Acute Overdose in the Setting of a Signed ‘Do Not Resuscitate’ Order

Abstract

OPEN ACCESSNovember 25, 2014Acute Overdose in the Setting of a Signed ‘Do Not Resuscitate’ Order Matthew Ryan, MD, PhD, Lars Beattie, MD Matthew Ryan, MD, PhD University of Florida College of Medicine Google Scholar More articles by this author , Lars Beattie, MD University of Florida College of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9945 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: This simulation case is targeted towards third- and fourth-year medical students, emergency medicine (EM) residents, EM nurses, and adjunct EM staff. The purpose of this case is to improve interdisciplinary communication skills, recognition and management of an acute intentional overdose, recognition of the ethical dilemmas regarding Do Not Resuscitate (DNR) orders complicated by an acute intentional overdose, general crisis resource management skills through conflict resolution, team-based communication, and patient-centered care. The simulation folds together the reality of practicing EM by way of bona fide critical-care medicine, psychosocial complications, and medical ethics. Methods: The simulation takes approximately 20 minutes to run, followed by a debriefing lasting roughly 30 minutes. Three to four trainees at a time move through the scenario, led by an upper level resident and at least two other residents (PGY1 or PGY2) or students (fourth-year). Two faculty members and two senior residents observe the training scenario. The simulation is based on a composite of cases seen in our Emergency Department regarding intentional overdoses and DNR orders with concomitant family conflicts. An intentional medico-ethical dichotomy has been built into the case to enhance its breadth of use among learners at various levels of training. For example, earlier learners (students and interns) may focus on the medical management of the aspirin overdose and its associated pathophysiological ramifications. More advanced learners may likely understand management of salicylate toxicity and thus be able to focus on and learn from the ethical issues the case presents. Results: The overall resident and student evaluation of this case has been high: 4.75 on a 1-5 (low-high) scale. Discussion: This case has not been used to formally evaluate residents, medical students, or medical staff. Depending on the learners involved in the simulation, different aspects can be emphasized at the instructors' discretion. EM physicians encounter these complex issues daily, and recognition of and familiarity with complex psychosocial issues is incumbent on their training. Educational Objectives By the end of this simulation, learners will be able to: Recognize the signs and symptoms of a salicylate overdose.Perform resuscitative actions to stabilize a patient.Understand treatment and management regarding aspirin overdose.Understand the clinical and ethical concerns surrounding Do Not Resuscitate orders.Understand the clinical and ethical concerns regarding the resuscitation of a patient who has attempted suicide.Develop team organization in a crisis situation.Develop team-centered communication skills toward management of a crisis.Develop individual resuscitative skills.Identify the indications for emergent resuscitation in a critically ill patient.Resolve conflicts with regard to family issues in the emergency department. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx ASA DNR Case.docx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationRyan M, Beattie L. Acute Overdose in the Setting of a Signed ‘Do Not Resuscitate’ Order. MedEdPORTAL. 2014;10:9945. https://doi.org/10.15766/mep_2374-8265.9945 Copyright & Permissions© 2014 Ryan and Beattie. This is an open-access article distributed under the terms of the Creative Commons Attribution license.KeywordsDNRSuicideSuicide AttemptSalicylate OverdoseAttempted Disclosures None to report. Funding/Support None to report. Loading ...