Vempati Amrita, Greene P J
Creighton University School of Medicine Phoenix Program, Valleyhealth Medical Center, Department of Emergency Medicine, Phoenix, AZ.
J Educ Teach Emerg Med. 2025 Jul 31;10(3):S25-S54. doi: 10.21980/J8WD3X. eCollection 2025 Jul.
This simulation is intended to be used for emergency medicine (EM) residents (all levels) and 4th year medical students.
Beta-blocker (BB) toxicity ranks seventh among the top 25 substances associated with fatalities, with a cardiovascular mortality rate of up to 1.4%.1,2 Patients with BB overdose may present with bradydysrhythmias, hypotension, hypoglycemia, altered mental status, and cardiogenic shock.3 Given that EM physicians are often the first to encounter such patients, EM learners need to be proficient in managing all aspects of BB toxicity.
By the end of the session, learners will be able to: 1) manage a patient with hypotension, and bradycardia while maintaining a broad differential, 2) evaluate the causes of hypotension by utilizing ultrasound, 3) review when to initiate vasopressors and first-line agents for beta-blocker toxicity, 4) discuss treatment algorithm for BB toxicity including high-dose insulin and, 5) discuss the risk factors for suicide.
This session employed high-fidelity simulation followed by an in-depth debriefing. It was conducted during the orientation for first-year EM residents, with 16 residents participating. The group was divided into two cohorts: eight residents actively managed the simulated patient, while the other eight observed.
Following the simulation and debriefing, participants were surveyed online using Google Form. The survey included the following questions: 1) the case was believable, 2) the case had right amount of complexity, 3) the case helped in improving medical knowledge and patient care, 4) I feel more confident in managing undifferentiated hypotension, 5) I feel more confident in managing BB overdose, 6) the simulation environment gave me a real-life experience and, 7) the debriefing session after simulation helped improve my knowledge. Responses were collected using a Likert scale.
Ten participants completed the post-session survey. All respondents either agreed or strongly agreed that the case was effective in enhancing learning, medical knowledge, and patient care skills. Every participant found the debriefing session valuable and reported increased confidence in managing undifferentiated hypotension and BB toxicity.
The simulation session effectively educated participants on the management of BB toxicity, reinforcing key concepts such as the treatment of hypoglycemia, bradycardia, and hypotension. As the case unfolded, learners were required to assess refractory hypotension and initiate vasopressor therapy and specific treatments for BB toxicity. Overall, participants found the simulation beneficial for learning the management of BB overdose.
Beta-blocker toxicity, refractory hypotension, bradycardia, toxicology, mental health, psychiatry.
本模拟旨在供急诊医学（EM）住院医师（各级）和四年级医学生使用。
β受体阻滞剂（BB）中毒在导致死亡的25种物质中排名第七，心血管死亡率高达1.4%。1,2 BB过量的患者可能出现缓慢性心律失常、低血压、低血糖、精神状态改变和心源性休克。3鉴于急诊医生常常是首批接触此类患者的人，急诊医学学习者需要熟练掌握BB中毒各方面的处理。
课程结束时，学习者将能够：1）在保持广泛鉴别诊断的同时处理低血压和心动过缓患者；2）利用超声评估低血压的原因；3）回顾何时启动血管升压药和治疗BB中毒的一线药物；4）讨论BB中毒的治疗算法，包括大剂量胰岛素；5）讨论自杀的风险因素。
本课程采用高保真模拟，随后进行深入的总结汇报。课程在一年级急诊医学住院医师入职培训期间进行，有16名住院医师参与。该组被分为两个队列：8名住院医师积极处理模拟患者，另外8名进行观察。
模拟和总结汇报后，通过谷歌表单对参与者进行在线调查。调查包括以下问题：1）病例是否可信；2）病例的复杂程度是否合适；3）病例是否有助于提高医学知识和患者护理水平；4）我对处理未分化性低血压更有信心；5）我对处理BB过量更有信心；6）模拟环境是否给了我真实的体验；7）模拟后的总结汇报环节是否有助于提高我的知识水平。使用李克特量表收集回答。
10名参与者完成了课后调查。所有受访者均同意或强烈同意该病例在增强学习、医学知识和患者护理技能方面是有效的。每位参与者都认为总结汇报环节很有价值，并表示在处理未分化性低血压和BB中毒方面信心增强。
模拟课程有效地让参与者了解了BB中毒的处理方法，强化了诸如低血糖、心动过缓和低血压治疗等关键概念。随着病例的展开，学习者需要评估难治性低血压并启动血管升压药治疗以及针对BB中毒的特定治疗。总体而言，参与者发现模拟对学习BB过量的处理很有帮助。
β受体阻滞剂中毒、难治性低血压、心动过缓、毒理学、心理健康、精神病学。
