Simulation in healthcare : journal of the Society for Simulation in Healthcare
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Observational Study
Short-term and long-term impact of the central line workshop on resident clinical performance during simulated central line placement.
The Central Line Workshop (CLW) was introduced at our institution to better train residents in safe placement of the central venous catheter (CVC). This study sought to determine if immediate performance improvements from the CLW are sustained 3 months after the training for residents with various levels of experience. ⋯ Resident CVC placement performance improved immediately after the CLW. Although performance 3 months after the CLW revealed evidence of skill decay, it was improved when compared with initial baseline assessment. Novice learners had the greatest benefit from the CLW.
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Easy-to-implement oral cavity modification to expand simulation-based training in airway management.
Injuries to the oral cavity and teeth can occur during routine intubation and general anesthesia but often occur in emergency situations when the priority of securing the airway supersedes preanesthetic evaluation. This study demonstrates the feasibility of modifying the oral cavity to increase the dental fidelity during emergency airway management. ⋯ This project proves the concept of feasibly fabricating anatomic variations to increase the fidelity of existing simulation manikins. Other anatomic variations present challenges to airway management, and future research will aim at creating additional modifications. In addition, future research will seek to quantify the improvement in airway management skills by anesthesia and emergency medicine providers by training on manikins with variable oral cavity anatomy.
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Management of pediatric cardiac arrest challenges the skills of prehospital care providers. Errors and error-producing conditions are difficult to identify from retrospective records. The objective of this study was to identify errors committed by prehospital care providers and the underlying causes of those errors during a simulated pediatric cardiopulmonary arrest followed by a structured debriefing. ⋯ We systematically observed many types of errors and identified some of the underlying causes during a simulated, prehospital, pediatric cardiopulmonary arrest. There were numerous, multifactorial, and sometimes, synergistic causes of medication dosing errors. Emergency medical service officials can use these findings to prevent future errors.
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Traditionally, pausing chest compressions during airway management in a cardiac arrest has been the accepted norm. However, updated American Heart Association and the European Resuscitation Council guidelines for Advanced Cardiac Life Support emphasize reducing pauses in chest compressions, often referred to as "no-flow time," to improve return of spontaneous circulation. We used simulation to evaluate whether placing a laryngeal mask airway versus endotracheal intubation via direct laryngoscopy would reduce no-flow times during a simulated cardiac arrest. ⋯ We conclude that although neither device was superior to the other with respect to the primary outcome of reducing no-flow time, effective ventilation was established more rapidly with the laryngeal mask airway in the hands of the RTs who participated in this study. These results may be affected by the differences between simulated and human airways.