To evaluate high-fidelity medical simulation as an assessment tool for pediatric residents' ability to manage an acute airway.
We performed a prospective, observational study in which 16 pediatric residents were consented and then brought to the medical simulation center. They were placed in 2 different computer-driven scenarios and asked to manage the cases. The first scenario was a 3-month-old infant with bronchiolitis and severe respiratory distress and was programmed to develop respiratory failure. The second case was a 16-year-old adolescent with alcohol intoxication and respiratory depression and was programmed for emesis and aspiration. Both cases included a nurse, parent, and intern. We recorded performance of predetermined critical actions and any harmful actions.
There were 47 attempts at intubation with 27 successes (56%). Appropriate preoxygenation was performed in 15 (47%) of 32 cases. Appropriate rapid sequence induction was administered in 21 (66%) of 32 cases. Cricoid pressure was applied in 20 (63%) of 32 cases. End-tidal carbon dioxide detector was used in 11 (34%) of 32 cases. A nasogastric tube was placed in 14 (44%) of 32 cases. Harmful actions included rapid sequence induction administered before intubation equipment setup, bag-valve mask not connected to oxygen, inappropriate endotracheal tube size, pulling cuffed endotracheal tube out while inflated, and placing the laryngoscope blade on backwards.
Our data identified many areas of concern with resident skills in managing an airway. This project suggests that high-fidelity medical simulation can assess a resident's ability to manage an airway as well as a program's effectiveness in teaching the skills necessary to manage an acute pediatric airway.
"Many deficits were found, including only a 56% success rate of intubation and decreased success of subcomponents of intubation, such as preoxygenation in only 47% and application of cricoid pressure in only 63% of cases. The authors also noted potentially harmful actions, such as delivering bag-mask ventilation without oxygen and administering intubation medications (including paralytic agents) before having all necessary airway equipment ready . Adler and colleagues  also noted deficiencies in the acute care skills of pediatric residents, but have helped to advance the assessment of competency by developing valid and reliable assessment tools that discriminated the performance of upper and lower level pediatric residents in three out of four cases of simulated pediatric emergencies. "
[Show abstract][Hide abstract] ABSTRACT: Recent data from in- and out-of-hospital cardiopulmonary arrests reveal that health care teams frequently deviate from American Heart Association guidelines during resuscitation efforts. These discrepancies between the current state of evidence-based resuscitation guidelines and the quality of basic and advanced life support actually delivered represent a missed opportunity and provide a significant target for optimizing patient outcomes through improved educational effectiveness. This article presents discussion of the quality of resuscitation delivered to patients, a brief history of the development of cardiopulmonary resuscitation and attempts to translate the science of resuscitation to the bedside through effective educational strategies, a review of educational best practices that relate to resuscitation education, and discussion of the role of medical simulation in resuscitation training.
Pediatric Clinics of North America 09/2008; 55(4):1025-50, xii. DOI:10.1016/j.pcl.2008.04.007 · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The education and maintenance of medical staff procedural sedation privileges are one practical focus of simulation training at Shands Jacksonville. Simulation-centered training allows for a consistent set of principles to be discussed and demonstrated by designated anesthesia and emergency medicine instructors. The physicians receiving the instruc - tion then apply the principles on the high-fidelity simulator under the guidance of the instructor. This format allows for immediate feedback and performance review and is an innovative use of a simulation lab to simultaneously reinforce safe sedation practices, demonstrate basic airway rescue techniques, and allow practitioners to apply their train- ing in a controlled setting. Finally, this training and testing program assures that the facility meets the standards set by the Joint Commission for procedural sedation.
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