StrokeNarrationScript

=Stroke Video Narrations= (Pause on opening screen until this sentence is read) Welcome to an introduction to the MIND Project’s Virtual Stroke Lab. When students first enter the lab, they are asked to type in their last name.

Students role play an endovascular neuroradiologist throughout this virtual lab, (Start video now… ) and must make decisions based on what they learn about diagnosing and treating stroke victims.

Before students begin their experience they are asked to orient themselves to the navigation buttons located in the lower right hand corner.

The Protocol button brings up a small window that students consult in order to learn the step-by-step instructions for each part of the lab. The EMR, shown here, stands for The Electronic Medical Record, provides background descriptions on strokes and possible treatments. This button will be used often throughout the lab. The “Doctor’s Notes” button is where important decisions that the students made are recorded. The “Patient Data” button is where students access the medical records and other information about the patients. The “Map” button gives students a bird’s eye view of the hospital layout and a red triangle lets them know their location to help make navigate easier.

(0:52) (Start narration with the "Paging Dr. Smith…." pop up) In this first scene, the student participant is paged to the emergency room to see Mr. Jones a patient just admitted. Students will be asked to use the patient history and information they have read in the EMR to answer questions.
 * Section 2: Diagnostic testing**

Students will click on the continue button as they answer questions regarding the patient’s stroke risk factors to determine the Hunt & Hess score, before making their initial diagnosis of hemorrhagic stroke. The student finishes this section once the primary diagnostic test of CT Head scan is made.

(1:29: Beginning of Section 2: right after scene 1 congratulations screen) In this scene, the patient has been prepped and taken to the CT Room. Student participants must navigate from the ER to the CT room, using the map if they need to.

(Start narration at the CT door) When they first enter the CT room, they start the CT machine, and then using their arrow keys on the keyboard, align the patient’s head within the machine.

(1:58 CT Control Room: primary & secondary diagnosis)

After completing this task, students navigate to the control room where they run a “CT Head Scan without Contrast” and a “3D CT Head Angiogram” After each of these scans is complete, students must locate and highlight the suspected bleed. The EMR will help students learn how to interpret both of these CT Scans. It describes what dark, light and grey parts of the scan may indicate. When students highlight the correct area, they are told of the confirmed report that the bleed indicates a Hemorrhagic stroke and that the blood’s location in Mr. Jones’s case classifies it as a Subarachnoid Hemorrhagic Stroke (SAH). After viewing the 3D reformation, Students are informed that a digital subtraction angiogram will provide the detail needed.

(2:54 Moving to Neuroendovascular Suite)

Student participants then navigate from the CT control room, and move to the Neuroendovascular Suite.

(Start narration as the door of the Neuroendovascular Suite is opened 2:59) In this scene, performing several diagnostic tests is crucial in order to determine whether or not an aneurysm is the cause of the SAH bleed. Students simulate a Digital Subtraction Angiogram (DSA) on Mr. Jones’ head. With specific prompting from the protocol, student click and drag items from the tool tray in order to insert introducer needles, guidewires, sheaths, and catheters into the femoral artery and then slowly move toward the brain injecting dye at each stage while in looking for an aneurysm.

This part of the lab is interactive as students are asked to use the line control to advance the main catheter from the femoral artery to the area near the bleed. There are several screens students will be viewing while doing this part of the lab. The Upper left screen: shows the live view via the fluoroscopy machine. The Right screen: displays a reference map of the arteries relevant to this particular procedure and also indicates the positing in the body. The Lower left screen: will show any 3D models or other images taken during the procedure. Once the main catheter is in place near the area of interest, students are prompted to begin the scanning process. They inject contrast dye into the blood vessels while taking a series of scans with the fluoroscopy machine. Then, the computer interprets the scans and removes everything except the areas where the dye has flowed through, leaving a pristine image of only the blood vessels and organs. Once that image is obtained, the student creates a 3D image of the hemorrhaging area to determine how to treat it.

Students determine that an aneurysm is present in Mr. Jones’ left internal carotid artery and was the cause of the subarachnoid hemorrhage. The student then is given options on how to treat the aneurysm; to clip the aneurysm, coil it or refuse to do the procedure. The neck size of the aneurysm, is crucial as students determine that endovascular coiling would be the best treatment for Mr. Jones’ condition. This ends section 2 of the Virtual Stroke Lab.

End of Section 2: 5:02

Section 3: Coiling the aneurysm This is the last part of the lab, and where the life-saving procedure is completed. Student simulates a coiling treatment procedure on Mr. Jones’ aneurysm. Students thread a microguidewire and microcatheter through the main catheter and up to the neck of the aneurysm. Students block blood flow to the aneurysm by inserting varying size coils directly inside of it. The number of coils varies based on the size of the aneurysm. Usually, as in this lab, the larger coils are inserted first with the smaller coils used to fill in gaps.

The final DSA scan and 3D scan shows no aneurysm because the contrast dye only shows blood flow. Since the aneurysm is completely coiled, no blood can enter the aneurysm, which is why it no longer shows up on the scan. This should indicate to students that the procedure was effective.

The final feedback explains that Mr. Jones awoke from the procedure without any neurologic change, and that after 14 days in ICU he went on to make a full recovery.