This resource is a simulation scenario intended for senior and junior anesthesiology residents. It can be used as an independent scenario for a simulation-based course, or as a component of a larger course. In this scenario, a 57-year-old male is in the recovery room following a total thyroidectomy. He is under general anesthesia and begins to complain of increasing neck pain and difficulty breathing. His respiratory status continues to deteriorate and he develops stridor. The learner must decide how to secure the airway and whether the incision should be opened at the bedside. Additional elements of the scenario include nursing confederates who flush the IV, which results in a bolus of remifentanil, and a surgeon who is hesitant to open the wound. The main objectives for the learner are to rapidly assess and identify an emergency airway compromise and then formulate and execute a corrective plan incorporating principles of team work and communication. The scenario was developed for anesthesiology residents as a supplement to their current traditional curriculum of clinical training and didactic teaching. The simulation environment offered the opportunity to reinforce what residents were experiencing in the operating room and discussing in their lectures. Depending on the needs of the learner and the goals for the curriculum, the debriefing session can focus purely on clinical objectives or non-technical skills such as calling for assistance, working as an interdisciplinary team, and improving communication.
- Distinguish etiologies for peri-operative respiratory insufficiency.
- Provide management of an emergent difficult airway outside the operating room.
- Discuss etiologies of airway compromise following thyroidectomy.
- Discuss the challenges of managing critical events in the post-anesthesia care unit.
- Determine cues for calling for assistance.
- Improve communication with recovery room nurses and surgical colleagues.
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