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Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents

INTRODUCTION: Sepsis is a major cause of morbidity and mortality in medicine and is managed in ICUs daily. Critical care training is a vital part of anesthesiology residency, and understanding the presentation, management, and treatment of septic shock is fundamental to intraoperative patient care....

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Autores principales: Webb, Timothy T., Boyer, Tanna J., Mitchell, Sally A., Eddy, Christopher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Association of American Medical Colleges 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083602/
https://www.ncbi.nlm.nih.gov/pubmed/32206702
http://dx.doi.org/10.15766/mep_2374-8265.10886
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author Webb, Timothy T.
Boyer, Tanna J.
Mitchell, Sally A.
Eddy, Christopher
author_facet Webb, Timothy T.
Boyer, Tanna J.
Mitchell, Sally A.
Eddy, Christopher
author_sort Webb, Timothy T.
collection PubMed
description INTRODUCTION: Sepsis is a major cause of morbidity and mortality in medicine and is managed in ICUs daily. Critical care training is a vital part of anesthesiology residency, and understanding the presentation, management, and treatment of septic shock is fundamental to intraoperative patient care. METHODS: This simulation involved a 58-year-old man undergoing surgical debridement of a peripancreatic cyst with hemodynamic instability and septic shock. We conducted the simulation yearly for clinical anesthesia year 2 residents (n = 26) in 1-hour sessions with three to five learners at a time. The simulation covered the six Anesthesiology Milestones related to sepsis and septic shock as outlined in the Anesthesiology Milestones Project. RESULTS: To date, 155 anesthesiology residents have completed the simulation. Commonly missed critical actions included failure to recognize the need for invasive lines, provide appropriate volumes of fluid resuscitation, inquire about blood cultures and antibiotics, and recognize the need for the patient to remain intubated. Most participants could appropriately diagnose and treat intraoperative septic shock, but all had moments of action or inaction to discuss and improve upon, and all learned from this scenario. DISCUSSION: Simulation is an optimal way to practice the more rare and life-threatening clinical events in medicine. Even though septic shock is commonly managed in the ICU, it is relatively uncommon for it to develop acutely in the OR. This simulation is an effective and educational way to discuss the most recent sepsis/septic shock definition and review evidence-based guidelines for treatment.
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spelling pubmed-70836022020-03-23 Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents Webb, Timothy T. Boyer, Tanna J. Mitchell, Sally A. Eddy, Christopher MedEdPORTAL Original Publication INTRODUCTION: Sepsis is a major cause of morbidity and mortality in medicine and is managed in ICUs daily. Critical care training is a vital part of anesthesiology residency, and understanding the presentation, management, and treatment of septic shock is fundamental to intraoperative patient care. METHODS: This simulation involved a 58-year-old man undergoing surgical debridement of a peripancreatic cyst with hemodynamic instability and septic shock. We conducted the simulation yearly for clinical anesthesia year 2 residents (n = 26) in 1-hour sessions with three to five learners at a time. The simulation covered the six Anesthesiology Milestones related to sepsis and septic shock as outlined in the Anesthesiology Milestones Project. RESULTS: To date, 155 anesthesiology residents have completed the simulation. Commonly missed critical actions included failure to recognize the need for invasive lines, provide appropriate volumes of fluid resuscitation, inquire about blood cultures and antibiotics, and recognize the need for the patient to remain intubated. Most participants could appropriately diagnose and treat intraoperative septic shock, but all had moments of action or inaction to discuss and improve upon, and all learned from this scenario. DISCUSSION: Simulation is an optimal way to practice the more rare and life-threatening clinical events in medicine. Even though septic shock is commonly managed in the ICU, it is relatively uncommon for it to develop acutely in the OR. This simulation is an effective and educational way to discuss the most recent sepsis/septic shock definition and review evidence-based guidelines for treatment. Association of American Medical Colleges 2020-03-13 /pmc/articles/PMC7083602/ /pubmed/32206702 http://dx.doi.org/10.15766/mep_2374-8265.10886 Text en Copyright © 2020 Webb et al. https://creativecommons.org/licenses/by-nc/4.0/ This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial (https://creativecommons.org/licenses/by-nc/4.0/) license.
spellingShingle Original Publication
Webb, Timothy T.
Boyer, Tanna J.
Mitchell, Sally A.
Eddy, Christopher
Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents
title Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents
title_full Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents
title_fullStr Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents
title_full_unstemmed Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents
title_short Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents
title_sort intraoperative sepsis: a simulation case for anesthesiology residents
topic Original Publication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083602/
https://www.ncbi.nlm.nih.gov/pubmed/32206702
http://dx.doi.org/10.15766/mep_2374-8265.10886
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