Alterations in cardiac hemodynamics following endotoxin are not due to reduced myocardial contractility

• DOI: 10.1186/cc7062
• Publication Date: 2008-11-18T19:14:22Z
• Authors: Li Jianhui; Françios Feihl; Bernard Waeber; Lucas Liaudet
• Keywords: Contractility

BackgroundThe morbidity and mortality from severe sepsis depends largely on how quickly comprehensively evidencebased therapies are administered.As such, a huge opportunity exists.However, optimal care requires not only factual knowledge, but also numerous practical strategies including the ability to recognize disease, identify impending crises, communicate effectively, run team, work under stress simultaneously coordinate multiple tasks.Medical simulation offers way practice these essential crisis management skills, without any risk patients.Methods Following didactic lecture key components of Surviving Sepsis Campaign Guidelines, we trained 20 emergency medicine residents portable Laerdal Patient Simulator.Pre-programmed scenarios were developed following needs assessment modified Delphi technique.To maximize realism, this was performed in acute area Emergency Department included pre-briefed respiratory therapist nurse.We videotaped resident performance provided nonpunitive feedback, focusing comprehensiveness therapy (for example, whether broad-spectrum antibiotics given) resource help asked for tasks appropriately allocated).Results Evaluation using five-point Likert scale demonstrated that participants found very useful (4.5/5), lessons complementary supplementary those learned lectures (4.5/5) medical realistic (4/5).In addition, despite prior lectures, comparison pre-tests posttests showed more would: administer as soon possible hypotension (14/20 pre-test, compared with 16/20 posttest), low-dose corticosteroids refractory shock (10/20 13/20 post-test), would favour norepinephrine vasopressor (8/20 12/20 post-test).Participants specifically valued chance observe which they felt had been previously addressed (19/20).Conclusion Medical appears be an effective change both knowledge behaviours treatment sepsis.Many education licensing boards expect trainees become content experts, communicators, collaborators, managers advocates.These laudable goals difficult capture traditional comparably easy simulation.We hope others will consider teaching quality-assurance strategy fight against sepsis.