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Inappropriately Firing Defibrillator: A Simulation Case for Emergency Medicine Residents.

ABSTRACT: Introduction:Emergency physicians must be able to manage inappropriately firing defibrillators. Many physicians may not experience this high-risk, low-frequency patient presentation during residency. We created this simulation to increase residents' knowledge of basic defibrillator function and confidence in managing patients with malfunctioning defibrillators. Methods:Sixteen emergency medicine residents of all levels of training participated in this curriculum. The educational experience began with a lecture. Residents then managed the simulated patient encounter in groups of four. The patient was a 63-year-old male presenting after feeling his defibrillator fire. He was found to have a supraventricular tachycardia with an inappropriately firing defibrillator. Learners needed to recognize the inappropriately firing defibrillator, inactivate it with a magnet, and treat the arrhythmia. Implementation of this scenario required audiovisual equipment and a simulation room equipped with high-fidelity simulator, patient monitor, code cart, defibrillator, and pacemaker magnet. Learners completed pre- and postcourse surveys to assess changes in baseline knowledge of defibrillator function and self-reported confidence in managing these complicated patients. Results:After participating in this educational intervention, residents improved their performance on a 10-question quiz from a class mean of 60% to 84% (p < .001). Residents also exhibited an increase in self-reported confidence in managing patients with inappropriately firing defibrillators (p < .001) and in knowing when to place a magnet over a patient's defibrillator (p < .001). Discussion:Residents demonstrated increased knowledge of defibrillator function as well as increased confidence in managing patients with malfunctioning defibrillators after participating in this simulation experience.

SUBMITTER: Thorpe RL

PROVIDER: S-EPMC6415004 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe majority of children seeking care in emergency departments are seen by general emergency medicine (EM) residency program graduates. Throughout training, EM residents manage fewer critically ill pediatric patients compared to adults, and the exposure to children with illness and injury requiring emergent assessment and management is often limited and sporadic across training sites. This report describes the creation of a robust set of simulation cases for EM trainees incorporating topics identified during a previous modified Delphi study to improve their pediatric acute care knowledge and skills.MethodsAll 30 pediatric EM topics and 19/26 procedures previously identified as "must be taught by simulation" to EM residents were mapped to 15 simulation case topics. Twenty-seven authors from 16 institutions created cases and supporting materials. Each case was iteratively implemented during a peer review process at two to five sites with EM residents. Feedback from learners and facilitators was collected via electronic surveys and used to revise each case before the next implementation.ResultsThirty-five institutions participated in the peer review process. Fifty-one facilitators and 281 participants (90% EM residents) completed surveys. Most facilitators (98%) agreed or strongly agreed with the statement "This simulation case is relevant to the field of emergency medicine." A majority of facilitators and participants agreed or strongly agreed with the statements "The simulation case was realistic" (98% of facilitators, 94% of participants) and "This simulation case was effective in teaching resuscitation skills" (92% of facilitators, 98% of participants). Most participants reported confidence in knowledge and skills addressed in the learning objectives after participation.ConclusionsFacilitators and EM residents found cases from a novel simulation-based curriculum covering critical pediatric EM topics relevant, realistic, and effective. This curriculum can help provide a standardized, uniform experience for EM residents who will care for critically ill pediatric patients in their communities.

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Inappropriately Firing Defibrillator: A Simulation Case for Emergency Medicine Residents.

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