Simulation of Urgent Airway Management in a Postthyroidectomy Hematoma

Kitty Wu, Stephanie Kim, Shihan J. Rajasingham, Ida Bruni, Kevin Fung, Kathryn E. Roth. MedEdPORTAL: The Journal of Teaching and Learning. Feb, 2019 doi:10.15766/mep_2374-8265.10802


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.

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