Anesthesia Management: Subdural Hemorrhage and Difficult Airway: A Flat-Screen Simulation and Interactive Debriefing

Publication ID Published Volume
7891 January 14, 2010 6


Anesthesiology residents, who have previously been taught to use a screen-based anesthesia simulator (Anesoft Anesthesia Simulator), are instructed to manage a simulated case of a patient with a subdural hemorrhage and a difficult airway. Learners work individually and anonymously. Once the simulation has been completed, the residents are debriefed. The debriefing consists of a PowerPoint presentation which includes a number of clinical management decisions. The learners are asked to respond to the management questions using an Audience Response System (Turning Point). The anonymous responses are shared with the group and then the instructor discusses the correct, and incorrect, answers.

The educational philosophy is based on experiential learning. First the learner is stressed to make management decisions in the simulation. Then the learner again has to make specific decisions, and the learner's response is compared to that of other members of the audience, and finally the learner gets the expert answer. Because the experience is anonymous, learner embarrassment is minimized. This format can be scaled up to any class size. This material is designed primarily for formative assessment but may be used for summative assessment as part of an OSCE.

This simulation has been used repeatedly for residents in the Department of Anesthesiology, Penn State Hershey Medical Center, with very good satisfaction scores (data available). No formal assessment of knowledge retention, or knowledge application, has been performed. This simulation was presented as a Simulation Workshop at the World Congress of Anesthesiologists, Cape Town, South Africa. March 2008. The significance of this submission is that it includes not only the simulation, but also a structured debriefing. Advantages of using a screen-based simulation over using a manikin simulation include: - The embarrassment factor for the learner is avoided. - The technique is equally effective for small and large class sizes. - The capital and maintenance costs of the simulation are low compared to manikin-based simulation. - Only one faculty is required to provide a simulation for the class. The authors hope that other teachers will be able to use this model of instruction effectively, and will prepare different debriefings to share.


Pott L, Budde A. Anesthesia management: subdural hemorrhage and difficult airway: a flat-screen simulation and interactive debriefing. MedEdPORTAL Publications. 2010;6:7891.

Educational Objectives

  1. To be able to demonstrate the ability to develop an adequate anesthetic management plan for a patient with a subdural hematoma.
  2. To demonstrate the ability to develop an adequate anesthetic management plan for a patient with a full stomach and a potentially difficult intubation.


  • Anesthesia Management, Airway Management, Difficult Intubation, Subdural Hematoma, Traumatic Brain Injuries

Prior Scholarly Dissemination

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ISSN 2374-8265