A Simulated Case of Acute Salicylate Toxicity From an Intentional Overdose

Abstract

Introduction: Salicylate poisoning is a serious toxicologic problem with a complex pathophysiology that requires prompt diagnosis and action for a favorable outcome. A simulated experience in the evaluation and management of an aspirin-overdose patient allows learners to construct a differential diagnosis from an array of symptoms and signs, analyze a mixed acid-base disturbance, and explore the multistep management of this disorder. Methods: This simulation exercise was designed for second-year medical students. At the start of the session, teams received a 10-minute introduction to the activity. Upon entering a room in a simulated Emergency Department, teams had 15 minutes to complete a focused history and physical exam of the patient, interpret arterial blood gas and basic metabolic panel data, and administer treatment based on key findings and a presumptive diagnosis. The scenario was followed by a 90-minute facilitated debriefing session. An alternative 45-minute debriefing guideline is also included. Results: Students voluntarily completed a 13-question, 5-point Likert-scale survey about the educational exercise immediately following the session. They evaluated the preparatory materials and briefing, the simulation scenario, the usefulness of the debriefing, and their confidence in their understanding of salicylate poisoning following the session. Students reported a favorable response to the overall experience and the debriefing, as well as an increase in confidence following the session. Discussion: This simulation exercise was successful in exposing students to the clinical presentation of salicylate toxicity and giving them the opportunity to apply and synthesize basic science knowledge during the scenario.

The use and effectiveness of high-fidelity simulation in health professions education: current update

“…Students completed a 5-point Likert-type scale survey in both studies, which demonstrated high acceptability and engagement with the case simulations. 29,30 Since student satisfaction and exam performance are significantly and positively correlated with one another, 31–34 it is valid to consider student preference when choosing teaching methods. Several papers conducted quantitative studies to assess the impact of HFS on the application of theoretical knowledge in pharmacy students using the pre-simulation and post-simulation test intervention method.…”

Anual Evaluation of “Drug Poisonings, Emergency Service” Studies Published in Pubmed 01.01.2019-01.01.2020

“…Upon entering a room in a simulated ED, teams had 15 minutes to complete a focused history and physical exam of the patient, interpret arterial blood gas and basic metabolic panel data, and administer treatment based on key findings and a presumptive diagnosis. This simulation exercise was successful in exposing students to the clinical presentation of salicylate toxicity and giving them the opportunity to apply and synthesize basic science knowledge during the scenario (22).…”

The Treatment of Metabolic Acidosis: An Interactive Case-Based Learning Activity

“…Other learning resources related to metabolic acidosis exist; however, most of these resources are geared solely toward the identification and management of toxin ingestions. [1][2][3][4][5] Although these are clinically important medical emergencies, metabolic acidosis due to toxin ingestion remains a relatively rare clinical encounter. Metabolic acidoses due to renal failure, bicarbonate losses, or lactic acidosis are much more common conditions, and the appropriate medical management of each is relevant to any inpatient medical provider.…”

“…Some of the newer, more engaging resources are simulations of acute toxin ingestions, which require a high-fidelity patient simulator, medical equipment, and multiple faculty members. [1][2][3][4][5] Many of these simulation-based resources are focused on higher-level cognitive and procedural competencies surrounding the acute management of a patient in the emergency department. These simulations mostly target emergency department and pediatrics residents, as they are training to be team leaders in the acute care setting.…”