MedEdPORTAL (Jun 2015)
Hydrofluoric Acid Burn
Abstract
Abstract Introduction This simulation case was designed to teach emergency medicine residents and students the evaluation and appropriate management of systemic and local toxicity associated with a hydrofluoric acid burn. Developed as part of a burn simulation curriculum at Emory University, the case was designed to be performed in small groups. The scenario has been successfully integrated into our emergency medicine residency's simulation curriculum for emergency medicine residents in the PGY1-PGY3 positions. Medical students rotating on the emergency medicine service at the time also participated in the scenarios. Testing and feedback of the scenario occurred among four groups during the burn course. Methods The simulated case describes a patient who presents to a community emergency department after acute skin exposure to a high-concentration solution of hydrofluoric acid. The patient initially presents with a poor exposure history of the concentration and quantity of hydrofluoric acid as well as localized pain of the area splashed by the chemical. Providers need to recognize the need for decontamination and rapid assessment of electrolytes and myocardial function. After noting clear abnormalities in the electrocardiogram and serum calcium, learners should provide rapid intravenous calcium to prevent systemic toxicity and precipitous cardiovascular collapse. Finally, appropriate consultation with the poison center and appropriate disposition to a burn surgeon complete the scenario. The included debriefing materials provide a deeper understanding of the unique mechanisms of toxicity and treatment of hydrofluoric acid exposure. The case can be completed in approximately 20 minutes with another 20 minutes for debriefing. Results This scenario has been reviewed by several toxicologists and used successfully in real time; however, it has not been validated. Discussion Medical simulation requires an often-substantial investment in high-fidelity manikins, monitoring equipment, medications, disposable supplies, and available space for performance of the scenario. This scenario, however, does not require the purchase of materials that would not be found in most residency programs' simulation setup.
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