Simulation of Urgent Airway Management in a Postthyroidectomy Hematoma.

Introduction: An expanding neck hematoma following thyroidectomy is a rare complication requiring urgent airway management and potential bedside evacuation before definitive surgical intervention. Due to its rare occurrence and life-threatening consequences, appropriate crisis resource management and a systematic approach are critical for patient safety. Methods: In this simulation scenario using a high-fidelity mannequin, a 68-year-old male presented with an expanding cervical hematoma 2 hours after a total thyroidectomy. The target audience was junior residents (PGY 1, PGY 2) in otolaryngology-head and neck surgery. Residents were given a case stem to encourage active information gathering through history and physical examination. Setup and flow of the scenario were designed for residents to prioritize establishing an airway through bedside decompression of the hematoma prior to making operating room arrangements for definitive management. Standardized patients playing a ward nurse and patient family member added complexity to the case. Results: Since 2012, the simulation has been used with a total of 96 residents as part of an annual boot camp. Surveys conducted after the boot camp verified the effectiveness of simulations in learning and, specifically, the usefulness of this scenario. Discussion: Simulation-based training is an effective learning modality for critical cases in health care disciplines involving emergency airway management. A well-developed simulation that closely resembles a real-life scenario is essential in creating a rich learning environment for trainees. Our scenario can be a valuable resource for other institutions implementing simulation-based training as part of their medical education.

Novel High-Fidelity Peritonsillar Abscess Simulator.

OBJECTIVE: To create and assess a novel high-fidelity peritonsillar abscess simulation task trainer with junior otolaryngology-head and neck surgery residents. STUDY DESIGN: Prospective cohort study. SETTING: Third annual Emergencies in Otolaryngology Head & Neck Surgery Bootcamp course at the Canadian Surgical Technologies & Advanced Robotics in London, Canada. SUBJECTS AND METHODS: Fresh cadaveric material was obtained consisting of a head and neck. Abscess pockets were simulated with a finger of a latex glove containing vanilla pudding to represent pus, tied off with a silk suture. These abscess pockets were inserted into the peritonsillar space from the transected neck inferiorly, passing medial to the great vessels into the parapharyngeal space. Faculty members evaluated the models to test content validity. The primary outcome measure was a postbootcamp survey evaluation assessing specific domains: learning objectives, effectiveness of faculty, and the quality and realism of models. RESULTS: When working with this model, learners were able to locate, visualize, and manipulate the abscess. The materials and positioning of the pockets created high-fidelity models that were realistic in appearance and haptics feedback. CONCLUSIONS: A novel high-fidelity task trainer has been successfully developed to teach the technique of peritonsillar abscess incision and drainage. This task trainer is currently the highest-fidelity model reported in the literature. This model allows learners to practice a high-stakes emergency skill in a controlled environment, affording the opportunity to practice localization, visualization, and drainage of the abscess with a high level of realism.