Couloures Kevin G, Allen Christine
Assistant Professor, Department of Pediatrics, Yale School of Medicine.
Assistant Professor, Department of Pediatrics, University of Oklahoma College of Medicine.
MedEdPORTAL. 2017 Mar 16;13:10555. doi: 10.15766/mep_2374-8265.10555.
Cardiorespiratory events are infrequent in pediatric teaching hospitals but can lead to significant morbidity and mortality. Clear communication within the response team prevents delays in action and allows all team members to contribute to providing optimum management. This resource was developed to simulate high-acuity and low-frequency events for pediatric residents. The scenario options are recurrent supraventricular tachycardia, prolonged QT syndrome, myocarditis, and respiratory syncytial virus bronchiolitis.
The simulation is best performed in a simulation center with audio- and video-recording capabilities but could also be performed in situ in the pediatric intensive care unit or emergency room. Necessary personnel include a simulation technician and two instructors. A code cart, mock medications, and defibrillator with hands-free pads appropriate for the mannequin are necessary supplies. Critical actions include initial survey and intervention, rhythm recognition, cardiopulmonary resuscitation (CPR), use of defibrillator, and administration of anti-arrhythmic medications when needed. At the conclusion of the scenario, a formal debriefing with learners using structured feedback is performed.
These cases have been used with groups of pediatric or emergency medicine residents approximately 16 times over the past 3 years. Learners have reported that participation increased their confidence and comfort with management of cardiorespiratory events and that communication technique practice improved their teamwork and sign-out skills. Rhythm recognition and CPR performance scores during the simulation scenarios improved, with subjective improvement during actual cardiorespiratory events.
This resource advances learner knowledge of Pediatric Advanced Life Support algorithms and teamwork communication and identifies learner knowledge and management deficits.
心肺事件在儿科教学医院并不常见，但可能导致严重的发病和死亡。应急团队内部的清晰沟通可防止行动延误，并使所有团队成员都能为提供最佳管理做出贡献。开发此资源是为了模拟儿科住院医师的高急症和低频事件。场景选项包括复发性室上性心动过速、长QT综合征、心肌炎和呼吸道合胞病毒细支气管炎。
模拟最好在具备音频和视频录制功能的模拟中心进行，但也可以在儿科重症监护病房或急诊室现场进行。必要的人员包括一名模拟技术员和两名教员。必备用品包括急救推车、模拟药物以及适合人体模型的带免提电极片的除颤器。关键操作包括初始检查与干预、心律识别、心肺复苏（CPR）、使用除颤器以及在需要时给予抗心律失常药物。在场景结束时，使用结构化反馈与学员进行正式的总结汇报。
在过去3年中，这些病例已用于儿科或急诊医学住院医师组约16次。学员报告称，参与增加了他们对心肺事件管理的信心和舒适度，并且沟通技巧练习提高了他们的团队协作和交班技能。模拟场景中的心律识别和心肺复苏表现评分有所提高，在实际心肺事件中也有主观上的改善。
此资源提升了学员对儿科高级生命支持算法和团队协作沟通的知识，并识别出学员的知识和管理缺陷。
