Evaluations – Adult Emergencies SIM Lab – 13 February 2013

What were high yield successes of this topic/station?

  • Clinical pearls presented at the end were simple and useful
  • Comprehensive coverage of relevant topic
  • Good differential past just COPD exacerbation
  • Great incorporation of MAT and how to manage
  • Steroids, Antibiotics, Oxygen
  • Evaluation of respiratory distress in a systemic fashion, goals of PaO2
  • Review of COPD exacerbation
  • Initial management
  • Arrhythmia with disease and treatment
  • Yes. I even as an Intern have seen this type COPD type practice
  • Key points in COPD management, BiPap review, MAT
  • Algorithm for treating COPD exacerbation
  • Early recognition
  • Review COPD exacerbation tx options and other diff. dx to consider
  • Being able to recognize EKG findings for a COPD exacerbation
  • 88-92% ~ PaO2 60 ; BiPap 10/5

What will you do differently after this lecture/station?

  • Go home and study COPD findings
  • Review EKGs
  • Broaden DDx
  • With tachycardia, can expand EKG to better identify underlying rhythm
  • Treating MAT
  • O2 escalation
  • Decrease dose steroid
  • Not focus on primary complaint, still go in with broad differential
  • Get ECG in R.D.
  • Learn med dosing
  • Assess for arrhythmias in COPD patients
  • Early ABG, Verapamil for MAT
  • Consider 180 HR and other causes
  • Be able to treat COPD exacerbation
  • Assess for AMS in a patient in COPD exacerbation to determine need for intubation

Please include any other constructive comments or areas for improvement:

  • Well acted, helpful didactics
  • Bigger room
  • Great lab, EKG printout?
  • Going after EKG findings beforehand
  • It was difficult to read the EKG of MAT, would suggest paper copy instead

What were high yield successes of this topic/station?

  • Be the manager of the situation and recognize the reversible causes of CA
  • Good clinical scenario, enjoyed b/c not your typical code patient, i.e. MI
  • C-A-B instead of A-B-C for BLS
  • Call for help quickly, CPR and Epi
  • Realistic scenario
  • Yes, but was frantic
  • Access issues with long bore central
  • Hs and Ts
  • Review Hs and Ts systematically
  • Practice Hs and Ts
  • Knowing how to correct the Hs and Ts
  • Hs and Ts review, improved communication, practice code
  • Overall good simulation case – realistic
  • HHHHs and Ts, communication across team, basic skills
  • To assess the entire patient for exsanguination injury/bleeding

What will you do differently after this lecture/station?

  • Use adjunct airway right away
  • Be more assertive, take ownership and my role
  • Memorize Hs and Ts
  • Remember Hs and Ts better
  • Assign roles, use call-backs
  • Practice Hs and Ts
  • Review Hs and Ts
  • Give an example, i.e. demonstrate how you expect someone to run a code and go through Hs and Ts
  • CPR first
  • Clearer breakdown of material. Use a board or give a handout before you go over info for more retention
  • Learn femoral sticks
  • Continue chest compressions without stopping for breath while intubated
  • Memorize 5Hs and 5Ts
  • Continue to review ACLS
  • Act more definitively and manage when needed
  • Step back and make the decision of treatment, avoid getting entangled by “running” yourself from the immediate situation

Please include any other constructive comments or areas for improvement:

  • Proctors remained hands-off during code
  • More organized debrief would be nice
  • I hate to put all “5s” but it was really good
  • Good idea to incorporate femoral stick
  • Important to preface scenario with being comprehensive and not stopping when problem is identified
  • Add more lights/sounds as distracters

What were high yield successes of this topic/station?

  • Reminding us to take an organized methodical approach toward AMS patients
  • Review of trauma protocol, excellent thought exercise, lots of info
  • Good organization among team members
  • AMS review/AEIOUTIPS pneumonic
  • DDx of AMS, use of memory aids
  • Early interventions in AMS
  • Review broad DDx of AMS (AEIOU-TIPS)
  • Broad differential
  • Suction available is important
  • Yes, again I’m not sure of algorithms that were discussed. A handout or board chalk talk would be helpful in this case
  • Good trauma review
  • Thinking about expanding differential to include more than just the obvious
  • Alcohol intox with trauma
  • Good review
  • Using lab tests to rule out the DDx causes of AMX

What will you do differently after this lecture/station?

  • Getting imaging quicker
  • Expand my DDx during the initial exam to avoid life threatening omission
  • Consider CT scan immediately after stabilization
  • Identify trauma. Start trauma assessment, labs.
  • Early C-spine immobilization
  • Safety net quicker and thorough exam of alcoholics
  • Assess GCS sooner and intubate quicker
  • C-spine precautions in AMS, e/o trauma
  • Secondary survey
  • Remember “D” and “E” after A-B-C
  • Be more prepared to respond to AMS in systemic manner
  • Good organization among team members
  • Be systematic in approach to patients. Be assertive and get involved.
  • Consider all of the possible etiologies of AMS apart from the most obvious

Please include any other constructive comments or areas for improvement:

  • More realistic scenario, better explanation of roles supporting crew can have
  • History could be better for “trauma” cause of AMS
  • No issues
  • Consider changing scenario to “you are E.D. doc” rather than FM Team called to E.D. or FM at level I or II in theater
  • SIM with unintentional trauma
  • Did not see the benefit of reviewing how team members “felt”
  • Discuss about optimizing environment/familiarizing self with equipment when working off shift / new duty station / etc
  • Place make-up or blood on body to show bleeding
  • Case may have been more realistic for us if it was an elderly patient on floor with AMS since we probably wouldn’t be the first responders with a young person that is intoxicated (at least while in residing here @ MAMC)

What were high yield successes of this topic/station?

  • 1. NE 2. E 3. Vasopressin ; Well organized topics / discussion about what to do on septic patient
  • Review of sepsis management
  • First response and call for back-up assistance
  • Review new sepsis guidelines
  • Goal directed Tx of sepsis
  • New surviving sepsis guidelines
  • Goal directed therapy, IVF, labs, Abx
  • New guidelines
  • Antibiotics
  • Yes, chalk talk was great ; High yield take home points were laid out on board then reviewed
  • New sepsis guidelines
  • Quick identification, get help soon
  • Early recognition
  • Initial good review critical aspects in “sepsis management”
  • Start the sepsis work-up early and call for help early if available

What will you do differently after this lecture/station?

  • Target MAP > 65
  • Review the new sepsis guidelines and dosings for Nor Epi and Epi in sepsis situations
  • Review new 2012 sepsis guidelines
  • Call rapid response team earlier
  • Call RRS quickly, lots of fluids
  • RRS quicker
  • Get help / interventions quick
  • 30ml/kg IVF
  • I am now familiar with the new sepsis criteria
  • Systematic evalTx of sepsis
  • Follow new guidelines, use new definition of sepsis
  • Review sepsis guidelines
  • ABCs before jumping to MONA ; think which antibiotics to give
  • Keep sepsis near the top of my DDx b/c it may present at an unexpected time

Please include any other constructive comments or areas for improvement:

  • Good idea to incorporate early RRS as learning point

What were high yield successes of this simulation lab overall (weeks 1 and 2)?

  • This was the best preps and SIM intro experience I have had to date. Both the prep and SIM were very helpful primarily because I am now on the hotseat like I will be @ nightfloat and next year.
  • It was very helpful to have the didactic learning b/c I was able to internalize and ask questions before the actual SIM environment
  • Engaging in real life commonly seen scenarios
  • Realistic scenarios
  • I think the sepsis SIM if it had a handout would be perfect. Great review with high yield points. Methodical in the debrief.
  • Hs and Ts, initial quick sepsis management
  • Review of critical topics
  • Realistic scenarios
  • Mock code, managing sepsis outside of ICU, common admits (AMS and COPD)
  • Good cases and useful for everyday situations
  • The didactics were very helpful for giving some guidance and structure for how to think in week 2
  • Interactive training with reinforcement of concepts
  • Good reminder/refresher of useful topics

What improvements would you suggest for either didactic sessions or the simulation lab cases?

  • Better explanation of roles and scenarios. Did not know how much on BLS and how much I needed to get involved by my own efforts
  • Just better history for the AMS case
  • Handouts for all stations with summaries
  • Actual opportunity to practice procedure like central line
  • RSI drugs indicated for codes/intubation
  • Make SIM and practice on same rotation cycle
  • I would like to see the simulations occur more frequently to aid in training

Please include any other constructive comments or areas for improvement:

  • I purposely didn’t “study” b/c I didn’t want to cloud what I would / wouldn’t do. After seeing this, I am glad I did so. Helps me identify my own fear and weaknesses. *I have asked before but I ask again, PLEASE have / bring back mock “emergencies” in clinic. I know it can mess up the schedule but it would only help our skills. Do all of them, any of them, in OB emergency, peds, downrange barrage. We have the cases, it’s relatively easy regarding manpower to do so (only need 2-3 presenters/actors).
  • I think it may have been difficult for several of the residents b/c this was off cycle, i.e. some people were here for the review last week and rotations changed this week
  • Would keep in prior weeks lecture as they are VERY helpful
  • PLEASE pick dates that don’t span a rotation. I missed the pre-lecture which is SO valuable. I didn’t find this as useful as the other / previous two b/c I missed the previous week. Thank you for putting the time in!
  • Excellent variability in cases
  • Thanks for the session!
  • 45 minutes / case perfect amount of time!
  • 2nd years should continue to run cases