White J R, Shugerman R, Brownlee C, Quan L
Division of Pediatric Anesthesia and Critical Care, The Johns Hopkins Hospital, Baltimore, MD 21287-3711, USA.
Arch Pediatr Adolesc Med. 1998 Dec;152(12):1232-5. doi: 10.1001/archpedi.152.12.1232.
To describe pediatric housestaff resuscitation experience and their ability to perform key resuscitation skills.
Cohort study of 63 pediatric residents in a university-based training program.
Investigators observed, scored, and timed resident performance on 4 key resuscitation skills. Cognitive ability was tested with 4 written scenarios. Housestaff provided self-reports of the number of months since their last American Heart Association Pediatric Advanced Life Support course, number of mock and actual codes attended, number of times skills were performed, and self-confidence with respect to resuscitation.
A total of 45 pediatric residents (71%) participated. Median cognitive score was 5 (range, 1-5). Of all residents, 44 (97%) successfully bag mask-ventilated the mannequin; 24 (53%) and 36 (80%) used the correct bag and mask size, respectively. Thirty-nine residents (87%) placed a tube in the mannequin trachea, 12 (27%) checked that suction was working prior to intubation, and 30 (67%) chose the correct endotracheal tube size. Forty residents (89%) discharged the defibrillator, and 25 (56%) and 32 (71%) correctly chose asynchronous mode and infant paddles, respectively. Thirty-eight residents (84%) inserted an intraosseous line; 35 (78%) had correct placement. Median times for successful skill completion were 83 seconds for bag mask ventilation, 136 seconds for intubation, 149 seconds for defibrillation, and 68 seconds for intraosseous line placement.
Pediatric housestaff previously trained in pediatric advanced life support were generally able to reach the end point of 4 key resuscitation skills but less frequently performed the specific subcomponents of each skill. This poor performance and the prolonged time to skill completion suggest the need for greater attention to detail during training.
描述儿科住院医师的复苏经验及其执行关键复苏技能的能力。
对一所大学培训项目中的63名儿科住院医师进行队列研究。
研究人员观察、评分并记录住院医师在4项关键复苏技能上的表现及用时。通过4个书面场景测试认知能力。住院医师自行报告自上次参加美国心脏协会儿科高级生命支持课程以来的月数、参加模拟和实际急救的次数、执行技能的次数以及对复苏的自信心。
共有45名儿科住院医师（71%）参与。认知得分中位数为5分（范围为1 - 5分）。所有住院医师中，44名（97%）成功为模拟人进行了面罩通气；分别有24名（53%）和36名（80%）使用了正确尺寸的面罩和呼吸囊。39名住院医师（87%）为模拟人插入了气管导管，12名（27%）在插管前检查了吸引装置是否正常工作，30名（67%）选择了正确尺寸的气管导管。40名住院医师（89%）进行了除颤操作，分别有25名（56%）和32名（71%）正确选择了非同步模式和婴儿电极板。38名住院医师（84%）插入了骨髓腔内输液管；35名（78%）放置正确。成功完成技能的用时中位数分别为：面罩通气83秒、插管136秒、除颤149秒、骨髓腔内输液管放置68秒。
先前接受过儿科高级生命支持培训的儿科住院医师总体上能够完成4项关键复苏技能，但各技能具体子步骤的执行频率较低。这种不佳的表现以及完成技能所需的较长时间表明在培训过程中需要更加注重细节。
