Patient- and Family-Centered Care in the Preoperative Setting: Simulation Cases Featuring Standardized Patients for Anesthesia Residents.

INTRODUCTION: Evidence links patient-centered care to improvements in allocation of health care resources, patient satisfaction, chronic disease self-management, morbidity, and mortality. Support from families, too, can improve patients' health and well-being. However, patient- and family-centered care (PFCC) in the preoperative setting is challenging due to short-term relationships with patients, time constraints, and lack of training. METHODS: This module uses simulations with standardized patients. Groups of residents are divided into pairs, and each resident in a pair alternately participates in, or observes via live camera feed, a simulation case. The pair participates in both debriefing sessions. Two simulation cases are run. The first features a Jehovah's Witness who wants lifesaving blood but does not want her accompanying daughter to know. Despite excruciating pain, analgesia is being withheld because surgery consent has not been obtained. The second features a patient with HIV who does not want her accompanying pastor to know. The operating room nurse calls for a resident to bring her to surgery, but the patient wants to talk to her mother, who has yet to arrive. The purpose of the curriculum is for anesthesia residents to apply PFCC when having difficult preoperative conversations with patients and their families and obtaining anesthesia consent. RESULTS: Participants rated the training environment, faculty, debriefing, clinical application, and contribution of standardized patients highly. Participants' perceived self-efficacy for each core principle of PFCC improved postsimulation compared to presimulation. DISCUSSION: We believe this curriculum can contribute to improvement in PFCC and subsequent improvement in the quality and safety of health care.

Airway management of ruptured pulmonary artery "Rasmussen" aneurysm and massive hemoptysis.

BACKGROUND: Pulmonary tuberculosis is caused by Mycobacterium tuberculosis and its manifestations may include parenchymal, airway, vascular, pleural, mediastinal and chest wall lesions. Hemoptysis is a common complication of the disease. Massive hemoptysis occurs in about 8% of cases; with associated mortality ranging from 5 to 25% Massive hemoptysis secondary to pulmonary artery aneurysm rupture is a rare phenomenon presenting unique challenges in airway management and stabilization of oxygenation, ventilation and blood pressure. CASE HISTORY: We present a case of a patient with necrotizing pulmonary tuberculosis complicated by a ruptured pulmonary artery "Rasmussen" aneurysm requiring emergent intubation and embolization. CONCLUSION: Massive hemoptysis should be treated as a medical emergency requiring the coordinated care of multiple specialists including intensivists, interventional radiologists, anesthesiologists, and surgeons. Airway management and stabilization of cardiorespiratory status should be the highest priority, followed by timely diagnostic procedures to localize the site and cause of the bleeding.