Neurologic Deep Dive: A Simulation Case of Diagnosing and Treating Decompression Sickness for Emergency Medicine Residents
Abstract Introduction Decompression sickness (DCS) is a rare and dangerous complication from a rapid decrease in environmental pressure, commonly seen in patients leaving a compressed-air environment, such as scuba divers, aviators, and deep tunnel workers. Failure to clinically diagnose and adequat...
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| Format: | Article |
| Language: | English |
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Association of American Medical Colleges
2016-09-01
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| Series: | MedEdPORTAL |
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| Online Access: | http://www.mededportal.org/doi/10.15766/mep_2374-8265.10473 |
| _version_ | 1819027193918914560 |
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| author | Xiao C. Zhang Antoinette Golden David S. Bullard |
| author_facet | Xiao C. Zhang Antoinette Golden David S. Bullard |
| author_sort | Xiao C. Zhang |
| collection | DOAJ |
| description | Abstract Introduction Decompression sickness (DCS) is a rare and dangerous complication from a rapid decrease in environmental pressure, commonly seen in patients leaving a compressed-air environment, such as scuba divers, aviators, and deep tunnel workers. Failure to clinically diagnose and adequately treat DCS with hydration and supplemental oxygen before bridging to hyperbaric oxygen (HBO) therapy can result in permanent residual symptoms or, in rare cases, death. Despite the increasing incidence of DCS, there are limited published simulation case studies discussing this perilous environmental exposure. Methods This fictional simulation case is written for emergency medicine residents to diagnose and manage DCS from a live-actor patient presenting with unilateral neurologic symptoms and concealed cyanotic mottling (cutis marmorata). This case ran for four separate iterations at a simulation center, with a resident, fellow, and attending acting as specific confederates for their respective roles. Following each case, the learners were debriefed at bedside, discussed a PowerPoint presentation, and underwent a question-and-answer session. Results Based on postsimulation qualitative assessments, junior and senior residents correctly identified DCS, but junior residents alone were less likely to elicit pertinent social history or to fully physically examine the patient without the presence of senior residents. Both resident groups were able to verbally explain the fundamental DCS pathophysiology to the patient, but junior residents were unable to specifically direct oxygenation, hydration, and HBO protocols for DCS. After case completion and debriefing, all learners demonstrated achievement of primary learning objectives. Discussion Overall, we noted this case worked well for junior EM residents with senior-resident backup. Both learner groups appreciated the concealed elements of case, including scuba diving history and exposed dermatologic findings, and reported that these were invaluable learning moments for all future patient encounters, not just those limited to DCS. |
| first_indexed | 2024-12-21T05:38:35Z |
| format | Article |
| id | doaj.art-2a718ef9a2e64a44882a7cd2a6f65ed2 |
| institution | Directory Open Access Journal |
| issn | 2374-8265 |
| language | English |
| last_indexed | 2024-12-21T05:38:35Z |
| publishDate | 2016-09-01 |
| publisher | Association of American Medical Colleges |
| record_format | Article |
| series | MedEdPORTAL |
| spelling | doaj.art-2a718ef9a2e64a44882a7cd2a6f65ed22022-12-21T19:14:19ZengAssociation of American Medical CollegesMedEdPORTAL2374-82652016-09-011210.15766/mep_2374-8265.10473Neurologic Deep Dive: A Simulation Case of Diagnosing and Treating Decompression Sickness for Emergency Medicine ResidentsXiao C. Zhang0Antoinette Golden1David S. Bullard21 Fourth-year Resident, Department of Emergency Medicine, Warren Alpert Medical School of Brown University2 Medical Simulation Fellow, Warren Alpert Medical School of Brown University4 Emergency Medicine Physician, Miriam Hospital and Rhode Island HospitalAbstract Introduction Decompression sickness (DCS) is a rare and dangerous complication from a rapid decrease in environmental pressure, commonly seen in patients leaving a compressed-air environment, such as scuba divers, aviators, and deep tunnel workers. Failure to clinically diagnose and adequately treat DCS with hydration and supplemental oxygen before bridging to hyperbaric oxygen (HBO) therapy can result in permanent residual symptoms or, in rare cases, death. Despite the increasing incidence of DCS, there are limited published simulation case studies discussing this perilous environmental exposure. Methods This fictional simulation case is written for emergency medicine residents to diagnose and manage DCS from a live-actor patient presenting with unilateral neurologic symptoms and concealed cyanotic mottling (cutis marmorata). This case ran for four separate iterations at a simulation center, with a resident, fellow, and attending acting as specific confederates for their respective roles. Following each case, the learners were debriefed at bedside, discussed a PowerPoint presentation, and underwent a question-and-answer session. Results Based on postsimulation qualitative assessments, junior and senior residents correctly identified DCS, but junior residents alone were less likely to elicit pertinent social history or to fully physically examine the patient without the presence of senior residents. Both resident groups were able to verbally explain the fundamental DCS pathophysiology to the patient, but junior residents were unable to specifically direct oxygenation, hydration, and HBO protocols for DCS. After case completion and debriefing, all learners demonstrated achievement of primary learning objectives. Discussion Overall, we noted this case worked well for junior EM residents with senior-resident backup. Both learner groups appreciated the concealed elements of case, including scuba diving history and exposed dermatologic findings, and reported that these were invaluable learning moments for all future patient encounters, not just those limited to DCS.http://www.mededportal.org/doi/10.15766/mep_2374-8265.10473SimulationDecompression SicknessArterial Gas EmbolismScuba Diving ComplicationHyperbaric Oxygen Therapy |
| spellingShingle | Xiao C. Zhang Antoinette Golden David S. Bullard Neurologic Deep Dive: A Simulation Case of Diagnosing and Treating Decompression Sickness for Emergency Medicine Residents MedEdPORTAL Simulation Decompression Sickness Arterial Gas Embolism Scuba Diving Complication Hyperbaric Oxygen Therapy |
| title | Neurologic Deep Dive: A Simulation Case of Diagnosing and Treating Decompression Sickness for Emergency Medicine Residents |
| title_full | Neurologic Deep Dive: A Simulation Case of Diagnosing and Treating Decompression Sickness for Emergency Medicine Residents |
| title_fullStr | Neurologic Deep Dive: A Simulation Case of Diagnosing and Treating Decompression Sickness for Emergency Medicine Residents |
| title_full_unstemmed | Neurologic Deep Dive: A Simulation Case of Diagnosing and Treating Decompression Sickness for Emergency Medicine Residents |
| title_short | Neurologic Deep Dive: A Simulation Case of Diagnosing and Treating Decompression Sickness for Emergency Medicine Residents |
| title_sort | neurologic deep dive a simulation case of diagnosing and treating decompression sickness for emergency medicine residents |
| topic | Simulation Decompression Sickness Arterial Gas Embolism Scuba Diving Complication Hyperbaric Oxygen Therapy |
| url | http://www.mededportal.org/doi/10.15766/mep_2374-8265.10473 |
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