Alkhalifah Mohammed, McLean Michelle, Koshak Ahmad
Neurocritical Care Fellow, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine.
Assistant Director of the Clinical Simulation Center, Central Michigan University College of Medicine.
MedEdPORTAL. 2016 Sep 23;12:10466. doi: 10.15766/mep_2374-8265.10466.
This case was designed to be an interprofessional scenario to assist the learner in the approach to a patient with cardiac tamponade. This resource provides information and materials for a high-fidelity simulation scenario that is appropriate for learners at multiple levels. Each learner has the opportunity to interact with embedded patient actors. This scenario includes the opportunity to conduct a bedside echocardiogram and perform an ultrasound-guided pericardiocentesis.
A 51-year-old female presents to the emergency department with a chief complaint of shortness of breath and with a history of cancer. Her shortness of breath evolves into tachypnea, hypoxia, altered mental status, hypotension, and shock. The physical assessment reveals hypotension, muffled heart tones, and jugular vein distension. One critical action requires the recognition of pericardial effusion on a bedside echocardiogram. The learner needs to interpret the ultrasound findings in conjunction with the physical exam findings to diagnose cardiac tamponade. An emergent ultrasound-guided pericardiocentesis is to be performed. Equipment needed includes a high-fidelity adult mannequin, the low-cost ultrasound pericardiocentesis model (or pericardocentesis model of choice), bedside ultrasound, the PowerPoint presentation containing imaging, and laboratory data.
A survey was completed by 23 residents who participated in this simulation. Ninety-five percent of those responding felt that this simulation in conjunction with the debriefing was effective in managing a patient presenting with undifferentiated shortness of breath and pericardial tamponade.
This case will be incorporated into the 3-year curriculum for our emergency medicine residency program and assist with evaluation of resident performance of pericardiocentesis.
本病例旨在设计一个跨专业场景，以帮助学习者处理心脏压塞患者。本资源为适合多个水平学习者的高保真模拟场景提供信息和材料。每个学习者都有机会与嵌入式患者角色互动。该场景包括进行床边超声心动图检查和超声引导下心包穿刺术的机会。
一名51岁女性因呼吸急促为主诉就诊于急诊科，有癌症病史。她的呼吸急促发展为呼吸急促、低氧血症、精神状态改变、低血压和休克。体格检查发现低血压、心音减弱和颈静脉扩张。一项关键操作需要在床边超声心动图上识别心包积液。学习者需要结合体格检查结果解读超声检查结果，以诊断心脏压塞。需进行紧急超声引导下心包穿刺术。所需设备包括高保真成人人体模型、低成本超声心包穿刺模型（或所选的心包穿刺模型）、床边超声、包含影像的PowerPoint演示文稿和实验室数据。
23名参与此次模拟的住院医师完成了一项调查。95%的受访者认为，此次模拟结合汇报对处理表现为不明原因呼吸急促和心包压塞的患者有效。
本病例将纳入我们急诊医学住院医师培训项目的三年课程中，并有助于评估住院医师心包穿刺术的操作表现。
