The PSL is an excellent environment in which to introduce non-medical and new paramedical personnel to simulated clinical situations. We have developed courses ranging in length from one to three days for the employees of several companies desiring an introduction to medical and physiologic concepts as well as specific equipment use and teamwork issues in medical care. Coursework can be tailored to a client’s specific learning needs. See the links to our program offerings and fee schedule.
Simulation Lab Orientation
A one-hour session is mandatory for students to get oriented to the simulation lab. First through a 20 minute videotape presentation, followed by 40 minutes of hands-on exploration of the simulation facility and its supplies. The students are introduced to the mannequin and are taught how to interact with the mannequin and drug injection system.
Anesthesia Machine and Gas Delivery Safety Systems.
A combination of lecturing and interaction with the VIRTUAL ANESTHESIA MACHINE (online), produced by the University of Florida for the Anesthesia Patient Safety Foundation. This program was edited by Dr. Olympio. This session looks at anesthesia machine design in detail and emphasizes the gas delivery safety systems that a conventional anesthesia machine incorporates. Particular emphasis is placed upon component interactions and systems which prevent harm to the patient. This presentation ranges from one to as long as three hours, depending upon the degree of hands-on evaluation of, and correlation with the anesthesia machine.
This one to two hour lecture and applications course features the essential patient monitors as described by the American Society of Anesthesiologists. It discusses the proper application of monitoring systems as well as the theory behind non-invasive blood pressure systems and pulse oximetry. Students also gain an appreciation for the recognition of abnormal vital signs. The course includes actual interactions with the mannequin and application/interpretation of monitoring. The students learn how to operate the monitors as well. A further look at alarms and warning systems helps the students to appreciate the extreme variability in normal patients.
Pulmonary Artery Catheter Monitoring (not interpretation)
This is a one-hour bedside course demonstrates and explains of the pulmonary artery catheter. The student will understand the various pressures within the heart and the means by which this catheter obtains these data. The principles of thermodilution cardiac output monitoring are explained with demonstrations. Students gain experience in placing the catheter and operating the monitor to collect these essential hemodynamic data.
Basic Anesthesia Setup
This one-hour course reviews the set-up of anesthesia supplies and equipment with emphasis upon disposable items. It includes the set-up of basic airway equipment, circuits, IV fluids, blood warmers, and pressure infusion devices. Emphasis is placed upon the dangers inherent in using these devices. Students are expected to replicate the set-up at the end of the session.
This two-hour course reviews the pharmacology and application of common anesthetic drugs and examines their respiratory and cardiovascular effects in particular. The students also gain an understanding of neuromuscular blockade, twitch monitoring, and the reversal of neuromuscular drugs. A further explanation of common emergency drugs is also given in the lecture. The second part of this course uses the simulator to examine and observe the effects of various drugs, and the students could be asked to guess the type of drug that is blindly given to the mannequin.
Basic Airway Management
This one-hour course examines the basic components of an airway and the airway examination, and emphasizes proper management of an airway under awake, sedated, apneic, and paralyzed conditions. The students are expected to ascertain their success in ventilating the mannequin using these basic airway adjuncts. Detection methods are described and demonstrated. Only the anesthesia circle system is used for ventilation in this course. Students must be able to recognize and correct inadequate ventilation.
Advanced Airway Management
This two to four hour bedside discussion, demonstration, and practice session emphasizes the subtleties of various airway devices and methods for accomplishing ventilation. Beginning with the self-inflating resuscitation bag, the students gain experience in using the equipment as well as understanding the potential difficulties and pitfalls of using such equipment. The level of complexity gradually increases as the students are shown more and more invasive methods of managing the airway.
Ventilation of the Lungs
Managing the airway and managing ventilation are distinctly different concepts. Ventilation of the lung is accomplished through spontaneous, manual, or controlled methods, and these are analyzed and contrasted at bedside. Students will appreciate the proper indication for each and the supplemental adjuncts that are used for each type of ventilation. The lecture portion of this course focuses on mechanical ventilation systems and compares and contrasts pressure-control ventilation with volume-control ventilation. Students also learn about capnography and carbon dioxide absorption in rebreathing systems. Hands-on experience is then obtained in ventilating patients with various conditions of the lung. This is a one to two hour session, depending upon intensity of the individual experience.
Anesthesia Breathing Systems
This two hour lecture and demonstration consists of a comparison of semi-open and semi-closed breathing systems. Specifically, it compares the Mapleson systems as they relate practically to breathing bags and transport systems, compared to anesthesia Mapleson D circuits. Students gain an appreciation for the complexity of these systems and the many shortcomings of these transport devices. We then take a look at the semi-closed systems comparing the circle system in a conventional anesthesia machine with the modern fresh gas decoupling systems of newer gas machines. Throughout this course the hazards of mechanical ventilation are emphasized. Actual demonstrations clarify the concepts in dramatic fashion.
Critical Equipment Failure
This is a 60 minute formal lecture given by Dr. Olympio on several occasions, but most prominently at the North Carolina Society of Anesthesiologists annual meeting. It is a vivid slide presentation of the most infamous of anesthesia equipment failures.
Modern Anesthesia Machines
This is another 60 minute formal lecture presented by Dr. Olympio to the New York Postgraduate Assembly of Anesthesiologists and is an in-depth look at the modern computerized anesthesia machines that are now flooding the U.S. market. These machines are radically different than the conventional machines of the past 30 years.
This one to three hour session begins with a videotape of Dr. Olympio conducting a routine general anesthetic induction within the Patient Simulation Laboratory. The points of the video are to emphasize to the student the complicated multi-tasking involved in any anesthetic induction and to demonstrate efficiency, coordination of movement, and situational awareness. The videotape is deceptively simple in appearance until the students are challenged to replicate those same procedures on the mannequin while giving their own anesthetic induction. The students are videotaped and observed by the remainder of the group for later debriefing and analysis. This session is classically one of the most amusing for beginners in anesthesia, and it truly gives the students a sense of hands-on empowerment. The session could last a minimum of one hour to as long as two to three hours, depending upon the level of mastery and involvement by all students.
Physiology of Respiration and Oxygenation
This is an old-fashioned chalkboard lecture presentation beginning with the very basics of respiration and oxygenation. A physician explains these concepts in very simplistic fashion to develop a solid foundation of understanding hypoxemia and the reasons for treating hypoxemia with various airway pressure strategies. This one hour lecture explores the causes of hypoxemia and relates arterial oxygen tensions to pulse oximetry. More advanced concepts of oxygen delivery and shunt are also presented in a very understandable manner.
Rapid Sequence Induction
This is the most common type of anesthetic induction for all emergency patients, and it differs dramatically from routine anesthetic inductions. Special supplies and techniques are utilized. The students are challenged in individual group session to explore the indications and techniques of rapid sequence induction and are then debriefed by the instructor with several slides prior to practicing the technique themselves in group format on the mannequin. The minimum time required for this session is one to two hours, depending upon level of participation of all students.
Beginning with a chalkboard lecture and explanation of the physiology of various types of hypotension, a physician analyzes both mechanical and physiologic causes of hypotension in particular, with emphasis on the cause of hypotension with specific treatments. Most importantly, follow-up clinical scenarios on the simulator emphasize the various treatment modalities and enable the students to practice their team interaction skills prior to a subsequent session on CRM training. The time requirement for this session is one to two hours.
Crew Resource Management (CRM)
Based upon the team interactions displayed during the hemodynamic scenarios, a physician explains the principles of crew resource management adopted from the aviation industry. Crew Resource Management are the principles behind which groups must work together to accomplish a successful outcome. The session involves a videotape debriefing and group discussion of their interactive skills.
Acute Coronary Syndromes, Part 1
Following a 30 minute ACLS introductory lecture, participants then examine the simulated patient, take vital signs, analyze laboratory data and EKGs, and determine the appropriate treatment strategies. Students are taught to recognize various rhythm abnormalities and cardiogenic shock. Use of the Baxter electronic infusion pump is taught. Concepts and treatment strategies excluding full arrest are taught. Time requirement for this session is one to two hours.
Emergence from Anesthesia
This 60 minute session begins with a group discussion regarding the process to end a general anesthetic. The students learn about the reversal of apnea, neuromuscular blockade, narcosis, and amnesia. They decide upon the proper sequencing of these treatments and predict potential complications during emergence from anesthesia and extubation of the trachea. Specific emphasis is placed upon weaning from the mechanical ventilator and weaning strategies that have been incorporated in technologic advances in ventilation. During the final portion of the hour the students actually work with the simulator to reverse a general anesthetic, proceed through extubation, and then diagnose and treat at least one complication of this process.
Complex Anesthesia Case Management
This is another 60 minute session that is analogous to an American Board of Anesthesiology oral board examination and applied to a practical simulation exercise. The students analyze a medically complicated patient presenting for acute cholecystectomy. With assistance, the students develop a list of conflicting medical problems which require ranking and prioritization. Students gain an understanding of the risk benefit ratios of various interventions, proper sequencing, and the need for concurrent treatment. Following development of this plan, the students move to the simulator to actually manage the presenting case.
Acute Coronary Syndromes, Part 2
After a 15 minute refresher on the ACLS algorithm for cardiac arrest, the students are presented with a patient sustaining a complete arrest. Their goal is to recognize the urgency of the situation, organize their approach to care, and begin treatment of the patient. They initiate monitoring, recognize respiratory and cardiac arrest, begin CPR, initiate ventilation with appropriate chest compressions, and learn specifically how to use the Zoll defibrillator. The instructor assists the students to accomplish the task successfully with encouragement and support, enabling the intubation and ventilation of the patient. Students will recognize the deterioration in cardiac rhythm from multi-focal PVCs to ventricular tachycardia to ventricular fibrillation and back to sinus rhythm with heart block. The onset of bradycardia is treated with appropriate pacing modalities using the Zoll pacemaker. Appropriate, official ACLS instruction aides are used.
Witness to a Simulated Crisis
Students have the opportunity to witness the conduct of a medical crisis, managed by our resident physicians. They are able to observe the process in the briefing/observation room with a live feedback and commentary by the instructor. These sessions typically last for 60 minutes or more and must be pre-scheduled. The students also witness the debriefing exercise following the simulated event.
Malignant hyperthermia is strictly a disease of “anesthesia.” It is still a life-threatening condition, and while once fatal is now treatable with appropriate recognition and management. This 90 minute session begins with the students reviewing a self-study video and slide presentation before encountering a patient under general anesthesia who begins to experience the signs of malignant hyperthermia. However, there is a mechanical abnormality with the gas machine that complicates the presenting signs of the malignant hyperthermia, which the students must detect. The problem is located within the breathing circuit. This sets the stage for differential diagnostic analysis of the patient’s presentation and lead to appropriate therapy and management. The simulated event is followed by a lecture on malignant hyperthermia and an explanation of the mechanical problem with the breathing circuit.
This 90 minute session includes two booklets of background information, the first of which is read ahead of time to prepare the students for placement of a chest tube and setup of the chest tube suction system. Students learn the physiology of pneumothorax, tension pneumothorax, and gain an understanding of the mechanical treatment of such by using the Pleurevac system. The simulated patient with the pneumothorax then proceeds to hemorrhage into the airway requiring lung isolation techniques using one or two particular brands of bronchial blockers for one-lung ventilation. The session is followed with further lecture and discussion to emphasize the learning points. The second booklet is for home reading and review.
Congestive Heart Failure
This is another formalized learning session requiring 60 to 90 minutes, with a preprinted pamphlet of information and sequential case development. Students are introduced to a patient in heart failure who has had a number of diagnostic studies and treatments, all of which have failed, leading to potential heart transplantation. However, the patient presents in the Emergency Room with acute dyspnea and requires placement of a pulmonary artery catheter for diagnostic interpretation of the condition as well as guided medical therapy. Students apply what they’ve learned earlier about the pulmonary artery catheter and diagnose the causes of hypotension. They then use the catheter to witness and to interpret the effects of various treatment modalities. A formal slide presentation is available for debriefing and explanation.
This is a potentially fatal problem caused by air, fat, or blood clots. It can occur under anesthesia or in a hospital bed in patients at risk. This 30 minute simulated case occurs in the operating room in a patient undergoing major spine surgery. The students are introduced to the case and witness the onset of a major venous air embolism requiring recognition, diagnosis, and appropriate treatment. With the patient initially prone, the management of this near fatal event is dramatically hindered, if not impossible. Therefore, a team approach to carefully turn the patient emphasizes team cooperation and communication as well as exquisite attention to detail as all of the wires and connections and monitors must be retained during the turn to the supine position. The patient requires CPR and defibrillation.
Back to Basics
This is a rather enjoyable and exciting 30 minute scenario which occurs during the management of a routine and healthy patient under general anesthesia. The students are not forewarned about the occurrence of a complete power failure during a major weather system moving through the vicinity. Suddenly the students are faced with a total blackout and must know how to monitor a patient using clinical examination skills. Students suddenly realize that high tech equipment is not necessarily essential in these crisis simulations. They gain further understanding of the safety backup systems for power and oxygen supply. The use of transport ventilation devices are emphasized as well as management of an airway problem in the dark.
Many non-anesthesia healthcare professionals are now being asked to administer non-anesthesia sedation to patients in x-ray or other procedure areas. These personnel have been given license to administer highly potent drugs which can cause respiratory depression, apnea, or changes in blood pressure. This one hour session begins with a discussion of the various sedatives and their effects. Students differentiate apnea from airway obstruction, and identify the causes of obstruction. Students compare the effectiveness of four different devices for ventilation and oxygenation.
Unfortunately, this is an extremely common occurrence in everyday operating room practice but, fortunately, is usually detected immediately. However, many patients have died from unrecognized esophageal intubation. This 30 minute session covers some interesting research that is now being published in the British Journal of Anesthesia conducted at Wake Forest. The course analyzes the treatments for esophageal intubation and proposes a new technique for more safely handling the occurrence. Following the introduction and explanation the students practice their management of otherwise unrecognized esophageal intubation. They will understand the risks involved and the means of preventing complications in these patients.
This 30 minute scenario portrays the insidious but frightening onset of severe anaphylaxis in an otherwise healthy patient who has been given an antibiotic. The presentation is complicated by a spinal anesthetic at the level of T-10. Students will recognize the severity of symptoms, convincing themselves that it is indeed anaphylaxis and then respond with the epinephrine treatment. The rapid effects and ill effects of epinephrine will be observed.
Acute Hemorrhagic Shock.
The successful management of trauma and acute hemorrhagic shock requires a great deal of knowledge and technical skill in treating the patient. Since hemorrhagic shock can affect other organ systems, the student will realize the profound influence of the condition and respond with aggressive fluid and blood administration. This requires the proper and safe setup of pressurized infusion devices and fluid warming systems, under stressful conditions, emphasizing how improper setup can result in a clandestine fatality. Total time required is 30 to 60 minutes, depending upon degree of CRM instruction.
Awake Nasal Intubation
Students are advised of the indications and contra-indications of awake nasal intubation in this 30 minute scenario. They are briefed on the supplies needed to accomplish this process and are then placed in the simulation lab to practice the technique in an otherwise awake patient. Potential complications are discussed, encountered, and treated.
General Anesthetic Comparisons
There are typically two types of "general" anesthesia. One is achieved through the use of volatile agents, while the other is "balanced" through the combination of intravenous agents, each one supplying a specific component of the anesthetic. Students discuss these differences in group session and identify various drugs for each type. Then, they use the simulator to compare and contrast the various anesthetics, recognizing the advantages and disadvantages of each. "Inhalation" inductions are also contrasted with "intravenous" inductions. Students will be quite surprised at the potential complications of each! The time requirement for this scenario is 90 minutes.
Automated External Defibrillators (AEDs)
These devices are now installed on airplanes, in airports, golf clubs, and many health clubs. Research shows that lay persons with NO experience whatsoever, have actually saved lives by using these devices. In this 60 minute scenario, students receive an introductory lecture with "official" AHA slides, and actually apply the device to the mannequin in various settings. They gain an appreciation for the (various) underlying medical problem(s), and learn to prioritize care of a patient who has fallen unconscious. Coordination of AED, Basic Life Support (BLS) and Advanced Life Support (ALS) are emphasized.
Other, Unlisted Topics
There are, of course, many other potential scenarios that can be taught. Merely suggest what you need, and these can be developed.