The mental load of the laparoscopic surgeon might be highly optimized by continuous activity of the sympathetic nervous system. The question of what extent or quality of stress produces adverse effects remains unclear.
Simulation training plays an essential role in aviation and minimizes the risk for human errors. In the current study it is clearly shown that simulation training is also useful in gastrointestinal endoscopy. The newly developed workshop may thus be of crucial importance to improve personal crisis management. Simulation also leads to an improvement of endoscopic and emergency skills. Accordingly, simulation training should be recommended or offered as an education option in gastrointestinal endoscopy.
The virtual reality coronary angiography simulator "CATHI" (Catheter Instruction System, Mannheim, Germany) simulates coronary arteries with implemented vessel lesions in virtual patients. Like similar systems the software model runs on common PC systems, which are linked to the mechanical device for manual training. We combined the advantages of this skill trainer with the near to reality assembly of a cardiac catheterization laboratory (Cath-lab) by connecting it to a full scale simulator (HPS, METI, Sarasota, FL). We present two methods of synchronizing the heartbeat between both simulation devices. Method A-the hardware solution-uses the electrocardiogram-synchronization signal of the HPS as a pacemaker for CATHI's heartbeat. Method B, a more sophisticated software solution, uses a communication protocol between the HPS software and the CATHI system to realize bi-directional data exchange. In 14 identical courses we performed four different scenarios using the above described setup, all of which had to be undergone by the 143 participants (including nursing staff, experienced- and inexperienced cardiologists). The synchronization of the two systems contributed to a close to reality situation. Scenario control was accomplished via commercially available HPS-software. Tachycardic and bradycardic arrhythmias were predetermined by predefined scenarios of the HPS-software, the trainee's intervention resulting in realistic treatment outcomes. Using either method, the transmitted signals resulted in the same heartbeat in the CATHI-system, making the cardiologic interventions more difficult but more realistic.
Management of the trauma patient has a lot of different demands in the work of the anaesthesiologist. Guidelines for the treatment of brain injured patients (causing, e.g. elevated intracranial pressure), management of thorax trauma patients (adverse effect on ventilation or circulation) or treatment of those with abdominal trauma (severe blood loss and haemorrhagic shock) have to be known [1–4]. Routine anaesthesiological skills (intubation, setting up central venous or arterial lines) should be done qickly and in a safe way. It is extremely important that interaction with other disciplines (neurosurgery, radiology, chest and abdominal surgery) should be performed efficiently [5].
With one group of anaesthetists (residents and consultants) with different experience in emergency room management (all members of the Department of Anesthesiology, University School of Medicine, Mainz, Germany) we trained theoretically and practically on a full‐scale simulator in a realistic environment setting a guideline‐oriented trauma‐patient treatment. After a determined time, we compared any improvement of theoretical and practical skills in emergency room management with another group, which only had theoretical lessons in emergency room management.
The aim of this study was to show that theoretical and practical training of anaesthesiologists (with different experiences and educational background) on a full‐scale simulator in a realistic environment setting improves knowledge of head, chest and abdominal trauma management and it can help to make therapeutic decisions faster and safer than theoretical training alone.
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