Septic Abortion Complicated by Disseminated Intravascular Coagulation.

Journal of education & teaching in emergency medicine Pub Date : 2024-04-30 eCollection Date: 2024-04-01 DOI:10.21980/J8GH1G
Lauren Moore, Jennifer Yee
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引用次数: 0

Abstract

Audience: This scenario was developed to educate emergency medicine residents on the diagnosis and management of two concurrent conditions: septic abortion and disseminated intravascular coagulation (DIC).

Introduction: Patients with an abortion (spontaneous or induced) of less than twenty weeks gestation may present with concurrent uterine infection, also known as septic abortion. One of the complications of septic abortion is DIC. Early management of both underlying etiology (septic abortion) and subsequent complications (DIC) is crucial to minimize morbidity and mortality.

Educational objectives: At the conclusion of the simulation session, learners will be able to: 1) Obtain a relevant focused history including pregnancy history, medication use, and past medical history. 2) Develop a differential for fever and vaginal bleeding in a pregnant patient. 3) Discuss management of septic abortion, including empiric broad-spectrum antibiotics and obstetric consultation for source control with dilation and curettage (D&C). 4) Discuss expected laboratory findings of disseminated intravascular coagulation (DIC). 5) Discuss management of DIC, including identification of underlying etiology and supportive resuscitation with blood products. 6) Review the components of blood products. 7) Identify appropriate disposition of the patient to the intensive care unit (ICU).

Educational methods: This session was conducted using high-fidelity simulation followed by a debriefing session and discussion about the diagnosis, differential, and management of both septic abortion and DIC. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. In this technique, the facilitator described something they observed in the case, outlined their reasoning as a facilitator why this observation was important or why they had questions, and then asked the learners to share their frame of reference at the time. An example: "I heard the team leader state that the platelets were normal, but then another resident disagreed. No one paused to come to a consensus. I'm wondering why this wasn't explored further in real time. Tell me more." This scenario may also be run as an oral boards case or adapted for other learners such as critical care fellows.

Research methods: Our residents were provided a survey at the completion of the debriefing session so they could rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. The local institution's simulation center's electronic feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form,1 with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7.

Results: Thirteen learners completed a feedback form out of seventeen participants. This session received all six and seven scores (consistently effective/very good and extremely effective/outstanding, respectively) other than two isolated 4 scores.

Discussion: This is a cost-effective method for reviewing septic abortion and DIC. The case may be modified for appropriate audiences, such as simplifying the case to septic abortion without DIC. You can also consider not showing an initial temperature with the initial set of vitals unless it is specifically asked for by the participants. We encourage readers to utilize bleeding moulage techniques as a visual stimulus to increase psychological buy-in.

Topics: Medical simulation, septic abortion, pregnancy complications, hematology emergencies, obstetric emergencies, disseminated intravascular coagulation, emergency medicine.

弥散性血管内凝血并发的化脓性流产。
受众:本情景模拟旨在向急诊科住院医师传授两种并发症的诊断和处理方法:脓毒性流产和弥散性血管内凝血(DIC):妊娠不足 20 周的人工流产(自然流产或人工流产)患者可能会并发子宫感染,也称为脓毒性流产。化脓性流产的并发症之一是 DIC。尽早处理潜在病因(脓毒性流产)和后续并发症(DIC)对于最大限度地降低发病率和死亡率至关重要:模拟课程结束后,学员将能够1) 获取相关的重点病史,包括妊娠史、用药史和既往病史。2) 对妊娠患者发热和阴道出血进行鉴别诊断。3) 讨论化脓性流产的处理方法,包括经验性广谱抗生素和产科会诊,以通过扩张和刮宫术(D&C)进行源头控制。4) 讨论弥散性血管内凝血(DIC)的预期实验室结果。5) 讨论 DIC 的处理,包括确定潜在病因和使用血制品进行支持性复苏。6) 回顾血液制品的成分。7) 确定将患者送入重症监护室(ICU)的适当处置方法:教育方法:本课程采用高仿真模拟,随后进行汇报,并讨论脓毒性流产和 DIC 的诊断、鉴别和处理。汇报方法可由参与者自行决定,但作者采用了宣传-探究技术。在这种技巧中,引导者描述他们在病例中观察到的一些情况,概述他们作为引导者的理由,为什么这种观察是重要的,或者为什么他们有疑问,然后要求学员分享他们当时的参照系。例如"我听到组长说血小板正常,但另一位住院医师不同意。没有人停下来达成共识。我想知道为什么当时没有进一步探讨这个问题。告诉我更多"。这个情景也可以作为口述板案例,或为其他学习者(如重症监护研究员)改编:研究方法:在汇报环节结束后,我们向住院医师提供了一份调查问卷,以便他们对模拟情景的不同方面进行评分,并提供定性反馈。当地医疗机构模拟中心的电子反馈表以医学模拟中心的医疗模拟汇报评估(DASH)学生版简表1 为基础,如果某项内容得分低于 6 分或 7 分,则加入必要的定性反馈:结果:17 名参与者中有 13 名学员填写了反馈表。除了两个个别的 4 分外,本节课获得了全部 6 分和 7 分(分别为一贯有效/非常好和非常有效/杰出):讨论:这是一种复习脓毒性流产和 DIC 的经济有效的方法。该病例可针对适当的受众进行修改,如简化为无 DIC 的化脓性流产。您还可以考虑在显示初始生命体征时不显示初始体温,除非参与者特别要求。我们鼓励读者利用出血模拟技术作为视觉刺激,以增加心理上的认同感:医学模拟、脓毒性流产、妊娠并发症、血液学急症、产科急症、弥散性血管内凝血、急诊医学。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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