MedEdPORTAL (Jul 2012)
Critical Care Medicine Simulation: 72-Year-Old Female with Fever, Hypotension, and Altered Mental Status
Abstract
Abstract Introduction This simulation presents participants with a patient in septic shock. The target audience includes all levels of providers who practice within a critical care or emergency room setting. The learning/assessment objectives include the following: recognize the characteristics of septic shock, manage the hemodynamics of a patient presenting with septic shock, manage the respiratory mechanics in a patient with septic shock, and investigate and treat sources of infection in a patient who presents with septic shock. Methods The environment for this computerized simulation is available as a download via Anesoft Corporation and is free for use by any participant with permission from Anesoft. The simulation resource file for the Anesoft program can be downloaded and then uploaded into the Anesoft program via the instructions listed in this resource. The actor for this simulated patient will be present in the simulation. Participants in the scenario act as the primary caregiver within a critical care environment when a patient with septic shock arrives at the intensive care unit (ICU). We also include an evaluation form for participants. Thus, each participant receives a detailed printed record of the case simulation and printed debriefing of his or her case management. Results This scenario has been simulated for over 22 months by CA-1, CA-2, and CA-3 anesthesiology residents at the University of Washington. Over 30 residents per month participate in an ICU rotation. Based on aggregate pre- and posttest scores for each CA-2 resident on the critical care medicine rotations within the VA Puget Sound SICU, correct answers on questions related to sepsis, severe sepsis, and septic shock increased by 40% after the implementation of this simulation during the 2009–2010 academic year. Discussion Several anticipated management mistakes were identified while pilot testing and revising the simulation expectation. First, many residents utilized vasopressor/intotrope therapy prior to maximizing volume administration. Second, many residents were unfamiliar with the association between acute respiratory distress syndrome and septic shock. Finally, many residents did not understand the concept of source control and providing the appropriate antibiotic selection based on the risk factors for community, health care–associated, and hospital-acquired infections.
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