Dr. Singer

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The following video depicts a simulated medical intensive care unit (MICU) room with a 61-year-old patient admitted for pneumonia, respiratory failure, and shock.

Resident physicians were asked to collect data in preparation for simulated bedside rounds. While they reviewed the available data, the team members responded to a high peak pressure alarm from the mechanical ventilator. The exercise was designed to teach basic principles in respiratory system mechanics, including use of an end-inspiratory hold maneuver as a diagnostic tool.

In the simulation, mucous plugging caused an increase in airways resistance; suctioning via an in-line catheter relieved the obstruction and decreased airway pressures to a normal range.

Our residents undergo simulation training in many topics including central venous catheter insertion, lumbar puncture, paracentesis, thoracentesis, IV line placement, and ACLS.

Stages of a simulation exercise:

1. Introduction: explaining the scenario
2. Purpose: prepare for rounds and manage changes
3. Investigation: residents examine available data
4. Complication: patient condition changes
5. Reaction: request a respiratory therapist consult
6. Identification: residents identify the issue and recommend further action or ask for guidance
7. Interpretation: teacher checks residents’ understanding of the situation
8. Debriefing: what did the residents think?