1. printed by
www.postersession.com
At CAPE (Center for Advanced Pediatric and PerinatalAt CAPE (Center for Advanced Pediatric and Perinatal
Education), the primary goal is to teach physicians, nurses, andEducation), the primary goal is to teach physicians, nurses, and
residents how to most efficiently and effectively solve medicalresidents how to most efficiently and effectively solve medical
crises involving neonates, infants, and children throughcrises involving neonates, infants, and children through
mannequin-based simulation. During simulations, it has beenmannequin-based simulation. During simulations, it has been
observed that participants who are acting as primaryobserved that participants who are acting as primary
responders within a crisis are often hesitant to call for backupresponders within a crisis are often hesitant to call for backup
assistance. Often times participants are overwhelmed and taskassistance. Often times participants are overwhelmed and task
saturated and need to mobilize additional resources to assistsaturated and need to mobilize additional resources to assist
with critical thinking and interventions. CAPE urgeswith critical thinking and interventions. CAPE urges
participants to feel more comfortable calling for backupparticipants to feel more comfortable calling for backup
assistance, arguing that more hands and more brains help toassistance, arguing that more hands and more brains help to
improve the situation. We were curious to see if calling forimprove the situation. We were curious to see if calling for
help not only improves the situation, but resolves the crisishelp not only improves the situation, but resolves the crisis
faster.faster.
It is important to discover if the ability to stabilize aIt is important to discover if the ability to stabilize a
patient as quickly as possible is affected by how early thepatient as quickly as possible is affected by how early the
primary responder or responders call for help. By timing andprimary responder or responders call for help. By timing and
comparing numerous simulations, it is possible to decipher ifcomparing numerous simulations, it is possible to decipher if
a correlation exists between calling for help and the end of thea correlation exists between calling for help and the end of the
simulation (the simulation is completed once patient issimulation (the simulation is completed once patient is
stabilized). We hypothesize that if the backup team is calledstabilized). We hypothesize that if the backup team is called
earlier then it will take less time to stabilize the patient.earlier then it will take less time to stabilize the patient.
BACKGROUND
PURPOSE AND HYPOTHESIS
MATERIALS AND METHODS
RESULTS
CONCLUSIONS
6 0:06 3:22
9 0:25 4:22
13 0:32 4:36
17 0:52 4:42
12 1:34 6:23
8 2:20 8:28
20 2:30 9:57
MECONIUMMECONIUM
ASPIRATIONASPIRATION
LATELATE
DECELLERATIONDECELLERATION
5 0:05 3:24
19 1:31 4:35
3 1:45 12:06
7 2:05 N.A.
11 2:42 10:02
14 2:12 7:52
2 3:32 8:15
CYSTICCYSTIC
HYGROMAHYGROMA
PLACENTALPLACENTAL
ABRUPTIONABRUPTION
16 0;05 5:39
4 0:10 9:55
18 0:32 5:39
21 0:46 11:12
1 0:49 8:04
15 0:52 5:17
MASMAS
Time(seconds)Time(seconds)
PlacentalPlacental
AbruptionAbruption
Time(seconds)Time(seconds)
CysticCystic
HygromaHygroma
Time(seconds)Time(seconds)
LateLate
DecelerationDeceleration
Time(seconds)Time(seconds)
Experiment#
Experiment#
Experiment#
Experiment#
CalledforHelp
CalledforHelp
CalledforHelp
CalledforHelp
ScenarioEnded
ScenarioEnded
ScenarioEnded
ScenarioEnded
A common pattern arose. In most cases, the earlier the primaryA common pattern arose. In most cases, the earlier the primary
responder called for backup assistance, the earlier the crisis wasresponder called for backup assistance, the earlier the crisis was
resolved. This occurred 100% of the time within the meconiumresolved. This occurred 100% of the time within the meconium
aspiration simulation, 100% of the time during the cystic hygromaaspiration simulation, 100% of the time during the cystic hygroma
simulation, and 80% of the time in the late deceleration simulation.simulation, and 80% of the time in the late deceleration simulation.
During the placental abruption simulation there was no detectableDuring the placental abruption simulation there was no detectable
correlation within results. This may be due to the varying amountscorrelation within results. This may be due to the varying amounts
of time it took for supplemental blood to arrive, which disrupted theof time it took for supplemental blood to arrive, which disrupted the
experiment. Our hypothesis was ultimately supported when theexperiment. Our hypothesis was ultimately supported when the
results suggested that in most cases, it was beneficial to call forresults suggested that in most cases, it was beneficial to call for
backup assistance as soon as possible.backup assistance as soon as possible.
REFERENCES
ACKNOWLEGEMENTS
We analyzed a total of 20 simulations broken into four different categories:We analyzed a total of 20 simulations broken into four different categories:
meconium aspiration, cystic hygroma, placental abruption, and late deceleration. Themeconium aspiration, cystic hygroma, placental abruption, and late deceleration. The
timer was started once the primary responder entered the simulation room and endedtimer was started once the primary responder entered the simulation room and ended
when the patient was stabilized. The baby was born approximately 10 seconds into everywhen the patient was stabilized. The baby was born approximately 10 seconds into every
simulation. The first category was meconium aspiration. Fetal distress during laborsimulation. The first category was meconium aspiration. Fetal distress during labor
causes intestinal contractions and relaxation of internal sphincters. This can causecauses intestinal contractions and relaxation of internal sphincters. This can cause
meconium, the fetusmeconium, the fetus’ waste, to enter the amniotic fluid during labor, putting the baby at’ waste, to enter the amniotic fluid during labor, putting the baby at
risk for respiratory arrest. In this simulation, it was necessary to intubate and suction therisk for respiratory arrest. In this simulation, it was necessary to intubate and suction the
airway. If the heart rate was less than 60 beats per minute (bpm), then it was thenairway. If the heart rate was less than 60 beats per minute (bpm), then it was then
necessary to provide chest compressions and possibly administer epinephrine.necessary to provide chest compressions and possibly administer epinephrine.
The second category was cystic hygroma. This is a congenital growth in the neckThe second category was cystic hygroma. This is a congenital growth in the neck
that forms from embryonic lymphatic tissue that has the potential to block the airway.that forms from embryonic lymphatic tissue that has the potential to block the airway.
Participants were required to intubate the baby to insure that an effective airway wasParticipants were required to intubate the baby to insure that an effective airway was
established, and insert an Umbilical Venous Catheter (UVC) in order to provideestablished, and insert an Umbilical Venous Catheter (UVC) in order to provide
medication.medication.
The third category was placental abruption, which is a separation of the placentaThe third category was placental abruption, which is a separation of the placenta
from the uterine wall before the baby is born. This causes significant blood loss for bothfrom the uterine wall before the baby is born. This causes significant blood loss for both
the mother and the baby. It was necessary to insert a UVC and provide supplementalthe mother and the baby. It was necessary to insert a UVC and provide supplemental
blood to the baby. If the heart rate was less than 60 bpm, then it was necessary to provideblood to the baby. If the heart rate was less than 60 bpm, then it was necessary to provide
chest compressions.chest compressions.
The final simulation was late deceleration. During the onset of a contraction, it isThe final simulation was late deceleration. During the onset of a contraction, it is
completely normal for a baby’s heart rate to decelerate, called early deceleration.completely normal for a baby’s heart rate to decelerate, called early deceleration.
However, if the babyHowever, if the baby’s heart rate decreases after the peak of a uterine contraction, this is’s heart rate decreases after the peak of a uterine contraction, this is
an indicator of fetal hypoxia. In this simulation, it was necessary to intubate the baby inan indicator of fetal hypoxia. In this simulation, it was necessary to intubate the baby in
order to provide supplemental oxygen, provide chest compressions, and administerorder to provide supplemental oxygen, provide chest compressions, and administer
epinephrine.epinephrine.
(1)(1) “Solutions for Neonatal Training.”“Solutions for Neonatal Training.” Solutions for Neonatal Training. NSolutions for Neonatal Training. N.p., n.d. Web. 26 July 2012..p., n.d. Web. 26 July 2012.
(2)(2) “Neonatal Scenario Training: The Birth of a New Era of Education” P“Neonatal Scenario Training: The Birth of a New Era of Education” Primary Care Today., n.d. Web. 26 July 2012.rimary Care Today., n.d. Web. 26 July 2012.
(3) Kattwinkel, John, and Ronald S. Bloom. T(3) Kattwinkel, John, and Ronald S. Bloom. Textbook of Neonatal Resuscitation.extbook of Neonatal Resuscitation. [Dallas, Tex.]: American Heart Association,[Dallas, Tex.]: American Heart Association,
2006.2006.
(4) Louis P Halamek. Simulation: The New(4) Louis P Halamek. Simulation: The New “Triple Threat”. Pediatric Research 67 (130-131)“Triple Threat”. Pediatric Research 67 (130-131)
(5) Musson, David M., and Robert L. Helmreich. "Team Training and Resource Management in Health Care: Current Issues and(5) Musson, David M., and Robert L. Helmreich. "Team Training and Resource Management in Health Care: Current Issues and
Future Directions."Future Directions."
(6) Musson and Helmriech: Team Training and Resource Management 5.1 (2004): 25-34. Print.(6) Musson and Helmriech: Team Training and Resource Management 5.1 (2004): 25-34. Print.
(7) Salas, E., and C. S. Burke. "Simulation for Training Is Effective When: Simulation Can Benefit the Medical Community by(7) Salas, E., and C. S. Burke. "Simulation for Training Is Effective When: Simulation Can Benefit the Medical Community by
Training Both Individuals and Teams to Reduce Human Error Ad Promote Patient Safety."Training Both Individuals and Teams to Reduce Human Error Ad Promote Patient Safety." Quality and Safety inQuality and Safety in
HealthHealth CareCare (2002)(2002)
Special Thanks to: Kimberly Yaeger, Dr. Lou Halamek, Barbara Beebe, Alba Rivera, Dr. Paul Brown, BeverlySpecial Thanks to: Kimberly Yaeger, Dr. Lou Halamek, Barbara Beebe, Alba Rivera, Dr. Paul Brown, Beverly
Chiang, Matthew Stephens, and Margaux SchwartzsteinChiang, Matthew Stephens, and Margaux Schwartzstein