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At CAPE (Center for Advanced Pediatric and Perinatal At CAPE (Center for Advanced Pediatric and Perinatal Education), the primary goal is to teach physicians, nurses, and Education), the primary goal is to teach physicians, nurses, and residents how to most efficiently and effectively solve medical residents how to most efficiently and effectively solve medical crises involving neonates, infants, and children through crises involving neonates, infants, and children through mannequin-based simulation. During simulations, it has been mannequin-based simulation. During simulations, it has been observed that participants who are acting as primary observed that participants who are acting as primary responders within a crisis are often hesitant to call for backup responders within a crisis are often hesitant to call for backup assistance. Often times participants are overwhelmed and task assistance. Often times participants are overwhelmed and task saturated and need to mobilize additional resources to assist saturated and need to mobilize additional resources to assist with critical thinking and interventions. CAPE urges with critical thinking and interventions. CAPE urges participants to feel more comfortable calling for backup participants to feel more comfortable calling for backup assistance, arguing that more hands and more brains help to assistance, arguing that more hands and more brains help to improve the situation. We were curious to see if calling for improve the situation. We were curious to see if calling for help not only improves the situation, but resolves the crisis help not only improves the situation, but resolves the crisis faster.faster.

It is important to discover if the ability to stabilize a It is important to discover if the ability to stabilize a patient as quickly as possible is affected by how early the patient as quickly as possible is affected by how early the primary responder or responders call for help. By timing and primary responder or responders call for help. By timing and comparing numerous simulations, it is possible to decipher if comparing numerous simulations, it is possible to decipher if a correlation exists between calling for help and the end of the a correlation exists between calling for help and the end of the simulation (the simulation is completed once patient is simulation (the simulation is completed once patient is stabilized). We hypothesize that if the backup team is called stabilized). 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

MECONIUM MECONIUM ASPIRATIONASPIRATION

LATE LATE 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

CYSTIC CYSTIC HYGROMAHYGROMA

PLACENTALPLACENTAL ABRUPTIONABRUPTION

16 0;05 5:394 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

Placental Placental AbruptionAbruption

CysticCysticHygromaHygroma

LateLateDecelerationDeceleration

A common pattern arose. In most cases, the earlier the primary A common pattern arose. In most cases, the earlier the primary responder called for backup assistance, the earlier the crisis was responder called for backup assistance, the earlier the crisis was resolved. This occurred 100% of the time within the meconium resolved. This occurred 100% of the time within the meconium aspiration simulation, 100% of the time during the cystic hygroma aspiration 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 detectable During the placental abruption simulation there was no detectable correlation within results. This may be due to the varying amounts correlation within results. This may be due to the varying amounts of time it took for supplemental blood to arrive, which disrupted the of time it took for supplemental blood to arrive, which disrupted the experiment. Our hypothesis was ultimately supported when the experiment. Our hypothesis was ultimately supported when the results suggested that in most cases, it was beneficial to call for results 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. The meconium aspiration, cystic hygroma, placental abruption, and late deceleration. The timer was started once the primary responder entered the simulation room and ended timer 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 every when the patient was stabilized. The baby was born approximately 10 seconds into every simulation. The first category was meconium aspiration. Fetal distress during labor simulation. The first category was meconium aspiration. Fetal distress during labor causes intestinal contractions and relaxation of internal sphincters. This can cause causes 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 the risk 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 then airway. 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 neck The 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 was Participants were required to intubate the baby to insure that an effective airway was established, and insert an Umbilical Venous Catheter (UVC) in order to provide established, 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 placenta The 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 both from 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 supplemental the 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 provide blood 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 is The 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 in an indicator of fetal hypoxia. In this simulation, it was necessary to intubate the baby in order to provide supplemental oxygen, provide chest compressions, and administer order 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 EducationNeonatal Scenario Training: The Birth of a New Era of Education”” P 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 ThreatTriple Threat””. Pediatric Research 67 (130-131). 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 in Quality and Safety in Health Health CareCare (2002) (2002)

Special Thanks to: Kimberly Yaeger, Dr. Lou Halamek, Barbara Beebe, Alba Rivera, Dr. Paul Brown, Beverly Special 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

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