Hartford Emily, Thomas Anita, Keilman Ashley, Uspal Neil, Stone Kimberly, Reid Jennifer, Burns Rebekah
Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine.
Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Seattle Children's Hospital.
MedEdPORTAL. 2019 Oct 25;15:10846. doi: 10.15766/mep_2374-8265.10846.
Bupropion is a commonly used antidepressant, and overdose can lead to both neurologic and cardiovascular toxicity, including agitation, seizure, tachycardia, QT and QRS prolongation, and rhythm disturbances.
We developed this simulation case for attendings, fellows, nurse practitioners, and nurses in the pediatric emergency department (ED). The scenario involved a 13-year-old male presenting to the ED with altered mental status and a generalized tonic-clonic seizure shortly after arrival. The team needed to quickly perform primary and secondary surveys, manage his airway and breathing, and initiate treatment for seizure. The team had to obtain an abbreviated history and include ingestion in the differential. The patient then developed pulseless ventricular tachycardia, and the team needed to respond with high-quality CPR, defibrillation, and advanced airway management. Preparatory materials, a debriefing guide, and scenario evaluation forms assisted with facilitation.
Twenty-eight physicians, 56 nurses, 10 nurse practitioners, four pharmacists, two students, and one respiratory therapist completed this simulation in 13 sessions. On a 5-point Likert scale, participants agreed with the stated objective of ability to manage a patient with a bupropion overdose ( = 4.09; range, 2-5). The scenario was rated as highly relevant ( = 4.93) and the debriefing as very effective ( = 4.85).
This scenario is a complete educational resource for setting up, implementing, and debriefing in an interprofessional setting. It was well received by learners from diverse professional backgrounds working together in actual care teams in the pediatric ED.
安非他酮是一种常用的抗抑郁药，过量服用可导致神经和心血管毒性，包括烦躁不安、癫痫发作、心动过速、QT和QRS间期延长以及心律紊乱。
我们为儿科急诊科的主治医师、住院医师、执业护士和护士开发了这个模拟病例。该病例是一名13岁男性，到达急诊科后不久出现精神状态改变和全身性强直阵挛性癫痫发作。团队需要迅速进行初级和次级评估，管理其气道和呼吸，并开始癫痫治疗。团队必须获取简要病史，并将摄入药物情况纳入鉴别诊断。患者随后出现无脉性室性心动过速，团队需要进行高质量心肺复苏、除颤和高级气道管理。准备材料、汇报指南和情景评估表格有助于促进模拟的进行。
28名医生、56名护士、10名执业护士、4名药剂师、2名学生和1名呼吸治疗师在13次课程中完成了这个模拟。在5分制的李克特量表上，参与者同意该模拟设定的管理安非他酮过量患者的目标（平均分 = 4.09；范围为2 - 5）。该情景被评为高度相关（平均分 = 4.93），汇报被评为非常有效（平均分 = 4.85）。
这个情景是一个完整的教育资源，可用于跨专业环境中的设置、实施和汇报。它受到了在儿科急诊科实际护理团队中共同工作的不同专业背景学习者的好评。
