Dr. Michael Brown ordered a third dose of adenosine to try to stabilize the heart rhythm of his 4-year old patient on a Wednesday morning in the Resuscitation Room at Pender Memorial Hospital. Still, Johnny cried and complained that he felt like he had been kicked in the chest.
Johnny’s dad suspected asthma, and Dr. Brown knew that Johnny had drank a little coffee with his breakfast milk earlier in the morning. But there was little explanation for the young boy’s racing heart.
Dr. Brown called for his team to shock the boy’s heart. Almost instantly, the monitor showed that Johnny’s heartbeat had calmed to a normal rhythm. He relaxed a little, and the emergency team at Pender Memorial also breathed easier.
Through a monitor set up at the foot of Johnny’s bed, Yale University professor Dr. Marc Auerbach then yelled “End simulation!”
Dr. Auerbach had provided the voice of Johnny and Johnny’s dad during the simulation, and he also had manipulated Johnny’s vital signs to indicate the effectiveness of the treatment supplied by the Pender team.
The manikin itself is a technologically advanced teaching tool, complete with simulated veins for IVs, a tongue that swells, and a realistic airway for intubation. After the morning session, little Johnny was delicately boxed up and shipped off to another team, who will undergo similar training.
The simulation was part of a year-long training program, where professors at esteemed medical schools work with rural critical access hospitals to train them for scenarios they don’t see on a regular basis. Critical access hospitals are granted certain opportunities because they provide care to rural communities without having the resources of large medical systems. The program is federally funded through Johns Hopkins. Back-to-back training sessions (one for night shift; one for day shift) will be held monthly at Pender through next May, providing more opportunities for the staff to receive hands-on training.
One challenge of emergency pediatric medicine is medication dosing, since pediatric patients sometimes require fragments of an adult dose. The Pender nursing team was prepared with the Broselow Emergency Tape, which provides a quick reference for commonly used emergency medications and eliminates the possibility of a mathematical error.
“The simulations provide our teams with exposure to high-risk, low-volume scenarios we need to practice on,” said Sharon Becker, Director of Nursing Operations at Pender Memorial. “Every simulation makes us more prepared for a real-life scenario so that we can provide the best possible care to our community.”
At Pender Memorial, nurses Sara McKenzie, Renee Brown and Marsha Saunders participated in the training, along with Emergency Department technician Whitney Eakins and respiratory therapist Daniel Davis. Together, they impressed Dr. Auerbach, who insisted that he would bring them a more difficult case the next time.
“The Pender team did an amazing job,” Dr. Auerbach said. “The medication dosing was appropriate, and the communication was outstanding.”
“Everyone knew their roles and snapped into action,” said Dr. Brown, who also provides emergency care at New Hanover Regional Medical Center. “I think they did a great job.”
Pender Memorial Hospital is a critical access hospital in Burgaw, NC. It is affiliated with New Hanover Regional Medical Center.