Assistant Clinical Professor, Emergency Medicine, Central Michigan University College of Medicine.
MedEdPORTAL. 2020 Jun 26;16:10916. doi: 10.15766/mep_2374-8265.10916.
Epistaxis is a common presenting complaint in the emergency department. Proper technique to control the bleeding is essential. Active bleeding on an anticoagulant requires special consideration. Blood products and coagulopathy reversal are an important part of the resuscitation of an unstable bleeding patient on warfarin.
This resource was created to simulate a high-acuity and moderate-frequency event seen in emergency departments and on hospital wards. The target audience included emergency department residents, internal medicine residents, and advanced practice providers. The scenario detailed the case of an 82-year-old male on Coumadin who presented with epistaxis. A mannequin equipped with an epistaxis task trainer in which rate of bleeding could be controlled was required. The case was complicated by a choking episode on attempted nasal packing. It also involved warfarin coagulopathy requiring blood products and warfarin reversal. The simulation may be performed in a simulation lab or in situ in the emergency department, intensive care unit, or medical floor. Critical actions include addressing epistaxis with packing, recognizing blood-loss anemia related to warfarin coagulopathy, and recognizing and managing airway obstruction.
Approximately 35 learners completed this module in five separate sessions. Written evaluation from learners showed that 95% felt the simulation scenario and debriefing were effective.
Simulation is an ideal teaching tool for this life-threatening presentation. Learners can demonstrate proper technique and management of this difficult case.
鼻出血是急诊科常见的就诊主诉。掌握正确的止血技术至关重要。正在服用抗凝药物的患者发生活动性出血时需要特别考虑。对于华法林抗凝治疗不稳定出血患者，血液制品和凝血功能障碍逆转是复苏的重要组成部分。
本资源旨在模拟急诊科和医院病房中常见的高频率中度紧急事件。目标受众包括急诊科住院医师、内科住院医师和高级执业医师。该场景详细介绍了一名 82 岁男性患者的情况，该患者正在服用华法林，因鼻出血就诊。需要使用配备有可控制出血速度的鼻出血任务训练器的模拟人。该病例还因试图鼻腔填塞时发生窒息而变得复杂，并且涉及华法林导致凝血功能障碍，需要血液制品和华法林逆转。该模拟可以在模拟实验室或在急诊科、重症监护病房或医疗病房现场进行。关键操作包括用填塞物治疗鼻出血、识别与华法林凝血功能障碍相关的失血贫血、识别和处理气道阻塞。
大约 35 名学习者在五个单独的会议中完成了这个模块。学习者的书面评估显示，95%的学习者认为模拟场景和讨论有效。
对于这种危及生命的表现，模拟是一种理想的教学工具。学习者可以展示这种棘手病例的正确技术和管理方法。
