December | 2015 | Tomoyuki Endo

I’ve forgotten to upload about my original simulation seminar called “SimMarathon” that was held on Nov 3rd, 2015.

At that time, 11 doctors and 6 nurses participated in this simulation.

They were divided into two teams and managed scenarios one after another.

Two doctors were attending emergency physicians and both gave a lot of comments and tips for young doctors.

Even though each scenario was so sick and difficult to handle, they did their best to make the patients stable as a team.

I had prepared 10 scenarios for this 8-hour sim, but just 7 scenarios were completed.

Especially ECMO scenarios took longer time than other ones, for example more than 1.5 hours for persistent VF scenario.

I know that too much complicated and comprehensive scenario that has bunch of teaching points is not suitable for less experienced learner, but that is the case they will have to deal with in the near future.

Scenarios were as follows;

55M
CC: dyspnea, altered consciousness
Diag: severe pneumonia of Legionella
Interventions: intubation/EGDT/ABX→ventilatory support

60M
CC: hypothermia, fine VF
Diag: accidental hypothermia with GI bleeding
Interventions: ECMO, defib after rewarming more than 30 degree, massive blood transfusion, endoscopic/operative hemostasis

20F
CC: blunt trauma, hemorrhagic shock
Diag: facial trauma, hemorrhagic shock due to fractures of pelvis and multiple limbs
Interventions: cricothyroidotomy for airway emergency with multiple facial bone fractures, massive blood transfusion, FAST/FACT→TAE→external fixation of pelvis

60M
CC: lt.hemiparesis, altered consciousness
Diag: AAD(Stanford A), dissection 3 branches of aortic arch, seizure
Interventions: intubation, CE-CT→ope

20F
CC: altered consciousness, fever
Diag: bacterial meningitis/septic shock/sepsis-induced cardiomyopathy
interventions: blood culture, intubation, EGDT, early ABT administration(MEPM/VCM), CT, lumbar puncture

44M
CC: burn by explosion, face to leg,
Diag: large burn with inhalation injury, TBSA 40%, hemoglobinuria
Interventions: fluid resuscitation according to Pakland formula, bronchoscopy, intubation, wound care

51M
CC: Fall from 4m hight, VF during CT scan
Diag: traumatic SAH, rib fractures, transverse process fracture of lumbar spine, retroperitoneal hemorrhage,
new onset of AMI(broad anterior), persistent/reccurent VF
Interventions: VA-ECMO, PCI(only POBA) with minimum heparinization

This is the first time for me to let learners put the real REBOA catheter into my original water vascular circuit made for ECMO training.

REBOA means “Resuscitative Endovascular Balloon Occlusion of the Aorta”. This is used for temporary control of life-threatening hemorrhage caused by trauma or other etiology like AAA up until definitive therapy will have been done.

Actually, my circuit worked well!

I’ve realized that my original circuit is quite useful not only for ECMO training but also trauma simulation 🙂

Since the internal diameter of this vascular model is about 12mm, full inflation of the balloon couldn’t be done in this model.