Emergency Medicine Simulation: A Resident's Perspective

Abstract

a p p s m y s p e l b INTRODUCTION Stepping into the emergency department (ED) resuscitation room, the emergency medicine resident is immediately confronted with the noise and commotion that often accompany a coding patient. The nurse shuttles around the room grabbing supplies and attaches the monitor leads to the patient. The patient continues to cough and mumble incomprehensible sounds as his mental status further deteriorates. The resident’s primary survey reveals that the patient needs to be intubated. He decides to use the Macintosh blade but also prepares the video laryngoscope as a backup. Rapid sequence induction medications are administered, and the resident realizes that this airway is difficult to manage with direct laryngoscopy. He reaches for the video laryngoscope to help him visualize the vocal cords and establish a definitive airway. Sirens from the monitor blare as the oxygen saturation continues to decrease. With beads of sweat forming on his brow, the resident continues to struggle as precious seconds tick away. Desperate, he considers a surgical airway as his last resort and directs the nurse to prepare the patient’s neck in anticipation of a cricothyroidotomy. With this decision, the monitors are silenced and the instructor walks into the room. The resident is commended on his efforts, and thus begins the instructional component of this exercise—the debriefing. The key difference in this scenario is that the patient was actually a simulator mannequin and the aforementioned code did not occur in the ED but rather was a form of resident education that occurred in a simulation suite. Emergency medicine resident education and training has traditionally relied heavily on live patient encounters to master the art of medicine and health care delivery. In this setting, residents and educators are often challenged with balancing patients’ safety with their desired educational goals. Furthermore, the expanse of medical knowledge one is expected to master before independent practice continues to increase, whereas duty-hour restrictions have limited the resident’s exposure to these entities in the clinical setting. These 2 components have placed significant stress on the medical education sections across the spectrum of specialties including emergency medicine, in which critical decisions have immediate b