Clinical Simulation in Medicine Poonam Malhotra Kapoor, Navin C Nanda, Yatin Mehta, HK Chopra, KK Kapur
INDEX
Page numbers followed by f refer to figure and t refer to table.
A
Abdominal scanning probes 82, 370
Adult learning, circle of 327
Afibrinogenemia, case of 217f
Airway 282, 290f
anatomy of upper 13f
assessment 314
care 314, 315f
diagnosed difficult 300
difficult 297
evaluation, basic 298
intubator 304
management 292
simulation for 314
manual breathing unit 288
open 283
scenarios 366
simulation learning, upper 14f
upper 303
workshop, components of 317f
Alveolar concentration, minimum 359
Alveolar ventilation 357
American Board of Emergency Medicine 7
American Heart Association 67, 273, 278
American Society of Anesthesiologists 297, 314, 315
American Society of Echocardiography 86
Amyloidosis, case of 218f
Anaphylaxis 366
Anesthesia 211, 314
crisis resource management 238
depth of 240
low flow 356
simulation environment 238
Anesthetic concentration 360f
Anesthetizing airway 301, 302t
Aneurysm 180
Ankle jerk 349
Annular dilation 140
Anoxic brain injury 280
Anteflex 87, 89
Anticardiolipin antibodies 222
Antifibrinolytics, role of 212
Antiphospholipid antibodies 221, 222
syndrome 221
Aorta 96, 177
anatomy of 157f
arch of 34f
ascending 22f
descending 22f
evaluation of 156
pathology
ascending 93, 94, 98, 99, 180
descending 96, 97
Aortic aneurysms 161
Aortic annulus 180f
Aortic antegrade velocity 168
Aortic arch 156
Aortic dissection 131f, 161, 162
complications of 165
Aortic insufficiency 187f
severe 164f
Aortic lumen 131f
Aortic pathology, diagnosis of 131
Aortic position 176f
Aortic regurgitation 60, 62, 174, 179
severity of 63t, 168
Aortic root 61, 180f, 192
pathology 174
Aortic sclerosis 185
Aortic stenosis 60, 61, 64, 66, 171, 181, 186, 262
calcific 171, 182, 183, 185
etiology of 61
mild 172t
moderate 172t
planimetry 179
severe 172t
calcific 184f
severity, quantification of 62t
valvular 183f
Aortic valve 61f, 64, 9294, 99, 100, 108, 130, 130f, 167, 172, 173, 173f, 177, 182f, 183f, 186189f
anatomy of 167
apparatus 167, 178f
area 168
continuity equation 188
estimation 191f
calcification of 179f, 185f
complex 181
disease 180, 180f
doming of 189f
echocardiography of 183, 184t
endocarditis 175f
evaluation of 93, 167
implantation 63
infective endocarditis 186f
lumen, calcific 179f
mechanical 64, 65, 65f
normal 178f, 180f
outflow tract 180, 181
regurgitation, quantification of 176t
replacement, surgical 60
section of 173f
severity 171, 177
stenosis 61
systole of 179f
treat diseases of 177
vegetation 64
Aortic velocity, changes in 190f
Apoptosis 281
Artefact, extension of 165
Arterial blood 357
Arterial pressure, mean 240
Artery, large 177
Arytenoid cartilage 303
Asthma, severe 366
Atherosclerosis 180
of ascending aorta 156, 160
Athlete's heart 49t
Atlanto-occipital angle, measurement of 299, 299f
Atrial appendage 91
left 91, 99
thrombus, left 265
Atrial area, left 55
Atrial fibrillation 266
Atrial masses 9193, 101
left 95
right 95
Atrial myxoma 258f
left 257
Atrial pressure 251
assessment of left 40
estimation of right 252t
left 266
right 129t
Atrial septal defect 30
Atrial septum 35f
Atrium 91
dilated right 141f
left 57, 89, 91, 95, 128f
right 128f
Automated external defibrillator 282, 287
B
Bag volume 203
Bag-mask ventilation 284f
Basic life support 287, 290, 291f
Bernard-Soulier syndrome 221
Bernoulli equation 172
Bicuspid aortic valve 62, 171, 181, 184, 184f
Bicuspid value 62, 168
Bioprosthetic valve 176f
Biphasic defibrillators 284
Bleeding patient, management of 225
Blood 299
cells, packed rate 205, 248
component, type of 203
cylinder of 130
flow 151
simulation of 118, 118f
oxygen 291
pressure 289, 327
product 248
management of 196, 227
transfusion of 205
transfusion, whole 248
Blood-brain barrier, disruption of 281
Blue phantom simulator 83
advantages of 83
disadvantages of 83
Blue phantom simulation system 84
Body simulation, whole 366
Brachiocephalic artery 157
Bradycardia 292, 350
Brain
injury, irreversible 281
protection 273t
Breathing 282, 290f, 308
circuit 357, 360f
Bronchial
anatomy 307
sampling 310
wall 310
Bronchoalveolar lavage 310
Bronchoscope 301, 302f, 304f
Bronchoscopic competence 307
Bronchoscopic intubation 303, 304
Bronchoscopic simulation 306
Bronchoscopic skills 311
Bronchoscopy 30612, 322, 366
competence assessment 311t
simulation 310t, 311
training 309t, 311
Bronchospasm 303
Bundle branch block, left 147
C
Calcific degeneration 168
Capnography 300
qualitative role of 275f
Carcinoid syndrome 140
Cardiac arrest 273, 280, 293
treatment 294
Cardiac arrhythmias 310, 338
Cardiac critical care
medicine 365, 367
simulation for 251
Cardiac index 151
Cardiac life support, advanced 274f, 286, 287f, 314, 366
Cardiac output 149, 151, 152, 240, 276, 357
estimation of 129
Cardiac surgery 195, 198
Cardiac surgical patient bleeds 224f
Cardiac tamponade 254
Cardiogenic shock 366
Cardiopulmonary
arrest 287
bypass 224
anticoagulation for 198
resuscitation 272, 273, 274f, 282284, 286, 286f, 287, 287f, 292, 293, 295, 368
adult 282
basic 287, 289f
Cardiothoracic surgery scenarios 366
Cardiovascular intensive care unit 337
Cardiovascular life support, advanced 287, 291, 292
Central nervous system 202
Central venous
catheter insertion 366
oxygen saturation 292
pressure 276
Cerebral
blood flow 280
function, depressed 281
oximetry 273
oxygen delivery 273
performance category 281
thermopooling 281
Chest
compress 282
compression
before airway 286
before breath 286
types of 287
tube insertion 271
Child-Pugh score 204, 207, 209
Chordae tendineae 53
Chronic liver
disease 201, 207, 209
failure 204
Circulation simulator 340, 341f
Circumferential strain 44f, 47
Cleft lip repair 322
Clot rate 199
Clot retraction 176, 196, 197, 227
phase 197f, 227f
Clot viscoelastic test 213
Clotting time
activated 196, 199, 213, 224, 339
measurements, activated 226f
Coagulation abnormalities 281
Coagulation dysfunction, simulations for 201
Coagulation testing in perioperative period 225
Coagulation tests 213
Coaptation of aortic valve 185f
Cockpit resource management 328
Collapsed left lung 126f
Colloids 248
Color flow Doppler 141, 174
propagation velocity 39f
Commissural fusion 171, 171f
thickening 179f
Complete sonoclot signature 227f
Congenital
abnormalities 174
bicuspid valves 62
cardiac pathologies 36
Coronary arteries 69f, 71t, 178f
disease 68f, 72
right 53, 145
Coronary cusp-left coronary cusp, right 134
Coronary heart disease 67, 72
Coronary perfusion pressure 289
Coronary sinus 22f, 30, 91
Coronary syndrome, acute 277
Crawford classification 161, 161f
Cricoid pressure 304
Cricothyroidotomy 271
Crisis resource management 323, 326, 327, 368
Crisis simulation 350
Critical care units 126
Cryoprecipitate dose 204
Crystalloids 248
Cutaneous vasculitis, case of 220f
D
Deep transgastric long-axis 111f
Desflurane 356
Diastolic
coaptation defect 168
dysfunction 37
grading 50
function assessment 37
heart failure 37
pressure 289
Dilute Russell's viper venom time 222
Disc summation method 151
Disseminated intravascular coagulation 221
Distal lad tract 70
Dobutamine stress ECHO 190
Dopamine 240
Doppler assessment of aortic stenosis 186
Doppler echocardiography 136
Doppler spectral data 36
Drug delivery 292
Dyssynchronous left ventricular 45f
E
Ebstein's anomaly 140, 260, 260f, 261f
diagnosis of 260
Echocardiographic evaluation 38, 157
Echocardiographic sign 171
Echocardiography
for aortic valve 60
of mitral valve 53
usefulness of 125t
Echocom simulator 81
Ejection fraction, surrogates of 145
Emergency cardiovascular care 273
Emergency medical services 273, 293, 295
Emergency medicine 4
Emergency situation simulation 350
Emergency trauma training course 269
End diastolic area 148
Endobronchial ultrasound 313
Endocardial excursion 145
Endocarditis 129, 140
infective 64, 129, 177
Endocrine 298
Endoscopic ultrasound 312
Endotracheal intubation 315
Endotracheal tube 301, 302, 302f
tip 304f
Enflurane 356
Epiglottis 299, 303
Epistaxis 303
Esophageal
aortic arch, upper 109, 112f, 135, 135f, 158, 160
ascending aorta, upper 135
coronary, lower 101
Esophagus 88f
European Association of Echocardiography 85
Extracorporeal membrane oxygenation 322, 335, 367
mannequin's chest cavity 368f
simulation for 335
simulation systems 340
simulator 341, 341f
training 335
challenges of 336t
Eye balling 149
F
Facial trauma 299, 300
Fentanyl 276
Fiberoptic bronchoscope, size of 301t
Fiberoptic bronchoscopy of difficult airway 297
Fiberoptics 307
Fiberscope 302
Fibrin formation 196
Fibrin gel formation 196, 226
rate of 196
stage 226f
Fibrin interaction 197f
Fibrinogen 203, 204, 209, 212
converts into fibrin gel 196
levels 208
Fibrinolytic proteins 201
Fibrous annulus 178f
Fibtem 228
Fidelity bronchoscopy simulation, low 307
Fish mouth appearance 184
Flexible bronchoscope 306, 309
Flexible fiberoptic bronchoscope 303
complications of 303
Flexi-tip tubes 304
Fluid deficit replacement 248
Foreign body 298
Fresh frozen plasma 203, 208, 248
Functioning ultrasound system 84f
G
Gamma-aminobutyric acid 280
Garden hose 342f
Gargling lidocaine liquid 301
Gastrointestinal mentor 17f
Gentle puffs 284
Gerbode defect 252
Global cerebral ischemia 274
Global hemostasis test 213
Global pericardial effusion 131f
Glottic edema 300
Gorlin formula 173
H
Halothane 356
Head tilt lifting 283
Headache 348
Health
care simulation 6
record, electronic 13
Healthcare 6
decision makers 13
education 364
processes 15
simulation challenges 16
Healthy mitral valve 118, 118f
Heart
block 365
chambers of 31f
disease, ischemic 67
pumping chamber of 177
rate 276
various tomographic planes of 22f
Heartbeat 269, 291
Heartworks
advantages of 83
disadvantages of 83
simulation system 84
simulator 83
Hematoma 269
Hemodynamic
computer simulation of 241f
monitoring, simulation in 237, 367
parameter, teaching management of 240
Hemophilia A 218f
Hemostatic bleeders 227
Hepatic vein, transgastric modified 102, 103f
Hepatic venous flow 142
Hepatitis B reactivation 204
Hereditary disorders 315
High fidelity bronchoscopy simulation 308
Human patient simulator 17, 269, 270f
Hypercoagulation detection in liver disease 214f
Hyperfibrinolysis 197, 213
Hyperglycemia 275, 276
Hyperlipoproteinemia 182
Hypertension 244, 338
Hypertensive crisis 366
Hyperthermia 275, 277, 365
Hypertrophic cardiomyopathy 49t, 262, 265
Hypertrophic obstructive cardiomyopathy evaluation 93
Hypertrophy cardiomyopathy 263f
Hypervolemia 365
Hypocapnia 277
Hypoglycemia 277
Hypokalemia 275, 276
Hypomagnesemia 275
Hypotension 276, 277, 338, 365
Hypotension in critical care unit 127, 128t
Hypothermia 273, 274, 275, 295
suppresses inflammation 274
Hypovolemia 149f, 276
Hypoxia 277
I
Inflammatory disease 298
Instructor-driven simulators 243
Intensive care unit 124, 125t, 202, 245, 326, 365, 366
Interatrial septum 30, 90
International normalized ratio 212
International Pediatric Simulation Society 363
Interventricular septum 27
Intimal flap towards false lumen, systolic movement of 164f
Intra-aortic balloon pump 246
Intracardiac chamber masses 90
Intracranial hypertension 281
Intramural hematoma 165
Intraoperative echocardiography, role of 259
Intubation 322
causes of 298f
elective 300
Isoflurane 356
Isovolumic contraction time 153
J
Jaw thrusting 304
John Burns School of Medicine 343
K
Kidney injury, acute 367
Kissing papillaries 148, 149
Kolb's experiential learning cycle 327f
L
Laparoscopy 322
Laryngeal axes 315
Laryngeal mask 284f
airway 304
Laryngeal visualization 299
Laryngoscopy 297, 315
direct 297
Laryngospasm 303
Laryngotracheal airway 308
Laryngotracheobronchitis 300
Larynx injury 300
Larynx tumors 300
Leaflet
closure line 168
morphology 121f, 179
pathology 174
prolapse 180
stress distribution 121
thickening 174
Lidocaine spray 301
Liver
disease 201, 202t
chronic 210
plays 201
surgery 211
Lorazepam 276
Low molecular weight heparin monitoring 217f
Lungs 357
Lupus anticoagulant 221, 222
Lymph node stations 310
M
Macroglossia 299, 300
Macro-level simulation 12
Mallampati classification 299
classes of 299f
Manikin simulator package 115
Mannequin's chest cavity 339f
Mannequin-based computer simulators, advantages of 7
Mature clot process 214f
Medical record, electronic 13, 270, 270f
Medical simulation 4, 156
stages of 328
types of 237
Mentice aortic valve 63
Mercedes Benz sign 178f
Metabolic acidosis, severe 366
Micro-level simulation 12
Midazolam 276
Midesophageal aortic valve 71f, 93, 94, 181f, 182f
long axis 71, 79f, 93f, 94f, 157, 179, 180
short axis 71, 94f, 180
Midesophageal ascending aorta
long axis 97, 98f
short axis 98, 99f
Midesophageal descending 96, 158
Aorta
long-axis 96f
short-axis 97f
Midesophageal five chamber 168, 171
Midesophageal four chamber 79f, 89, 89f
Midesophageal right ventricular inflow outflow 100, 102f
Midesophageal short axis 183
Midesophageal two chamber 79f, 90, 90f
Mitral annular
dilatation 56f
motion 152
plane systolic excursion 152, 153f
velocity 154f
Mitral cusps 26
Mitral leaflet 53
Mitral pulmonic plane 22
Mitral regurgitation 54, 55, 80f
Mitral stenosis 54, 65f, 80f
Doppler 66
Mitral transannular velocity 153
Mitral valve 53, 57, 57f, 90, 91, 93, 99, 102, 104, 105, 114116, 117f, 118, 118f, 255f
anatomy 53, 54f
dynamics 119, 122
evaluation 90
leaflet
anterior 105
zona coapta of 54f
prolapse 55, 56, 258, 259f
Model-driven simulators 243, 243f
Modern medical simulation 7
Modern pediatric emergency trainees 321
Modified Simpson's biplane method 150, 151f
Modular simulation environment 344
Morbid obesity 300
Mortality rates 370
Mucocutaneous bleeds, diffuse 204f
Mucosal bleeds 203
Multifocal leukoencephalopathy 54
Multiplane angle range 9098, 179181
Multiplane probe angle 89
Muscle 356
relaxants 276
Myocardial contractility 365
Myocardial fiber arrangements 43f
Myocardial infarction 245, 256f
Myocardial ischemia 155
detection of 129
Myocardial performance index 153, 154f, 155f
Myocardial strain 45
N
Narcotics 276
Neck
cannula 339f, 368f
mobility 298, 299, 299f
Needle decompression 271
Neonatal resuscitation 284f
Program 284
learning 284
Nerve blocks 322
Neuronal death 281
Nitrogen 356
Nitrous oxide 356
Nonalcoholic steatohepatitis 202, 204
Nontechnical skills 328
Norepinephrine 245
Normal pulsed wave Doppler 140f
Normothermia 275, 280
O
Obstructive pulmonary disease, chronic 246
Occlusive portal vein thrombus 209f
Occult cardiac tamponade 254
Ochronosis 182
Oxygen
rich blood 282
via mouth-to-mouth resuscitation 288
P
Pain
medicine 348
simulation in 347
neuropathic 348
Pancreatitis 275
Papillary muscles 27f, 53, 117
Parallel three-dimensional models 4
Parasternal
long axis 22
short-axis 185
Partial pressure of end-tidal CO2 292
Patent foramen ovale 128, 257
Peak transvalvular velocity 186
Pediatric
acute care 323
airways 310
and neonatal intensive care 322
anesthesia and surgery 322
cardiopulmonary resuscitation 281
emergency medicine 321
intensive care unit 323
simulation 319
Percutaneous tracheostomy 271
Pericardial effusion 256, 256t
Pericardial tamponade, diagnosis of 131
Pericardiocentesis 271
Perioperative coagulation dysfunction, simulation for 195, 211
Peritoneal lavage, diagnostic 271
Persistent hypoxia
cause of 127
diagnosis of 127
Pharynx 300
Platelet 197f
count 202, 204, 209
function 197, 199, 212
rich plasma 213
Pneumothorax 350
Point-of-care testing 223
Positive pressure ventilation 295
Postcardiac arrest
brain injury 280
care 277
syndrome, management of 277t
therapy 295
Postcardiopulmonary bypass 195
Posterior descending coronary artery 70, 70f
Posterior mitral
leaflet, prolapse of 258f
valve leaflet 105
Postresuscitation care 277
Precocious defibrillation 287
Pressurization, simulation of 58
Propofol 276
Protease inhibitors 280
Prothrombin time 213, 214, 224
international normalized ratio 201
Proximal descending aorta 35f
Psychomotor skills 271
Pulmonary arterial hypertension 40, 251
Pulmonary artery 111
hypertension 251, 255f
transesophageal echo of 251
left 134
main 135
pressure 40, 252
right 33, 97, 98, 134
Pulmonary embolism
acute 132t
diagnosis of 132
dilation in 132f
Pulmonary hypertension 214, 252, 253
severity of 252
Pulmonary regurgitation 137
severity of 137t
Pulmonary stenosis 135
mild 136f
severity of 136t
Pulmonary valve 134136, 143
presence of 252
thickened 136f
Pulmonary vascular resistance 40, 254
Pulmonary vein
left upper 99, 266
right 95
Pulmonary venous
Doppler velocities 40f
flow 39
Pulmonic valve 99100, 111
Pulse oximetry 300
Pulsed wave 71, 136f
Doppler 142
across pulmonary valve 136f
Pulseless
electrical activity 292
rhythms 366
ventricular tachycardia 274, 293, 295
R
Radial strain 43, 44f, 47
Random donor platelet concentrate 204
Realistic simulation experience 285
Regional left ventricular function 145
Regional wall motion abnormalities 68, 145
Regular technical skills, development of 239
Regurgitation
fraction 176
volume 176
Renal replacement therapy 322
Rescue breaths 291, 291f
Respiratory
arrest 281
distress syndrome, acute 290, 367
therapists 335
Restrictive transmitral filling pattern 39f
Resuscitation training, simulation in 367
Retroflex 87, 89
Rheumatic
aortic stenosis 171, 185
disease 140
heart disease 54
stenosis 185f
Rheumatology 348
Rigid bronchoscopy 313
Ristocetin-induced platelet aggregation 221
Rotating tube 302f
Rotational thromboelastometry 223, 227, 229f, 230f
S
Septic shock 366
Shaken baby syndrome 221
Shock
stages of 247t
types of 246
Shockable rhythms ventricular fibrillation 295
Simman simulator 273f
Simpson's biplane method 150
Simpson's rule 151
Simulated transesophageal echocardiography 156, 167
Simulation 3, 11, 270, 326, 364
application of 239, 367
based advanced cardiac life support 286
based education, types of 322
based medical education 114
based TEE curriculum 166
based tools, types of 322t
computer-based 322, 366
in bronchoscopy 307
in medicine, role of 11
in paediatrics, role of 321, 368
in pain medicine 350
in transesophageal echocardiography 77
in trauma 269
learning, advantages of 5, 269
levels of 12
mannequin 4f
need of 355
of mitral valve repair 58
procedure 4
promotes training 11f
surgical 364
system, qualities of 340
techniques of 348
training 9, 337
significance of 9
types of 327
true benefit of 12
works for tee 115
Sinotubular junction 157, 174, 180
Sinuses of Valsalva 60, 168
Smarter simulation modes 12
Society of Cardiovascular Anesthesiologists 8, 86
Sodium nitroprusside 240
Sonoclot
analysis, steps to perform 227, 228f
parameters 209
signature, abnormal 203f, 204f, 207f, 209f
tracing 214f
Speakerphones 285
Spontaneous circulation, return of 273, 292
Stanford classification systems 162
Status epilepticus 366
Stenotic aortic valve 171f
Stridor 299
Stroke volume 129
calculation of 130
Strong platelet function 227
Subpulmonic valve 101
Subvalvular aortic stenosis 185
Sudden cardiac death 273
Supravalvular aortic stenosis 185
Supraventricular arrhythmias
stable 366
unstable 366
Symptomatic arrhythmias, management of 292
Systemic vascular resistance 276
Systolic anterior motion 262
Systolic function, left ventricular 145
Systolic mitral annular velocity 153
Systolic pressure 289
Systolic pulmonary artery pressure 252, 253f
underestimation of 253f
T
Tachycardia 303
Tachycardic rhythm 294
Target cut planes 115
Task oriented simulation 328f
Tear drop calcification 171
Temporomandibular joint ankylosis 300
Tetralogy of Fallot 230
Therapeutic bronchoscopy 301
Therapeutic hypothermia 273, 275, 276f, 277
complications of 276
machine, use of 274
phases of 281f
Thickend noncoronary cusp 188f
Thoracic aorta 157
descending 131
Thoracic aortic diseases 160
Thoracoabdominal
aneurysms 161f
aorta 32
dissections 162f
Three-dimensional
heart model 71f
speckle tracking echocardiography 46
Thrombasthenia 216f
Thrombin inhibitor
effects, direct 228
monitoring, case of direct 217f
Thrombin time 214, 221
Thrombocytopenia 201, 275
Thromboelastogram 223
Thromboelastography 223
Thromboplastin time 213, 214, 221, 224
Thrombus, movement of 128
Tissue Doppler imaging 40, 41, 41f, 42t, 153
Tissue mechanics, simulation of 58
Tracheal tube 304
Tranexamic acid 230
restriction of 197
Transbronchial needle aspiration 308, 310, 313
Transcatheter aortic valve
implantation 63, 64
replacement 60, 63, 64
Transesophageal echocardiographic
dataset 81f
examination 167
Transesophageal echocardiography 7, 50f, 69, 75, 77, 80, 80f, 81, 85f, 86, 114, 119, 124, 131, 134, 137, 138, 143, 145, 162, 177, 254, 257, 258f, 259, 369
probe manipulation, terminology of 89
simulator, arts of 78f, 369
training 144
simulation for 114, 134, 156, 177
traditional training of 144
simulation 7, 8, 78, 144
Transfuse platelets 207
Transfusing blood products 208
Transfusion 208
associated circulatory overload 224
Transgastral basal valve 80f
Transgastric
aortic valve 135
basal 105, 106f
hepatic vein 139
pulmonary valve 135f
right ventricle inflow 106, 109f, 110f, 139, 139f
tricuspid valve 138, 139
two-chamber view 102, 104f
Transmitral
diastolic inflow 38f
flow Doppler 51
velocities 38
Transthoracic echocardiography 19, 22f, 57, 67, 254, 259, 369
protocol 124
simulator 58, 68f, 81
training 72
utility of 57
Transthoracic imaging in intensive care unit 125t
Transversal strain 43, 44
Trauma 298
life support
advanced 269
course 269
sonography for 369
victims 322
Tricuspid
annular plane systolic excursion 251
disease, etiology of 140
leaflet, thickened 139
regurgitation 40, 140, 141, 252, 254
jet velocity 252
peak velocity 252f
severity of 143t
stenosis 142
valve 100, 101, 106, 137, 180f
evaluation 90
inflow 255f
Tube over scope, Hamper insertion of 303f
Tuberculosis 290
Tumors 298, 299
Two-dimensional
echocardiography 37, 136, 141
speckle tracking echocardiography 42
transthoracic echocardiography 37
Tympanic membrane 275
U
Ultrasonic bronchoscopy simulator 308f
Ultrasonography 350
Ultrasound simulator package 115
Ultrasound transducer's location 166
Umbilical line insertion 322
V
Valve
area by planimetry, calculation of 168
geometrical model 117
Valvotomy 259
Vasopressors 276
Vasospasm 280
Vena cava
orifice, inferior 95
pathology, superior 95, 99
superior 95, 98
Vena contracta 168
Ventilation ratio, compression to 287
Ventricle dimensions, left 148
Ventricle function 90
left 9193
Ventricle, right 101
Ventricular apex, left 46
Ventricular diastolic evaluation 93
Ventricular ejection fraction, left 37
Ventricular fibrillation 274, 284, 287, 293, 295
Ventricular outflow tract
left 92, 93, 108, 168, 185, 188, 191, 262
right 135
Ventricular systolic
function, left 127
pressure, right 142
Ventricular tachycardia 287, 295
Ventricular volumes, left 70
Vimedix simulator mannequin 83f
system 370
Vimedix
advantages of 81
disadvantages of 81
Virtual heart model 84
Virtual procedure stations 269, 270f
Virtual simulators 340
Viscoelastic tests 195
Vocal cord injury 303
von Willebrand disease 221
von Willebrand factor 201
W
Wave Doppler 142, 171
Wet drills 336
World Simulation Society 363
Worsening abdominal distension 202
Z
Zona coapta 53
×
Chapter Notes

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FM1Clinical Simulation in MedicineFM2
FM3Clinical Simulation in Medicine
For all Examinations in Cardiology, Critical Care, Anesthesia and Pulmonary Medicine
Editor-in-Chief Poonam Malhotra Kapoor MD DNB MNAMS FIACTA (Hony) FTEE (Hony) FISCU (Hony) Professor Department of Cardiac Anesthesia Cardiothoracic Center (CTC) All India Institute of Medical Sciences Ansari Nagar, New Delhi, India Chief-Editor Annals of Cardiac Anesthesia President Extracorporeal Membrane Oxygenation (ECMO) Society of India Secretary Society of Cardiac Anesthesia (SCA) New Delhi and NCR The Simulation Society Secretary and Chairperson Academics The Simulation Society (TSS) Section Editors Navin C Nanda Yatin Mehta HK Chopra KK Kapur Forewords MC Misra Balram Airan
Under the aegis of
THE SIMULATION SOCIETY
FM4
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Clinical Simulation in Medicine (For all Examinations in Cardiology, Critical Care, Anesthesia and Pulmonary Medicine)
First Edition: 2017
9789351525639
FM5Dedicated to
My father and family
Dr KK Malhotra
(4.7.1929—4.1.2011)
My father is a never-ending song in my heart—of comfort, happiness and well-being. I may sometimes forget the words but I always remember the tune.
My mentor, guide and inspiration in lifeAn extraordinary physician and human being with boundless affection, witty, hardworking and godly qualities who five years after he's gone, still inspires me to read and write. He is my bridge and a good luck charm.
—Poonam Malhotra Kapoor
FM7CONTRIBUTORS FM11FOREWORD
Medical simulation is a branch of simulation technology related to education and training in medical fields of various industries. It can involve simulated human patients, educational documents with detailed simulated animations, casualty assessment in homeland security and military situations, and emergency response. Its main purpose is to train medical professionals to reduce accidents during surgery, prescription, and general, clinical practice.
This book Clinical Simulation in Medicine edited by Dr Poonam Malhotra Kapoor and other stalwarts in academic teaching is a handbook for individuals working in or preparing to work in simulation and for academic and service organizations that are using simulation or are planning to use simulation. It provides the knowledge needed to become a simulation professional and generates information on how to best use that knowledge to effectively use simulation in their organizations for day-to-day procedures. Evidence-based and pragmatic, this book raises awareness of the knowledge and expertise required to utilize simulation strategies.
A true benefit of simulation can be harvested when the simulation models are fully integrated into the routine fabric of health care delivery and academics. Health professionals embarking on a career teaching simulation are embracing a world of innovation in which both teachers and students can develop their healthcare skills more rapidly and promote better patients’ outcomes. This is the first practice manual to assist healthcare simulation educators in India and internationally in preparing for certification in this rapidly emerging field.
Healthcare decision makers need reliable tools to support them in decision making for adapting policies to help cutting costs or reducing waiting time, and to provide visualization which allows them to rehearse innovative ideas before they are implemented. The tools should facilitate an evidence-based and informed decision-making environment. Simulation models, especially with transparency into their structure and underlying variables, which can be easily understood and trusted by decision makers, are a helpful tool in decision support, communication and discussion of ideas and policies, and analysis of scenarios.
The book is a guide and reference to the latest technology, operations and opportunities presented by clinical simulation in the field of bronchoscopy and the difficult airway, trauma and basic life support, echocardiography, hemodynamic monitoring and latest trends in monitoring the bleeding surgical patients in point-of-care testing. It shows how to develop and make efficient use of resources, and provides hands-on information to those tasked with setting up and delivering simulation facilities for medical, clinical and related purposes, and the development and delivery of simulation-based education programs.
All in all, the Clinical Simulation in Medicine is a very important entry into what I would consider the “examination preparation” category of cardiac critical skills for the fellows and students in the subject. The chapters are well illustrated, and most have an extensive number of topics that they may need to review in greater depth. With expert contributors and sound editing, the book would be a valuable addition to the library of anesthesiologists, surgeons, pulmonologists, pediatric intensivists, and cardiologists interested in a text covering the breadth of topics related to clinical medicine.
“The eyes do not see what the mind does not know” is very true about clinical medicine. As a result, a simple aortic stenosis may be missed. This first-of-its-kind book on the subject of clinical medicine has brought together different contributors from various branches of medicine. There is a great need for a book of this type and the author's present work goes a long way in fulfilling this need.
I wish the contributors, all success in their venture.
MC Misra
Director All India Institute of Medical Sciences
Ansari Nagar, New Delhi, India
FM13FOREWORD
The book promotes the value of simulation in healthcare and its associated outcomes while clarifying the operational requirements of successful simulations, featuring numerous contributions from international and national experts, consultants and specialists in clinical medicine in simulation.
The use of simulation to gain and maintain skills in healthcare has become critical to the delivery of the curricula in medical schools, nursing schools, residency programs, and hospital-based practice. Specialty boards, such as the American Board of Anesthesiology, now require simulation training as part of the maintenance of certification. This trend is fast catching up in medical simulation.
Medical simulation is a relatively new science that is achieving respectability among healthcare educators worldwide. Simulation and skills centers have become established to integrate simulation into mainstream education in all medical, nursing, and paramedical fields. Borrowing from the experience and methodologies of industries that are using simulation, medical educators are grappling with the problem of rapidly acquiring the skills and techniques required to implement simulation programs into established curricula. This book assists both novice and experienced workers in the field to learn from established practitioners in medical simulation. Simulation has been used to enhance the educational experience in a diverse range of fields; therefore, a wide variety of disciplines are represented.
The book begins with a section on the logistics of establishing a simulation and its role in the medical field and hospitals. Different sections deal with simulation in transthoracic and transesophageal echocardiography, hemodynamic monitoring, ECMO and many of miscellaneous diseases, such as advanced cardiovascular life support (ACLS), basic life support (BLS), and airway management that is required to equip a stand-alone or institution-based center. The features, strengths, and weaknesses of training devices are presented to help the readers find the appropriate simulator to fulfill their training requirements.
The book will continue to vibrate you from the beginning to the end and going through the book is a pleasure. The contributors of the book are unmatched in their pediatric perioperative TEE skills who have excelled in their fields.
I am sure the book will find a permanent place on the desk of all clinicians interested in simulation. I congratulate Dr Poonam Malhotra Kapoor and her team for this wonderful endeavor and wish the book and her great success.
Balram Airan
Professor and Head
Department of Cardiothoracic and Vascular Surgery (CTVS)
Dean, Academic, AIIMS
Chief, Cardiac Center
All India Institute of Medical Sciences (AIIMS)
Ansari Nagar, New Delhi, India
FM15PREFACE
Medical textbooks, continuing education programs and reference sources all provide the knowledge base needed for competent medical practice. This book presents the rest of what we need to know to be an outstanding clinician—that is practicing your clinical skills on simulators. Clinical Simulation in Medicine goes beyond basic routine teachings. It helps the clinicians improve patients’ outcomes with simulation-based learning to enhance practitioners’ skills, clinical competence and interdisciplinary collaboration. To advance the field of healthcare simulation, this book provides a platform for every clinician in improving and reforming education amongst the health professionals, in a more robust way!
Today, clinicians, hunting for the answers to questions can find more timely information online and they can find it faster than searching the index and then the numbered pages of a heavy book!! But, how do you practice your clinical skills? The physician participants in this book have discovered better and in some cases, incredibly effective ways to learn the clinical skills over the years by simulating them first, without weakening the conventional system and in most cases, learning and teaching it on the simulators to clear their concepts better! Research studies have proven their success!
The path to mastery and improved performance involves practice and experience. This is true if you are an athlete or a helicopter pilot, but not as a practicing clinician, on a live patient! For education and professional development in the medical field, simulation has provided practice and experiential learning opportunities for years. In my experience of teaching at AIIMS, simulation is the most essential to educate medical professionals.
Any individuals, societies or organizations discussed in this book are mentioned without malice. To the best of my knowledge, this book reports the truth, not with the intent to harm, but to inform to the best of my ability as a scholar who has devoted much time and is passionate about using simulation for academic teaching.
I am grateful to all my section editors, contributors and readers for their constant interest and expert help with this manuscript.
This book collaborates physicians from different fields, first time together with one aim—“Academic teaching and learning different clinical subjects with medical simulation”. Most of my thanks go to my teachers, students and family members—my first readers and key critics.
This is lucid text, explained simply by all of us in the words of Einstein, the Great—“If you cannot explain it simply enough, then you do not understand it well enough”.
Poonam Malhotra Kapoor
FM17ACKNOWLEDGMENTS
I am highly indebted to acknowledge the contributors of this book and deeply appreciate their cooperation. I am also grateful to my AIIMS colleagues for facilitating the preparation of this manuscript and using simulation ardently in teaching our students. My gratitude also goes to the assistance offered by Mr Sandeep Balyan, Mr Pradeep and Mr Sachin my efficient office staff. My son, Pranav Kapoor helped me with images in this book and I feel proud of his talent. My husband and son I remain most indebted to for bearing my long absence from home while I was preparing this first-of-its-kind book together in Clinical Simulation in Medicine. My parents and three lovely sisters are my constant source of inspiration. I thank them for their continuous support and patience. God bless each one of the above-mentioned supporters into formulating this book, especially the “students of cardiac critical care science”.
Writing and illustrating are part of a book, yet never the whole and my special thanks are due to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing), Mrs Samina Khan (Executive Assistant to Director Publishing), and whole production team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their cooperation in formulating this book.