From clinical reasoning to effective clinical decision making-new training methods.

Abstract

Identification of causes and immediate adjustment to treatment of acute thrombocytopenia occurring in patients in the intensive care unit is required to avoid imminent complications. Hence it is important to train awareness and clinical decision making of students in the medical curriculum. Therefore, real-life cases were transferred into an interactive eLearning platform comprising the steps of patient assessment and therapeutic decisions. Heparin-induced platelet count decrease is an immune-mediated prothrombotic disorder, resulting from an adverse drug reaction (Kelton and Warkentin, 2008). After cardiac surgery antibodies against circulating heparin—platelet factor (PF) four complexes develop in up to 50%. Patients experience a risk of 1–5% to acquire clinical symptoms of heparin-induced thrombocytopenia (HIT) (Warkentin et al., 2000; Linkins et al., 2012). Due to complications, mortality rates are high and amount to 5–10% (Kelton and Warkentin, 2008; Kelton et al., 2013). As clinical teaching case a 59-year-old male patient is presented, who was admitted to the intensive care unit (ICU) of the General Hospital of Vienna on extracorporeal life support (ECMO). The man underwent bypass surgery six days ago in a peripheral hospital and is concomitantly suffering from an active infection. On the fourth day at ICU a platelet count decrease has been noticed.