Abstract
This case is one of an eight-case multidisciplinary curriculum designed and implemented at the University of Ottawa by simulation educators with specialty training in obstetrics and gynecology (ob/gyn) and anesthesiology. Consultation with a nurse educator maintained quality and relevance of objectives for nursing participants.The curriculum was prepared to train ob/gyn and anesthesiology residents and nurses to hone crisis resource management skills and to recognize and manage rare/critical medical events in an obstetrical setting. Obstetricians, anesthesiologists, and nurses often work together in acute, high-stakes situations and this curriculum provides a safe environment to practice team-based management of such emergencies.Over an eight-year period, this curriculum has been executed in scenario couplets on a four-year cycle to allow ob/gyn and anesthesiology residents exposure to all scenarios during a five-year residency beginning in their second year. Prospective evaluation data has been positive. For example, over 90% of participants rated these simulations to be 5 out of 5 for “Was an effective use of my educational time” and “Will influence/enhance my future practice”.In this scenario, participants must recognize and manage a parturient with spinal cord injury in active labour who develops autonomic dysreflexia. The fetal heart tracing becomes abnormal and the team must respond with urgent delivery. This scenario requires a mannequin for a pelvic exam and a pregnant abdomen.This simulation case includes a case template, critical actions checklist, debriefing guide, summary of key medical content, and an evaluation form for learners to provide feedback.
Highlights
How to cite this article Rao P M, Garber A, Rajakumar C, et al (July 25, 2017) Autonomic Dysreflexia in the Peripartum Patient: A Multidisciplinary and Interprofessional Simulation Scenario
Multidisciplinary team debriefing guided by an experienced simulation instructor
Autonomic dysreflexia is a rare presentation; misdiagnosis and management leads to significant morbidity and mortality for the mother and fetus
Summary
How to cite this article Rao P M, Garber A, Rajakumar C, et al (July 25, 2017) Autonomic Dysreflexia in the Peripartum Patient: A Multidisciplinary and Interprofessional Simulation Scenario. Due to improvements in the acute management and rehabilitation of patients with spinal cord injuries (SCI) as well as advances in reproductive technologies, an increasing number of these women are becoming pregnant. Autonomic dysreflexia (AD) is a common syndrome that occurs in patients with an injury at or above T6, characterized by acute hypertension, bradycardia, headaches, arrhythmias, and in severe cases respiratory failure, intracranial hemorrhage or hypertensive encephalopathy. Pregnant patients will present with fetal distress due to uteroplacental vasoconstriction. This life threatening presentation, for both mother and baby, must be immediately recognized and appropriately managed. Most trainees and clinicians will see very few such patients in their career, making diagnosis and management challenging
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