Shock scenarios now available

You can read about shock all day. You can memorise the four phenotypes, draw the haemodynamic diagrams, recite the SSC bundles. None of that matters if the first time you see a septic patient transition from warm to cold shock is on a real transport at two in the morning with a 90-minute flight ahead of you.

That is what simulation is for. Not to test you. To let you fail safely, recognise the patterns, and build the clinical reasoning that works under pressure.

We have built a complete simulation pack for the Shock Module. Five scenarios. Each one comes in two formats: a Relaiti 360 / iSimulate scenario file (.isims) that you can import directly into the app and run as a live vital signs simulation, and a tabletop discussion document (.docx) designed to be worked through as a group with a facilitator.

The five scenarios:

SHOCK001 — Septic Shock: The Warm-to-Cold Transition. A 72-year-old with urosepsis who starts as textbook warm shock and then transitions to cold shock mid-scenario. The group has to recognise that this is myocardial depression, not fluid overload, and adjust their vasopressor strategy accordingly. The metformin on the medication list forces a discussion about lactate interpretation.

SHOCK002 — Cardiogenic Shock: The Post-STEMI Fluid Trap. A 58-year-old anterior STEMI where the sending ED has given a litre of fluid for the low blood pressure. The patient now has elevated JVP, bilateral crackles, and worsening hypotension. The group has to identify that the fluid was the wrong treatment, withhold further volume, and manage the oxygenation spiral from iatrogenic pulmonary oedema.

SHOCK003 — Obstructive Shock: Tension Pneumothorax in the Ventilated Patient. A 42-year-old trauma patient, intubated, ICC in situ, stable on departure. Twenty minutes into a fixed-wing transport the ventilator starts alarming. The group works through DOPES, identifies the tension pneumothorax clinically without imaging, and decompresses. The teaching point: positive pressure ventilation converted a simple pneumothorax to tension through a blocked ICC.

SHOCK004 — Neurogenic Shock: Bradycardia, Warm Peripheries and a Spinal Injury. A 24-year-old with a C5 burst fracture. The odd one out: bradycardia plus hypotension plus warm dry skin. The group has to recognise that fluid alone will not fix this, apply the higher MAP target for spinal cord perfusion, and manage the reflex bradycardia that develops when the vasopressor increases SVR against an unopposed vagus.

SHOCK005 — Undifferentiated Shock: Treat What You See. A 55-year-old immunosuppressed female, intubated, FAST positive, rigid abdomen, diagnosis uncertain. Mixed shock. The group applies the four bedside data points, identifies the chronic prednisolone as an adrenal suppression risk, switches the propofol to ketamine, and resuscitates without waiting for a definitive diagnosis. This is the capstone scenario for the module.

How to use them:

FOR INDIVIDUAL STUDY Download the tabletop document and work through it on your own. Read the clinical information, pause at each discussion question, and write down your answer before reading the model answer at the end. This is active recall, not passive reading.

FOR GROUP TABLETOP DISCUSSION Print the tabletop document. One person facilitates. Read the dispatch and clinical information aloud. Pause at each numbered discussion question and let the group reason through it. The facilitator prompts underneath each question tell you what to listen for. Do not reveal the model answer until the group has worked through all the questions.

FOR LIVE SIMULATION WITH REALITI 360 / iSIMULATE

Import the .isims file into Realiti 360. Run it on a tablet or monitor as your vital signs display.

Use the tabletop document as your facilitator guide.

The scenario phases in the app match the vital signs progression in the document. Advance through the phases as the group performs the expected interventions.

Built for international practice.

Every tabletop document includes a jurisdictional comparison table that maps the management across four guideline systems: Ornge (Canada), St John NZ (EAS CPGs), Ambulance Victoria (Australia), and JRCALC (UK). Not every service carries the same drugs. If your service uses metaraminol instead of noradrenaline, or adrenaline infusions instead of vasopressin, the documents address this directly. The principles are the same. The pharmacology adapts to what you carry.

Each document also includes a drug availability discussion section that walks through the receptor pharmacology of the available agents and how to apply the same clinical reasoning with different formularies. This is not a one-jurisdiction course.

TRANSPORT PEARL The vasopressor you use matters less than understanding why you are using it. Noradrenaline, metaraminol, and adrenaline all restore vascular tone through alpha-1 agonism. The difference is their additional receptor activity. Choose based on availability and clinical context, not habit.

What makes these different from a textbook case study?

Every scenario is structured as a progressive clinical narrative with embedded clinical traps. The sending facility has made decisions, some appropriate and some not, and the transport crew has to identify what has been done, what should not have been done, and what needs to happen next. The SAMPLE and OPQRST histories contain the information the group needs to reason through the case. The vital signs progress across phases. The labs tell a story. The positive treatment narrative at the end is not a checklist of correct answers. It is a narrated walkthrough of a crew managing the case well, including the clinical reasoning at each decision point.

These are designed to make you think, not just perform.

The simulation files and tabletop documents are available in the classroom under the Shock Module. Download them, run them with your team, and let us know how they go.

Which of the five scenarios do you want to run first with your team? Have you used Relaiti 360 / iSimulate before for transport-specific scenarios? Drop your thoughts below.

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