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 minimally invasive transoral surgery bleeding model implemented in a nationwide otolaryngology emergencies bootcamp.

Post-operative hemorrhage is the most concerning complication after minimally invasive transoral surgery, as can result in airway compromise. Simulation-based medical education provides trainees with structured learning in an intensive and immersive environment allowing deliberate practice of skills and behaviors in the management of real-life situations. We implemented a novel post-oropharyngeal surgery bleeding model in a nationwide otolaryngology emergencies bootcamp, to teach and evaluate technical and non-technical skills required to competently manage this clinical scenario. 28 Otolaryngology residents from 11 programs in Canada participated in the annual Otolaryngology Emergencies Bootcamp of Western University in London, Ontario. After teaching technical aspects of emergency surgical airways in models, the course culminated with a complex scenario of a post-minimally invasive transoral surgery bleeding model using a fresh cadaver. The Non-Technical Skills for Surgeons (NOTSS) rating scale was applied to video analysis and a scenario-specific Medical Expert Checklist was implemented. The model design in a cadaveric torso is described for use in a simulation of a high-volume oropharyngeal bleed after a minimally invasive approach. Participants agreed that the model evoked an elevated degree of realism and conveyed the emotion of a life-threatening event. NOTSS analysis identified a marginal score in the domains of decision-making and communication and teamwork. Critical action checklist analysis highlighted the early mobilization of available resources and time to decision for surgical airway. We present the first report of a post-minimally invasive transoral surgery bleeding model. It was successful in recreating with high fidelity such a high-stake event and to teach technical and non-technical skills.