucous plug, ventilator and airway equipment necessary for home mechanical ventilation and airway management, and adjustment of ventilator parameters following discharge are required.

ISD-07: Tetanus - This clinical simulation evolves around the management of a 65-year-old female who develops tetanus following a traumatic knee laceration. Decisions relative to clinical and laboratory assessment, initiation and adjustment of oxygen therapy, nasal intubation, initiation and adjustment of mechanical ventilation, patient/ventilator systems check, and endotracheal suctioning are required.

ISD-08: Acute Cerebral Vascular Accident (CVA) - This clinical simulation evolves around the management of a 57-year-old intubated and mechanically ventilated female who had developed neurological deterioration secondary to an acute stroke. Decisions relative to clinical and laboratory assessment, repositioning the endotracheal tube, accidental extubation and re-intubation, patient-ventilator system check, repositioning the endotracheal tube following re-intubation and adjusting the FIO2, recommending NPPV following a failed wean from mechanical ventilation, and setting initial NPPV settings are required.

ISD-09: Amyotrophic Lateral Sclerosis (ALS) - This clinical simulation evolves around the management of a 59-year-old intubated and mechanically ventilated male with a history of amyotrophic lateral sclerosis (ALS). Decisions relative to clinical and laboratory assessment, ventilator parameter adjustment, treatment for Staphylococcus aureus lung infection, tracheotomy with insertion of a tracheostomy tube for long-term mechanical ventilation, assistance with the tracheotomy procedure, interpretation and corrective action for an ECG rhythm disturbance, and assessment for weaning from mechanical ventilation are required.

ISD-10: Heavy Metal Poisoning - This clinical simulation evolves around the management of a 46-year-old female who is found unconscious at her place of work following an industrial accident in which a large amount of mercury was spilled. Decisions relative to clinical and laboratory assessment, chest x-ray interpretation, endotracheal intubation and initiation of mechanical ventilation, interpretation and corrective action for a ventilator graphic waveform abnormality, assessment for ventilator discontinuance once the patient’s condition improves, and extubation with the administration of supplemental oxygen are required.

ISD-11: Transient Ischemic Attack (TIA) - This clinical simulation evolves around the management of a 61-year-old male who is brought to the ED by his wife for slurred speech and altered mental status. Decisions relative to clinical and laboratory assessment, diagnosis of TIA/Stroke, DNR ethics, assessment for respiratory distress, initiation of NPPV, and NPPV troubleshooting are required.

ISD-12: Post-Polio Syndrome (PPS) - This clinical simulation evolves around the management of a 76-year-old male with post-polio syndrome who is receiving mechanical ventilation via a tracheostomy tube. The patient was brought to the ED by his primary care provider for evaluation of an acute onset of respiratory distress. Decisions relative to ECG rhythm interpretation, clinical assessment, suggesting that the trach tube has a herniated cuff with replacement of the trach tube, obtaining the necessary supplies needed for replacement of the trach tube, determining the proper procedure for trach tube replacement, patient assessment for the cause of an acute onset of agitation following the placement of the trach tube, and tracheal suctioning are required.

ISD-13: Necrotizing Autoimmune Myopathy (NAM) - This clinical simulation evolves around the management of a 66-year-old male with a history of scleroderma and NAM who presents with chief medical complaints of increasing fatigue with weakness in both the upper and lower body, difficulty in “catching his breath”, and difficulty in swallowing. Decisions relative to correcting the oxygen flow of a simple oxygen mask, clinical assessment, recommending manual ventilation and intubation, interpreting the ECG rhythm and taking corrective action for ventricular tachycardia, interpreting the ECG rhythm and taking corrective action for asystole, interpreting the ECG rhythm and taking corrective action for bradycardia, interpreting the ECG rhythm for normal sinus rhythm and initiating mechanical ventilation are required.

ISE-01: AIDS - This clinical simulation evolves around the management of a HIV-positive 50-year-old male who presents to the emergency department with complaints of dyspnea at rest, dry cough, and chest discomfort. Decisions relative to clinical and laboratory assessment, oxygen administration, chest x-ray and CT scan evaluation, sputum induction, bronchoscopy, chest x-ray interpretation of a pneumothorax, and placement of a chest tube are required.

ISE-02: Sepsis/ARDS - This clinical simulation evolves around the management of an intubated and mechanically ventilated 47-year-old female patient with acute pancreatitis complicated by sepsis and acute respiratory distress syndrome (ARDS). Decisions relative to clinical and laboratory assessment, adjustment of ventilator parameters, administration of a bronchodilator, patient-ventilator assessment, ventilator graphic waveform interpretation, calculating optimal PEEP, initiating pressure control ventilation (PCV), and recommending initial PCV settings are required.

ISE-03: Aspiration Pneumonitis - This clinical simulation evolves around the management of a 32-year-old male who was training to be a fire eater when he accidentally aspirates some unknown liquids he had used for this purpose. Decisions relative to clinical and laboratory assessment, pathophysiology, aerosol therapy, pharmacology, oxygen administration, patient-ventilator assessment and troubleshooting, and weaning from mechanical ventilation with subsequent extubation are required.

ISE-04: Bronchogenic Carcinoma - This clinical simulation evolves around the management of a 51-year-old female who has been referred by her family physician for increased fatigue, dyspnea on exertion, and a persistent dry cough. Decisions relative to clinical and laboratory assessment, chest x-ray and CT scan evaluation, pulmonary function testing and interpretation, bronchoscopy, pharmacology, double lumen endotracheal tube recommendation for left upper lobe lobectomy procedure, and initiation of pressure-controlled ventilation are required.

ISE-05: Carbon Monoxide Poisoning - This clinical simulation evolves around the management of a 19-year-old male who was brought to the ED after being found unconscious lying next to his car in an enclosed garage. Decisions relative to clinical and laboratory assessment, diagnosis, manual ventilation initiation and adjustment, endotracheal tube troubleshooting, recommending hyperbaric oxygen therapy, replacing the air in the cuff of the endotracheal tube with normal saline prior to hyperbaric oxygen therapy, titrating the FIO2 following hyperbaric oxygen therapy, and calculating new FIO2 are required.

ISE-06: Consolidative Pneumonia - This clinical simulation evolves around the management of a 24-year-old female who presents with a one-week history of malaise, fever, and intermittent headaches. Decisions relative to clinical and laboratory assessment, chest x-ray interpretation, diagnosis, initiation and adjustment of oxygen therapy, oxygen flowmeter troubleshooting, initiation of PEP therapy, initiation of bronchodilator therapy, and initiation of CPAP therapy are required.

ISE-07: Cystic Fibrosis/Noninvasive - This clinical simulation evolves around the management of a 27-year-old male with cystic fibrosis who has been admitted for increasing respiratory distress. Decisions relative to clinical and laboratory assessment, chest x-ray interpretation, concurrent diagnosis of P. aeruginosa lung infection and bronchiectasis, initiation and adjustment of oxygen therapy, initiation of aerosolized antibiotic therapy, initiation of aerosolized albuterol treatments, initiation of IPV, discontinuing IPV due to intolerance and switching to HFCWO, initiation of dornase alpha (Pulmozyme), and instructing the patient in the order that respiratory treatments should be administered upon discharge from the hospital are required.

ISE-08: Kyphoscoliosis - This clinical simulation evolves around the management of a 59-year-old female with severe, deforming kyphoscoliosis who presents to the respiratory clinic for evaluation of a 1-week history of increasing dyspnea at rest. Decisions relative to pulmonary function testing and interpretation, arterial blood gas analysis, chest x-ray interpretation, clinical and laboratory assessment, admitting the patient to the hospital, oxygen therapy administration, initiating mask NPPV for respiratory insufficiency, adjusting NPPV parameters, and intubation for respiratory failure are required.

ISE-09: Lung Abscess - This clinical simulation evolves around the management of a 21-year-old male who presents with fever and a productive cough that is purulent, blood-streaked, and foul-smelling. Decisions relative to clinical and laboratory assessment, oxygen therapy, bronchodilator therapy, chest x-ray interpretation, obtaining a CT scan of the chest, diagnosis of lung abscess, adjusting ventilator parameters, endotracheal suctioning, and obtaining and interpreting spontaneous respiratory parameters are required.

ISE-10: Near Drowning/ARDS - This clinical simulation evolves around the management of a 44-year-old male victim of a near drowning accident. Decisions relative to clinical and laboratory assessment, intubation, initiation of mechanical ventilation, adjustment of ventilator parameters, troubleshooting a high pressure alarm activation, endotracheal suctioning, administration of bronchodilator therapy, patient/ventilator evaluation, and diagnosis of adult respiratory distress syndrome are required.

ISE-11: Postoperative Thoracic Surgery - This clinical simulation evolves around the management of a 57-year-old male who underwent right pneumonectomy and subsequently develops bronchopleural fistula. Decisions relative to clinical and laboratory assessment, interpretation of a post-pneumonectomy chest x-ray, initiation and adjustment of oxygen therapy, diagnosis of bronchopleural fistula with empyema, placement of a right-sided intercostal drainage tube, initiation of and administering aerosol albuterol, initiation of pressure control ventilation followed by ventilator assessment, weaning from pressure control ventilation followed by extubation are required.

ISE-12: Pulmonary Fibrosis - This clinical simulation evolves around the management of a 54-year-old male who presents to the respiratory clinic with complaints of exertional dyspnea and a persistent, non-productive cough who subsequently is diagnosed with pulmonary fibrosis secondary to chronic inhalation of a herbicide. Decisions relative to clinical and laboratory assessment, interpretation of blood gas results, recommending a CT scan of the chest for further evaluation, obtaining and interpreting pulmonary function values, assessing for the cause of respiratory distress following video-assisted thoracic surgery (VATS) lung biopsy, chest x-ray evaluation of a misplaced chest tube, and taking corrective action regarding the misplaced chest tube are required.

ISE-13: Sarcoidosis - This clinical simulation evolves around the management of a 29-year-old female diagnosed with sarcoidosis who subsequently develops small cell carcinoma of the left lower lobe requiring left lower lobe wedge resection. Decisions relative to clinical and laboratory assessment, spirometry interpretation, arterial blood gas interpretation, assessment for respiratory distress, intubation and initiation of mechanical ventilation, adjustment of ventilator parameters, assessment for post-operative atelectasis, and fiberoptic bronchoscopy with removal of an impacted mucous plug are required.

ISE-14: SARS/ARDS - This clinical simulation evolves around the management of a middle-aged business man who develops ventilatory failure secondary to severe acute respiratory syndrome (SARS). Decisions relative to clinical and laboratory assessment, mechanical ventilation assessment and management, chest x-ray interpretation to determine the position of the endotracheal tube, placing the patient in the prone position for severe hypoxemia, recommending an anticoagulant for deep venous thrombosis, placement of a right-sided chest tube to correct a right-sided pneumothorax, switching to pressure-control ventilation when faced with rising plateau pressures and setting initial parameters are required.

ISE-15: Tuberculosis - This clinical simulation evolves around the management of a 41-year-old male admitted to the hospital to rule out tuberculosis. Decisions relative to clinical and laboratory assessment, obtaining an induced sputum sample, initiation of oxygen therapy, initiating CPAP therapy, adjustment of CPAP parameters, intubation and initiation of mechanical ventilation, and initiation of capnography with waveform interpretation are required.


Software Title:
Respiratory Administrator
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Self-Evaluation Clinical Simulation Examinations
Adult Self-Evaluation Clinical Simulations
Pediatric Self-Evaluation Clinical Simulations
Neonatal Self-Evaluation Clinical Simulations
TMC/CSE Calculations Companion Software

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