Bronshteyn Yuriy S, Lemm John, Malinzak Elizabeth, Ghadimi Nada, Udani Ankeet D
Assistant Professor, Department of Anesthesiology, Duke University School of Medicine.
Certified Registered Nurse Anesthetist, Department of Anesthesiology, Duke University School of Medicine.
MedEdPORTAL. 2017 Mar 30;13:10563. doi: 10.15766/mep_2374-8265.10563.
Sepsis should be included in the differential of any patient with unexplained organ dysfunction, whether or not an obvious infection is initially detected. Perioperative providers frequently care for patients with sepsis. This simulation case challenges participants to recognize and manage a presentation of postoperative sepsis, providing an opportunity to discuss the rationale behind sepsis management during debriefing.
Assuming the role of an anesthesia provider, the participant takes over the care of a 62-year-old female who has just undergone cystoscopy and is extubated in the operating room (OR). The participant receives a brief handoff from the outgoing anesthesiologist while the patient awaits a postanesthesia care unit slot. The case has been uneventful, aside from intermittent hypotension responsive to IV fluids and boluses of phenylephrine. Within minutes of the handoff, the patient becomes somnolent and hypotensive. Efforts to treat hypotension eventually precipitate hypoxemia. Trainees must recognize and manage this cardiopulmonary decompensation. The scenario benefits from an OR simulation environment containing an anesthetic ventilator, anesthesia drugs and equipment, and a mannequin on an OR table.
Twelve residents completed the simulation scenario. Formal feedback was collected via email questionnaire from faculty instructors within 30 days of teaching each session.
Sepsis presents a diagnostic dilemma in part because no single diagnostic test rules the syndrome in or out. Multiple operational definitions of sepsis in the academic literature add to the confusion for clinicians. Our case simulation challenges perioperative providers to make a timely diagnosis and initiate appropriate treatment of sepsis.
对于任何出现不明原因器官功能障碍的患者，无论最初是否检测到明显感染，都应将脓毒症纳入鉴别诊断。围手术期医护人员经常护理脓毒症患者。本模拟病例挑战参与者识别和处理术后脓毒症的表现，为在汇报过程中讨论脓毒症管理背后的基本原理提供了机会。
参与者扮演麻醉医护人员的角色，接手一名62岁女性患者的护理工作，该患者刚接受膀胱镜检查，正在手术室拔管。在患者等待进入麻醉后护理单元期间，参与者从即将交班的麻醉医生那里接收了简要的交接信息。除了对静脉输液和去氧肾上腺素推注有反应的间歇性低血压外，该病例一直很顺利。交接后几分钟内，患者变得嗜睡且血压降低。治疗低血压的努力最终导致了低氧血症。学员必须识别并处理这种心肺失代偿情况。该场景得益于手术室模拟环境，其中包括麻醉呼吸机、麻醉药物和设备，以及手术台上的人体模型。
12名住院医生完成了模拟场景。在每次教学后的30天内，通过电子邮件问卷从教员那里收集了正式反馈。
脓毒症存在诊断难题，部分原因是没有单一的诊断测试能明确该综合征的存在与否。学术文献中脓毒症的多个操作定义增加了临床医生的困惑。我们的病例模拟挑战围手术期医护人员及时诊断并启动脓毒症的适当治疗。
