Intraoperative Tension Pneumothorax in a Trauma Patient: An Adult Simulation Case for Anesthesia Residents

Abstract

Introduction: Anesthesiologists may encounter multiple obstacles in communication when attempting to collect information for emergency surgeries. Occult tension pneumothorax that was asymptomatic in the Emergency Department (ED) could become apparent upon positive pressure ventilation and pose a critical threat to the patient intraoperatively.

Methods: This simulation is primarily designed to train first-year of clinical anesthesia (CA-1) residents. It is designed as a 50-minute encounter consisting of 2 scenes. The first scene focuses on information collection and communication with a non-cooperative patient with multiple distractors. The second scene focuses on the early diagnosis of tension pneumothorax and the treatment.

Results: This scenario has been developed as one of the regular simulation trainings at our facility. We tried to keep the simulation environment as realistic as possible. We did not grade the learners based on their performance, although most of the residents met the educational objectives. Commonly missed critical actions included misdiagnosing the tension pneumothorax as mainstem intubation, bronchospasm, pulmonary thromboembolism, or anaphylaxis. All residents learned from this scenario, as they rated the feedback and debriefing as “extremely useful” or “very useful.”

Discussion: Our simulation program helps anesthesia residents develop crisis management skills for perioperative incidents in a safe environment, as well as to foster excellent communication skills. Time constraints limit the number of the residents who can sit in the “hot seat.” The structure of the mannequin often limits the ability to diagnose pneumothorax by auscultation. The scenarios can be also employed to educate student anesthesia assistants in the future.