introduction of simulation to the medical students

Ad hoc teams is different from permanent ones since they cannot be trained to work together. The team is formed in short period where the members may not know each other. Members need "portable skills" in many areas below in order to improve safety, efficiency and morale

Crisis resource management in medicine aims to develop the same set of portable skills, and includes teamwork as a component with elements of leadership, cooperate, coordinate and communicate.

Components of teaching simulation for undergraduates:

1. Trained and committed lecturers with exposure to medical simulation

2. Objectives and learning outcome

• Introduction to experiential learning
• ensure all students understand the limitation of the manikin (e.g. unable to show pallor, cyanosis), have an open mind during the session and to treat manikin as they treat their own patients. At the same time don't forget to interact. Allow them familiar with the manikins

3. Have the scenario, which is ususally specific to the environment (icu, operation theatre, ward, emergency room)

• in the end, give the management pathway (in this case may be appropriate to give principles and references
• show their basic clinical skills: accumulation of data from clinical observation, monitors, environment, equipment and lab/radiology and able to analyse them in looking for possible problems

4. The key elements are

• introduction to critical thinking
• Learn how to communicate effectively -verbally and non verbally
• introduction to crisis management principle
• team work

5. Debriefing

Oh December!

The title above has nothing to do with the content of this account. For a long time, I am struggling to teach the icu topics to 4th year medical students. It is only two tutorial and very minimal exposure to the units while doing their anaesthesiology two weeks rotation. Finally I have finished writing the chapter, well not quite writing it but the contents are appropriate for them to understand about icu. The second one is to introduce the concept of problem orientated systematic approach and this one is really challenging!

Well, I have been away for sometimes and I think the simulation skills classes for the students are a little bit out. I am working on this since I think I have the knowledge in this area.

I am going to revise the keys in crisis resource management and may revisit the whole thing in a formal manner.

1. Know your environment
2. Anticipate and plan
3. Call for help early
4. Take a leadership role
5. Communicate effectively
6. Allocate attention wisely, Use all available information
7. Distribute the workload and utilise all available resources
   

neutropenic sepsis

It has been a while since I am back for good. Sadly to say that I deferred my clinical exam to next year. Everything happenned for a reason and I had a fruitful break from my daily life. Here I come, fresh and vibrant!!
I just feel like writing something, it is not an update..just to write something that I saw on my table. It is a brief overview of neutropenic sepsis.
Don't you know that about 80% of infections in the neutropenic patient arise from endegenous flora. Bacteria pathogens are the most commonly isolated, in particular:
E.Coli, Pseudomonas, staph aureus, coagulase neg staph, pneumonococcus and other streptococci, Enterococci, enterobacter, Klebsiella and clostridium.
Please remember other pathogens which are of significant important such as aspergillus, candida species and viruses (HSV, VZV,CMV)

Looking for source of infection and source control are the mainstay of management. Infectious focus could only identified in only 30% of patients, therefore a thorough, structured and careful clinical examination is required. Specific infections that must be looked for include mucositis, catheter related infection, pneumonia, skin lesions, perianal abscess, sinusitis, dental abscess and abdominal pathology. A full septic screen is required and this include CXR. There shouldn't be a delay in administering antibiotic or antimicrobial therapy.

Source control is critical. Removal of CVC is required whenever there are clinical signs of CRBSI or suspected organisms are cultured. In septic shock (with hypotension and organ failure), empirical removal of CVC is strongly indicated.

Antimicrobial therapy: Delay in antibiotic therapy is directly correlated with mortality. Empiric antibiotic therapy is indicated for all patients with neutrophil count less than 0.5 or temperature more than 38C. Initial therapy is usually betalactam with antipseudomonal activity. Vancomycin is added if the patient is in shock, MRSA colonised, or has clinical evidence of mucositis or a catheter related infection. Initial antifungal therapy is indicated for bone marrow transplant recipients and for other patients if the febrile neutropenia persists despite 5 days of broad spectrum antibiotic therapy.

G-CSF are generally used for critically ill patients with post chemotherapy neutropenia. G-CSF has been shown to reduce the duration of neutropenia but not influence mortality in a broad population of neutropenic patients, and evidence is lacking for ICU patients. Usually its used is considered for patients with organ failure.