Application of medical simulation in the education of medical students in the area of gynecology and obstetrics

The education of new generations of doctors faces major challenges. The education system should ensure access to modernand effective educational techniques. Medical simulation is a method that is developing very dynamically. Currently, everymedical university in Poland has access to the facilities of a Medical Simulation Centre. Many types of simulations can beused. The variety of techniques is considerable. Starting from simple trainers, through advanced patient simulators to hybridsimulation or virtual reality. Thanks to their use, it is possible to teach basic medical procedures in a safe way, withoutcompromising the patient’s intimacy. An additional advantage is the possibility to train in an interdisciplinary team. Theaim of this work was to present the possibility of using medical simulation as a method of effective and interesting teachingof medical students in the field of gynaecology and obstetrics. The authors described different techniques and levels ofsimulation sophistication. The basic tasks of the teacher were also described. The paper may be an interesting complementto the knowledge of education for each physician involved in the work with students

Application of medical simulation in the education of medical students in the area of gynecology and obstetrics

The education of new generations of doctors faces major challenges. The education system should ensure access to modern and effective educational techniques. Medical simulation is a method that is developing very dynamically. Currently, every medical university in Poland has access to the facilities of a Medical Simulation Centre. Many types of simulations can be used. The variety of techniques is considerable. Starting from simple trainers, through advanced patient simulators to hybrid simulation or virtual reality. Thanks to their use, it is possible to teach basic medical procedures in a safe way, without compromising the patient’s intimacy. An additional advantage is the possibility to train in an interdisciplinary team. The aim of this work was to present the possibility of using medical simulation as a method of effective and interesting teaching of medical students in the field of gynaecology and obstetrics. The authors described different techniques and levels of simulation sophistication. The basic tasks of the teacher were also described. The paper may be an interesting complement to the knowledge of education for each physician involved in the work with students

Supraglottic devices — future or everyday life?

The most common cause of upper respiratory tract obstruction in an unconscious or unresponsive patient is the loss of muscle tone in the upper airway. Consequently, this leads to a reduction in the tone of the epiglottis, collapse of the tongue and closure of the airway at the level of the pharynx, preventing respiration. Diagnosing airway obstruction is associated with the implementation of urgent procedures aimed at restor­ing and maintaining patency. Among the techniques of restoring airway patency anatomically, we prefer extending the head and pushing the posterior mandible forward. Airway ventilation is not always possible through the use of non-surgical methods. Ventilating patients with obstructed airways using a self-inflating bag can prove to be very difficult. In such situations, it is necessary to use airway adjuncts. The purpose, regardless of the circumstances, is to remove anatomical barriers, prevent gastric aspiration and to facilitate proper lung ventilation. Endotracheal intubation is the gold standard for instrumentally maintaining a secure airway. The procedure, however, is reserved for experienced personnel because of how difficult it is to perform and the many complications that arise with it. In situations where difficulty is encountered, an alternative device to secure airway patency is needed

Successful management of severe exertional heat stroke complicated by ventricular fibrillation in 19 years old male

Heatstroke is a heat-related disease that is highly fatal. However, it is significant that if symptoms are quickly recognized, the outcome remains satisfactory. In this paper, the authors present the case of a 19-year-old physical worker in whom heatstroke was complicated by cardiac arrest. The proper action and full diagnosis of the underlying cause of cardiac arrest allowed for a full recovery. Attention was also drawn to the lack of appropriate equipment for active cooling and potential use of automatic chest compressions devices

The effectiveness of ‘practice while watching’ technique for the first aid training of the chemical industry employees

INTRODUCTION: Industrial accidents constitute about 20% of all causes of accidents. They are often sudden, unexpected and may lead to tragic consequences, which however can be partially reduced if first aid and emergency treatment are given as soon as possible. The most important part of a chain of survival is the bystanders’ response. In practice, it is highly dependent on the ability of co-workers to perform basic first-aid tasks. The aim of this paper was to present the effectiveness of ‘practice while watching’ training method for the first aid training of the chemical industry employees. The authors focused on the most important elements of the training, which have an impact on the acquisition of knowledge and skills of first aid.  MATERIAL AND METHODS: The training involved 69 employees of the chemical industry. The test sheets were used for the assessment, where each of the action steps was assigned points 0 for incorrect and 1 for a properly performed activity.  RESULTS: Each step was completed by at least 76% of workers. When providing both adult and infant CPR, the main difficulty was calling for help. Younger employees obtained better results than older colleagues.  CONCLUSIONS: The study demonstrated the high effectiveness of the ‘practice while watching’ method. In addition, workers’ age turned out to be a significant variable which affected their performance.

Use of video laryngoscopes by inexperienced personnel in difficult intubations

The current gold standard in securing airway patency remains to be endotracheal intubation. It is the only method, which allows for nearly 100% protection of the bronchial tree from aspiration of gastric contents as well as providing the most ideal circumstances for control of ventilation parameters. Endotracheal intu- bation, although in many aspects superior to other methods of securing airways, can only be performed by skilled and experienced personnel in ideal conditions. An example of such conditions are in an operating room in the preoperative period when an anesthesiologist is able to proficiently perform the task with all of the tools and equipment needed at hand. However, in many situations, especially in emergencies, such ideal conditions are difficult or impossible to achieve. One of the many reasons behind this is often the lack of experienced personnel at the scene of an emergency. Another significant difficulty arises from trauma patients who must maintain an immobilized cervical spine, as well as those patients who are undergoing active cardiopulmonary resuscitation when providing high quality chest compressions is the highest priority. Therefore, it seems reasonable to look for the methods which on one hand will secure an airway with a tube inserted directly into the larynx, and on the other hand will make the procedure more accessible to less expe- rienced personnel by maintaining the proper patient safety throughout the whole procedure. A noteworthy method, which achieves this goal, is the use of the video laryngoscopes for endotracheal intubation. The participation in a short introductory training, regarding the use of the device itself, is sufficient to allow for the efficient intubation. The parameters which can be used to compare these different intubation methods include the ease of use, the rate of effectiveness of the first intubation trial as well as the total time needed for the procedure. The authors of this article attempt to compare classic laryngoscopes to video-assisted laryngoscopes. 

Paramedic students need more training in left ventricular assist device — a pilot simulation study

INTRODUCTION: Mechanical Circulation Systems are a promising therapy for patients with end-stage of heart failure. Left ventricular assist device (LVAD) enforces using of concomitant anticoagulant therapy. This may lead to severe complications. LVAD patients are more and more frequent users of the emergency department. There are several differences in cardiovascular function in these patients, as well as on examination. Its interpretation may be challenging and result in potentially fatal conclusions. The aim of this research was to assess the skills of paramedic students in assessing patients with LVAD MATERIAL AND METHODS: The study was designed as a simulation study. The aim of this scenario was to provide a full primary survey of an unconscious, spontaneously breathing person with an LVAD pump implanted. Ten groups of paramedic students from Polish medical universities took part in this study. RESULTS: Four teams started chest compressions unnecessarily. Of them, only one had contacted LVAD local coordinator and discontinued after short instructions. Four teams completed the driveline and device check and six checked only the line without moving the controller. No major errors were noted in the field of airway assessment and management as well as assessment of consciousness, breathing, and circulation. CONCLUSIONS: More attention should be paid to educating paramedic students in LVAD therapy. Educators should focus mainly on differences in cardiovascular function and pay attention to complete perfusion assessment. Medical simulation seems to be a good tool for assessing difficult clinical cases rarely encountered in practice

Implementation of extended cardiopulmonary resuscitation procedure in in-hospital cardiac arrest: a preliminary simulated study

INTRODUCTION: The survival rate of patients after in-hospital cardiac arrest (IHCA) is poor. The implementation of novel technologies to conventional cardio-pulmonary resuscitation (CPR) may improve clinical outcomes.   Aim: To evaluate efficacy of extended CPR (ECPR) performed by physicians in the simulated scenario of IHCA.   MATERIAL AND METHODS: High-fidelity simulations were performed in a simulation room equipped with a full spectrum of emergency devices. Earlier, the physicians (n = 60, five courses) participated in a threeday training in the use of extracorporeal techniques. Eventually, 12 participants were divided into 4-member teams that were involved in three stages (assessed in terms of duration and quality) of scenario such as 1. Advanced Life Support (ALS) activities; 2. preparation of the extracorporeal membrane oxygenation device (ECMO); 3. cannulation and activation of ECMO.   RESULTS: All teams completed successfully scenario within recommended time of 60 minutes (ranged from 33 min. 55 sec. to 37 min.) after IHCA. In details, decision to activate ECMO team was taken between 8 min. 45 sec. and 14 min. 15 sec of scenario, ECMO device prepared within 10 min. 5 sec. to 15 min. 30 sec. whereas peripheral vessels cannulated in 4 min. 14 sec. to 6 min. 10 sec. Of note, all evaluated times were the shortest for teams with decisive leaders.   CONCLUSIONS: Implementation of ECPR procedure is possible within recommended time after IHCA. It has also been shown that training with application of high-fidelity simulation techniques is of paramount importance in achievement and maintenance of ECPR skills, not only manual but also in effective communication