I want to share the information about the next SimMarathon in SIMSTAR before the official announcement.
SimMarathon in Winter 2015 will be held on Dec 29 in SIMSTAR.
I’m not sure that I’ll be able to continue this crazy simulation seminar in 2016 as well.
If you want to experience comprehensive simulation about any kinds of emergency patients, why not join it!
I will wear one of our new LOGO-printed shirts 🙂
4つのオリジナルシミュレーションの案内です。
・PCPSシミュレーション
・急性心不全症候群シミュレーション
・緊急気道管理トレーニング
・Sepsis Management Simulation
私の週末確保のために、基本平日開催です。1月のみ土日開催です。3月は休みます。
希望者はメールでお申込み下さい。
This post is the announcement of my original simulation seminars from Oct 2015 to Feb 2016.
I’m going to hold 4 different kinds of simulation seminars based on the real cases. Each one is designed for somewhat experienced practitioners such as senior residents, ED nurses, critical care nurses, so forth.
Why not join all of them? Learn a lot while enjoying!
On July 26, SimMarathon in Okinawa clinical simulation center was done as scheduled. This center’s nickname is “Chura-Sim”. “Chura” means “beautiful” in Okinawan dialect. As it is, this center is very beautiful and well-equipped for training.
This time, all participants belong to a certain private hospital near this center.
An experienced doctor Mito who is a friend of mine since 2001 is in charge of emergency room of the hospital and invited me as a director of this simulation seminar.
More than 20 people joined and completed 8 scenarios as follows.
I really appreciate this remarkable facility and Dr Mito’s enthusiasm about simulation education.
In addition to holding seminar, I went to Okinawa’s sacred spot called Seifa-Utaki and then Syuri-Castle. Of course I enjoyed lots of local yummy foods.
44 M
CC; burn
Dx; large burn by explosion, face to leg, TBSA 40%
PH; n.p.
Tx; Airway control, fluid resuscitation by Parkland formula, wound care etc
67 M
CC; altered consciousness
Dx; Hyperkalemia,Acute Pancreatitis(alcoholic) with ARDS by CECT, severe shock
PH; alcoholics
Tx; Calcium iv, massive fluid resuscitation, ABx, intubation, low tidal volume ventilation for ARDS
60M
CC: lt.hemiparesis, altered consciousness
Dx: AAD(Stanford A), dissection of 3 branches from aortic arch, seizure
Tx; intubation, CECT→ope
20 M
CC; syncope, LOC→gasping, VF
Dx; Idiopathic VF, persistent VF
PH; WPW syndrome
Tx; DC many times/adrenaline/amiodarone/intubation → ECPR(PCPS) → rhythm conversion → CT(full body)& CAG, TTM
20M
CC; death-leap from 5th floor of an apartment, facial injury, leg deformation
Dx; hemorrhagic shock due to pelvic fracture, lt femor fracture and other limb fractures
PH; isolating himself from society
Tx; intubation/blood transfusion/FAST and FACT→TAE
53 M
CC; pyrexia, rt leg swelling,pain & erythema, consciousness down
Dx; NSTI with gas of rt. leg, septic shock/DIC
PH; untreated DM
Tx; EGDT, ABx, CECT, not only debriedmant but amputation needed for source control
50 M
CC; syncope, dyspnea, cyanosis
Dx; massive PE/DVT→syncope/shock
PH; overweight
Tx; intubation/catecholamine→VA-ECMO(PCPS)→CECT
52F
CC; severe hypoxemia, orthopnea
Dx; AHFS CS1+2, MR (MVP)
PH: HT, post Y-grafting for AAA
Tx; intubation, nitrate, diuretics
On July 17, 2015, I was in charge of ECPR simulation on APELSO conference 2015 in Kyoto, Japan. The LIVE video shooting was simultaneously displayed on the big screen of the other conference room.
In that conference room, several big figures of ECMO in the world were watching and evaluating the simulation.
Total number of participants of this sim was 10, and they came from China, Taiwan, Australia, Thailand, Japan so forth.
Some of them are already well-experienced and very knowledgeable about ECMO such as Cardiothoracic surgeon, Intensivist, Cardiologist, Perfusionist etc.
Planned Agenda was as follows;
1. Introduction and Briefing 15min
2. SAVE-J and Case Presentation 5min
3. Explanation of today’s ECMO device Priming of ECMO circuit 15min
4. Preparation of cannulas 10min
5. Percutaneous cannulation with water circuit during conventional CPR 15min
6. Tubing and initiation of ECMO circuit 5min
7. Post cardiac arrest assessment and intervention 10min
8. ICU management; Dealing with complications and Getting through weaning 35min
9. Discontinuation of ECMO and decannulation 10min
Before simulation I assigned their each rolls according to the following figure ” Sample of ECPR Code Team”. This time chest compressions were done by mechanical compression device called LUCAS2.
They did very well collaboratively and put the patient on ECMO quickly.
Most of them seemed to be interested in the method to provide practical education about ECMO. So they were very curious about my original water circuit.
Since the guy who played as a code team leader was so knowledgeable, and some of them were also good ECMO practitioners, they tended to discuss about each topics much more deeply.
Even though these discussions were important, it sometimes took longer than I expected. I couldn’t handle this situation skillfully because of my intermediate level of English.
Anyway this is a deep and powerful experience for me and perhaps for them.
For the next opportunity, I want to elevate my facilitation skill in English.
I’ve made this vascular model for extra-corporeal CPR simulation.
This might be the final version of groin vascular model that is modified for puncture and wiring with US guidance.
Of course, there is a gap between the real body part and this model, but this might be acceptable for simulation training.
All parts of this model is made of commercially available stuff. It means that this is super cheap compared to the stuff produced by specific companies, which provide very expensive models close to true physical parts.
This time, the slime works well 🙂
I modified the groin parts of my original ECMO training circuit to make US guiding cannulation possible.
I actually gave it try, and found that the level of reality might be acceptable :p
I finished ECMO sim and Acute Heart Failure sim.
Those two are my favorite simulation seminars.
I need some sort of extra energy to get through these simulation.
SimNight 20150609
Today, 4 medical students participated in this simulation.
All of them are in the 5th grade and they have done their clinical clerkship for just 2 months.
That means that they have little clinical experiences and their large amount of knowledge is not connected to true patient’s management, especially in emergency medicine.
I believe that simulation is supposed to be the effective bridge between their knowledge and patient management.
Case 1 : 50M
CC: chest pain lasting for one hour
PH: HT,DM,HL
Walk-in
Condition: anteroseptal AMI, acute pulmonary edema → VF → ROSC after 2 shocks
Case 2 : 35M
CC: orthopnea, coughing, sweating, cyanosis
PH: asthma
By ambulance
Condition:status asthmatics→β2 inhalation, steroid div → admission
Today, three doctors and seven nurses attended this seminar.
It took 2hours from 7pm to 9pm.
I provided 3 scenarios and did a tiny lecture about ARDS.
This time I had to mention about interprofessional communication skills and attitudes.
Case1
50M in general ward of surgery
CC:abdominal pain, cold sweating
Dx at admission: splenic injury, rib fracture etc
Condition: hemorrhagic shock from splenic injury → fluid resuscitation/CECT/TAE
Case2
60M in general ward of surgery
CC: dyspnea
Condition before deterioration: 2nd postoperative day of pancreatoduodenectomy for pancreatic tumor
After deterioration : acute pulmonary edema due to fluid refilling and afterload mismatch → NTG, lasix etc
Case3
50M in HCU
CC: chest pain & dyspnea
Dx at admission: severe stenosis of LMT, before CABG with heparin and nicorandil
Condition: cardiogenic shock from new onset of large MI → intubation, coronary reperfusion therapy
SimNight 20150519
Today there were three participants.
They were a senior resident, a general physician and a nurse.
I let them deal with two shock patients.
I emphasized the use of ultrasound for shock patients which now is called “RUSH exam” and an arterial line wave form(see attached photo) to evaluate patient’s stroke volume.
36M with obesity
CC: altered consciousness & convulsion while working under extremely hot weather
PH: n.p.
By ambulance
Condition: heat stroke 41.7℃→internal & external cooling(massive cold fluid infusion etc)
45F
CC: nausea, bradycardia, hypotension
PH: CKD, DM, HT
by ambulance
Condition: hyperkalemia caused by CKD and drugs(ACE-i etc)→Ca, GI etc
