Sepsis in the Operating Room: A Simulation Case for Perioperative Providers

Abstract

Introduction: Sepsis should be included in the differential of any patient with unexplained organ dysfunction, whether or not an obvious infection is initially detected. Perioperative providers frequently care for patients with sepsis. This simulation case challenges participants to recognize and manage a presentation of postoperative sepsis, providing an opportunity to discuss the rationale behind sepsis management during debriefing. Methods: Assuming the role of an anesthesia provider, the participant takes over the care of a 62-year-old female who has just undergone cystoscopy and is extubated in the operating room (OR). The participant receives a brief handoff from the outgoing anesthesiologist while the patient awaits a postanesthesia care unit slot. The case has been uneventful, aside from intermittent hypotension responsive to IV fluids and boluses of phenylephrine. Within minutes of the handoff, the patient becomes somnolent and hypotensive. Efforts to treat hypotension eventually precipitate hypoxemia. Trainees must recognize and manage this cardiopulmonary decompensation. The scenario benefits from an OR simulation environment containing an anesthetic ventilator, anesthesia drugs and equipment, and a mannequin on an OR table. Results: Twelve residents completed the simulation scenario. Formal feedback was collected via email questionnaire from faculty instructors within 30 days of teaching each session. Discussion: Sepsis presents a diagnostic dilemma in part because no single diagnostic test rules the syndrome in or out. Multiple operational definitions of sepsis in the academic literature add to the confusion for clinicians. Our case simulation challenges perioperative providers to make a timely diagnosis and initiate appropriate treatment of sepsis.

Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents

“…Relatively few peer-reviewed learning activities are published in MedEdPORTAL regarding education on sepsis and septic shock. A search performed on July 16, 2019, showed 20 such publications, only one of which included the perioperative setting and anesthesia learners, 3 albeit differently. That publication focused on urosepsis with hemodynamic instability presenting at the conclusion of the case and emphasized education on crisis resource management, whereas our simulation focuses on cardiovascular decompensation due to an abdominal process with a much broader differential diagnosis and emphasizes education on the latest treatment guidelines for sepsis.…”

“…Only four out of 20 peer-reviewed educational activities regarding sepsis have been published since the revised definition and treatment were published in early 2016. [3][4][5][6] Therefore, this simulation scenario is both novel and timely, and it can be used to teach anesthesia residents and adapted for other anesthesia learners across the United States and the world.…”

Identifying and Managing Intraoperative Arrhythmia: A Multidisciplinary Operating Room Team Simulation Case

“…During a critical event, not only is it important to identify the correct underlying diagnosis, it is equally important to know the appropriate modalities of the defibrillator in order to manage the patient. Our simulation relates to other scenarios published in MedEdPORTAL such as “Use of Simulation to Improve Cardiopulmonary Resuscitation Performance and Code Team Communication for Pediatric Residents” 3 and “Sepsis in the Operation Room: A Simulation Case for Perioperative Providers.” 4 In our simulation, we further emphasized crisis resource management to promote interprofessional skills and provided thorough detail for practical implementation at other institutions.…”

Orientation to the Operating Room: An Introduction to the Surgery Clerkship for Third-Year Medical Students

“…The OR simulation curricular design is guided by Kolb's experiential learning cycle. 13 Kolb's theory states “Learning is the process whereby knowledge is created through the transformation of experience.” To adequately “transform” the OR experience, the simulation environment and staff are a necessity. The OR simulation is the “concrete experience,” which is the basis for “reflective observation.” The students are asked to immediately reflect on the OR experience following the simulation during the in-person debrief discussion.…”