MedEdPORTAL (Sep 2014)
Toxic Ingestion: Anion Gap Metabolic Acidosis Caused by Acute Salicylate Ingestion
Abstract
Abstract Introduction This educational resource provides information and materials for a simulation case suitable for resident physicians in emergency medicine. The scenario has been used at our institution for the past year. Participants have included medical students, emergency medicine and general pediatrics residents in years 1-3 of postgraduate education, and pediatric emergency medicine fellows in years 4-6 of postgraduate education. Methods This simulation involves a patient presenting to an emergency department with an anion gap metabolic acidosis secondary to acute salicylate ingestion. Evaluation in the emergency department reveals a tachycardic, tachypneic patient who requires aggressive fluid resuscitation. The patient also requires alkalinization with bicarbonate to halt the progression of the acidosis. Ultimately, levels obtained should prompt learners to admit the patient to the intensive care unit for dialysis. The case has been used with small groups of two to four learners in each session. Debriefing materials are provided to illustrate key concepts in recognition of anion gap metabolic acidosis and to stimulate discussion of the important treatment steps in acute salicylate ingestion. Typical timing for the case is approximately 20 minutes for the simulation and 20 minutes for debriefing. Results Testing of this scenario has been accomplished via repetition with various learners. While this educational case has been used for simulation sessions as part of the didactic component of our residency and fellowship, it has not been validated as a formal assessments tool for evaluation of clinical competency. Discussion Implementation of this case requires significant resources: a high-fidelity patient simulator, appropriate environment, medical equipment, and personnel to provide the educational experience for learners. The case requires one faculty or staff member capable of running the simulator and one faculty member with the required clinical expertise to facilitate the case and conduct the debriefing and educational session. We have used this case primarily for resident physician education in pediatrics and emergency medicine, as well as for fellows in pediatric emergency medicine. Medical students have participated at times in supporting provider roles but not as team leaders given the degree of difficulty of this case.
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