Browsing by Author "Webb, Timothy T."
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Item Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents(AAMC, 2020-03-13) Webb, Timothy T.; Boyer, Tanna J.; Mitchell, Sally A.; Eddy, Christopher; Anesthesia, School of MedicineIntroduction: Sepsis is a major cause of morbidity and mortality in medicine and is managed in ICUs daily. Critical care training is a vital part of anesthesiology residency, and understanding the presentation, management, and treatment of septic shock is fundamental to intraoperative patient care. Methods: This simulation involved a 58-year-old man undergoing surgical debridement of a peripancreatic cyst with hemodynamic instability and septic shock. We conducted the simulation yearly for clinical anesthesia year 2 residents (n = 26) in 1-hour sessions with three to five learners at a time. The simulation covered the six Anesthesiology Milestones related to sepsis and septic shock as outlined in the Anesthesiology Milestones Project. Results: To date, 155 anesthesiology residents have completed the simulation. Commonly missed critical actions included failure to recognize the need for invasive lines, provide appropriate volumes of fluid resuscitation, inquire about blood cultures and antibiotics, and recognize the need for the patient to remain intubated. Most participants could appropriately diagnose and treat intraoperative septic shock, but all had moments of action or inaction to discuss and improve upon, and all learned from this scenario. Discussion: Simulation is an optimal way to practice the more rare and life-threatening clinical events in medicine. Even though septic shock is commonly managed in the ICU, it is relatively uncommon for it to develop acutely in the OR. This simulation is an effective and educational way to discuss the most recent sepsis/septic shock definition and review evidence-based guidelines for treatment.Item Managing ARDS in the Operating Room: A Timely Simulation for Anesthesiology Residents(2022-09-17) Daly, Christine A.; Eddy, Christopher; Boyer, Tanna J.; Mitchell, Sally A.; Sturm, Julie F.; Webb, Timothy T.Introduction: Acute respiratory distress syndrome (ARDS) is a serious medical condition with high morbidity and mortality that frequently requires management in the intensive care unit (ICU). As critical care training is a vital component of anesthesiology residency and critically ill patients often require procedures necessitating anesthesia, understanding the presentation, management, and treatment of ARDS is essential to perioperative patient care. Educational Objectives: By the end of this simulation case, learners will be able to: identify and define ARDS; describe and apply ventilator strategies for patients with ARDS; and discuss strategies to improve oxygenation in patients with ARDS in addition to adjusting ventilator settings. Methods: This simulation involved a 66-year-old man with inhalational burn injuries undergoing debridement and homografting of burns in the operating room. During the case, the patient’s oxygenation and lung compliance demonstrated changes consistent with worsening ARDS. We conducted this simulation yearly for clinical anesthesia year 2 residents (CA2/PGY3; n=26) in 1-hour sessions with three to four learners at a time. The simulation covered five Anesthesiology Milestones related to ARDS as outlined in the Anesthesiology Milestones Project. Results: At the time of submission, 130 anesthesia residents completed the simulation. Commonly missed critical actions include failure to: recognize the need to adjust ventilator settings prior to inducing anesthesia; investigate causes of acute hypoxemia during the procedure; provide appropriate ventilator changes to improve the patient’s acute hypoxemia; and recognize the need to cancel the procedure. Most participants appropriately diagnosed and managed hypoxemia, and all agreed the simulation was a valuable learning experience. Conclusions: Simulation presents trainees with an effective opportunity to further their learning with regard to the recognition, management, and treatment of ARDS. This simulation provides an opportunity to discuss the currently evolving management of ARDS.Item Medical Student Concerns For Respiratory Protection on Anesthesiology Electives(2022-09-17) Yu, Corinna J.; Webb, Timothy T.; Guillaud, Daniel; Mitchell, Sally A.