Evaluación sistemática de la actuación de los pediatras ante un caso simulado de taquicardia supraventricular
- Ignacio Oulego Erroz
- Antonio Rodríguez Núñez
- P. Alonso Quintela
- M. Mora Matilla
- Ana Iglesias Vázquez
- Manuel Fernández Sanmartín
- Eva Civantos Fuentes
- Luis Sánchez Santos
ISSN: 1695-4033, 1696-4608
Ano de publicación: 2012
Volume: 77
Número: 3
Páxinas: 165-170
Tipo: Artigo
Outras publicacións en: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría ( AEP )
Resumo
Introduction: The aims of this study are to: a) assess the quality in clinical management during a simulated scenario of acute supraventricular tachycardia (SVT) by means of a structured taskbased checklist and to b) detect pitfalls and grey areas where reinforcement in training may be needed. Material and methods: We systematically reviewed SVT simulated scenarios during simulation courses between June 2008 and April 2010. Three scenarios were programmed using SimBaby® simulation system, and included stable SVT (S-SVT), stable progressing to unstable SVT (SU-SVT) and unstable SVT (U-SVT). Scenarios were evaluated by means of an 18-task checklist based on ILCOR international recommendations. Results: A total of 45 scenarios were assessed with the participation of 167 paediatricians, including 15 S-SVT, 25 SU-SVT and 5 U-SVT scenarios. Out of a total of 551 possible tasks, 328 (59.5%) were completed correctly. The mean percentage of correct tasks per scenario was 63.4 (16.7) for S-SVT, 47.8 (20.3) for SU-ST and 38.6 (31) for U-SVT (p = 0.028). There were no signi?cant differences between primary care paediatricians and hospital paediatricians. Most of the participants correctly identi?ed non-sinus rhythm as SVT. However, important pitfalls were observed, including failure to identify haemodynamic instability in 20 out of 43 (48%) cases, an incorrect dose of adenosine in 18 out of 39 (48%), incorrect adenosine administration in 23 out of 39 (59%), and non-recognition of indication to emergent cardioversion in 15 out of 31 (48%). Conclusions: Paediatricians are able to diagnose SVT correctly, but need to improve their skills in treatment. Systematic analysis of clinical performance in a simulated scenario allows the identi?cation of strengths, as well as weak points, where reinforcement is needed.