Introduction: Sepsis and septic shock are common clinical entities seen throughout emergency departments within the US. However, disseminated intravascular coagulation (DIC) as manifest within sepsis is a rare clinical entity that learners rarely encounter in their career. This case is utilized primarily to introduce the learner (resident or medical student) to the many pitfalls and difficulties in the management of septic shock and DIC in the simulation bay. Methods: The case is a challenging one in which the learner is expected to go through a 30-45 minute scenario that deals simultaneously with both the management of sepsis, specifically early goal-directed therapy, as well as the development of DIC. After the completion of the case, there is a debriefing and a self-assessment at home tool. Results:
The case has been utilized both by fourth-year medical students, and 30 emergency medicine residents ranging in PGY year from 1-3. There have been little revisions necessary to implementation, based upon the usage of the curriculum. Discussion: The more junior the learner, the more important it is to slow down the information being delivered in the simulation encounter in order to focus on the salient clinical points. Senior learners tend to be able to quickly recognize and efficiently treat the shock state but tend to forget to broaden their differential beyond meningitis to consider DIC as being responsible for the patient’s underlying disease state.
- Recognize and manage septic shock.
- Understand the early goal directed therapy algorithm.
- Differentiate between idiopathic thrombocytopenia purpura (ITP), thrombotic thrombocytopenia purpura (TTP), and disseminated intravascular coagulation (DIC).
- Recognize the microbiological etiologies of sepsis with DIC.
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