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ISSN 2683-2348 (Electronic)
Federación Latinoamericana de Simulación Clínica y Seguridad del Paciente

2019, Number 3

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Simulación Clínica 2019; 1 (3)

Scenario of refractory sepsis and adrenal insufficiency, to promote clinical reasoning in medicine students

Labarca-Solar C, Reyes-Morales S, Valenzuela-Bodenburg P, Tapia-Trucco I, Armijo-Rivera S

Language: Spanish
References: 14
Page: 149-153
PDF size: 218.99 Kb.


ABSTRACT

Introduction: The scenario of sepsis refractory to treatment, due to adrenal insufficiency, allows us to face a situation that presents a typical pattern and evolves unfavorably despite proper management. Methods: The scenario was designed by a rheumatologist and a simulation expert. The observation guideline is based on the criteria of management of community-acquired pneumonia and sepsis. Results: The scenario was used in 12 simulations (86 students). The initial diagnosis of sepsis by community-acquired pneumonia was established in 100% of the cases. Suspicion of an underlying condition that could explain the lack of response required the use of scenario lifesavers. Several of the students failed to administer corticosteroids. In the debriefing it was necessary to reinforce the learning using cognitive aids on SIRS criteria, qSOFA, SOFA and Surviving Sepsis Campaign. Conclusions: The simulation scenario of sepsis refractory to initial management requires a comprehensive look at the patient, with knowledge about the clinical approach to the compromise of conscience and initial management of septic shock. Additionally, it is possible to evaluate the initial clinical reasoning and the cognitive strategies used to broad the diagnostic spectrum when things do not happen as expected.


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