灾难的配方——碳酸氢钠过量。

Journal of education & teaching in emergency medicine Pub Date : 2025-07-31 eCollection Date: 2025-07-01 DOI:10.21980/J8MW85
Adeola A Kosoko, Amara Ogoke, Kyle Vogt
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引用次数: 0

摘要

受众:急诊医学住院医师研究生1-4年级。简介:碳酸氢钠是一种化合物,在许多家庭和许多产品中都很常见。它可以用于无数的日常用途,包括烹饪和清洁。医生经常开碳酸氢钠的处方,包括标签上的和标签外的,用于治疗各种疾病由于急诊医生和公众使用和暴露于碳酸氢钠的普遍方式,我们希望让学习者做好识别和适当管理碳酸氢钠毒性的准备。不仅要获得处方药物的详细病史,而且要获得大量摄入或输注的病史,这对诊断这种毒性至关重要。此外,对于可能出现严重代谢性碱中毒的患者,应考虑急性碳酸氢钠过量本病例概述了急性碳酸氢钠中毒患者的常见体征和症状,并回顾了碳酸氢钠中毒的处理。教学目标:在这个口头委员会会议结束时,学习者将能够:1)获得病史,包括患者使用的药物和其他补充剂,2)解释延长的QTc, 3)诊断由于碳酸氢钠毒性引起的代谢性碱中毒,以及4)通过液体和电解质复苏处理碳酸氢钠毒性。教学方法:本案例采用美国急诊医学委员会(ABEM)口头认证考试的典型形式呈现给学习者,这是一种急诊医学知识的标准化测试。这种教育形式允许在安全的学习环境中探索评估、检查和管理罕见的碳酸氢钠中毒病例。对于教师来说,这个案例可以作为对急诊医学住院医生在住院期间的批判性思维技能的评估。口头委员会测试是住院医师学习的关键部分,因为它促使住院医师在低风险的环境中应用他们的学习,无论是准备口头认证考试还是临床实践。研究方法:学习者完成口头陈述和汇报后,立即使用谷歌表格征求反馈,谷歌是一个免费开放的在线工具。使用李克特量表(Likert scale, 1-5)记录参与者对案例的教育价值的反馈,表格还要求对案例进行反馈,包括哪些是有益的,以及改进的建议。结果:共有26名住院医师参与了本次口头董事会案例,5名教师作为辅导员参与了该案例。所有参与的教师都给出了口头反馈。参与案例后,13名居民完成了反馈表格,在李克特量表(1-5,1 =非常不熟悉,5 =非常熟悉)上描述了关于诊断和管理碳酸氢钠毒性的4和5分。讨论:碳酸氢钠中毒是一个真正的医学紧急情况,在多个身体系统的交叉点,尤其是管理液体和电解质。尽管毒性的发生是罕见的,但它需要及时诊断和治疗。酸中毒在急诊医学中更为常见。这个案例允许常驻学习者探索一种罕见的酸碱不平衡。根据学习者在完成案例之前和之后对主题熟悉程度的报告,该口头板案例的教育内容是有效的。此外,许多住院医师报告说,这种教育技术是了解罕见患者表现、诊断和治疗的好方法。我们了解到,与专注于紧急核心内容诊断的病例相比,该病例被认为更困难。然而,尽管困难,学员们很欣赏将他们从核心内容中学到的技能和基本的急诊医学病人护理概念结合起来,通过这个案例来工作,他们认为这适用于他们未来的病人护理。主题:碳酸氢钠,小苏打,碱中毒,低钾血症,高钠血症,毒理学,延长QTc,口服板病例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

A Recipe for Disaster - Sodium Bicarbonate Overdose.

A Recipe for Disaster - Sodium Bicarbonate Overdose.

A Recipe for Disaster - Sodium Bicarbonate Overdose.

A Recipe for Disaster - Sodium Bicarbonate Overdose.

Audience: Emergency medicine residents post-graduate years 1-4.

Introduction: Sodium bicarbonate is a compound found commonplace in many households and in many products. It lends itself to countless everyday uses including cooking and cleaning. Physicians prescribe sodium bicarbonate regularly both on- and off-label regularly for various ailments.1 Due to the ubiquitous way both emergency physicians and the general public use and are exposed to sodium bicarbonate, we wanted to prepare learners to identify and appropriately manage sodium bicarbonate toxicity.Obtaining a thorough history not just of medications prescribed but of significant ingestions or infusions is critical in diagnosing this toxicity. Furthermore, acute sodium bicarbonate overdose should be considered in a patient who may present with severe metabolic alkalosis.1 This case outlines the common signs and symptoms of a patient with acute sodium bicarbonate toxicity and reviews the management of sodium bicarbonate toxicity.

Educational objectives: At the end of this oral board session, learners will be able to: 1) obtain a history which includes medications and other supplements used by the patient, 2) interpret a prolonged QTc, 3) diagnose metabolic alkalosis due to sodium bicarbonate toxicity, and 4) manage sodium bicarbonate toxicity with fluid and electrolyte resuscitation.

Educational methods: This case was presented to learners using the typical format for the American Board of Emergency Medicine (ABEM) oral certification examination, a standardized test of emergency medicine knowledge. This educational format allows exploration of the evaluation, workup, and management of the rare case of a patient with sodium bicarbonate toxicity in a safe learning environment.For faculty, this case can act as an assessment of an emergency medicine resident's critical thinking skills as they progress through residency. Oral board testing is a key part of resident learning because it prompts residents to apply their learning in a low-stakes environment, both in preparation for the oral certification examination and for clinical practice.

Research methods: Immediately after the learners completed the oral boards case and debriefing, feedback was solicited using Google forms, a free and open-access online tool. The participants' feedback was recorded regarding the educational value of the case, using a Likert scale (1-5), and the form also requested feedback about the case, including what was beneficial, and suggestions for improvement.

Results: Twenty-six residents in total participated in this oral boards case and five faculty participated as facilitators. All participating faculty gave verbal feedback. After participating in the case, thirteen residents who completed the feedback form described a score of 4 and 5 on the Likert scale (1-5, 1 = very unfamiliar, 5 = very familiar) regarding diagnosing and managing sodium bicarbonate toxicity.

Discussion: Sodium bicarbonate toxicity is a true medical emergency at the intersection of multiple bodily systems but particularly that of managing fluids and electrolytes. It requires timely diagnosis and management, albeit the occurrence of the toxicity is rare. Acidosis is a far more common occurrence in emergency medicine. This case allows resident learners to explore a rare acid/base imbalance. The educational content of this oral boards case was effective based on the reports of the learners' familiarity with the subject before and after working through the case. In addition, many residents reported that this educational technique was a good way to learn about a rare patient presentation, diagnosis, and management. We learned that this case was considered more difficult compared to cases focusing on emergency core content diagnoses. However, though it is difficult, the learners appreciated putting together skills they've learned from core content and basic emergency medicine patient care concepts to work through this case, which they considered applicable to their future patient care.

Topics: Sodium bicarbonate, baking soda, alkalosis, hypokalemia, hypernatremia, toxicology, prolonged QTc, oral board case.

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