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{
    "pk": 52125,
    "title": "Septic Abortion Complicated by Disseminated Intravascular Coagulation",
    "subtitle": null,
    "abstract": "Audience: \nThis scenario was developed to educate emergency medicine residents on the diagnosis and management of two concurrent conditions: septic abortion and disseminated intravascular coagulation (DIC).\n \n \n \nIntroduction:\n Patients with an abortion (spontaneous or induced) of less than twenty weeks gestation may present with concurrent uterine infection, also known as septic abortion. One of the complications of septic abortion is DIC. Early management of both underlying etiology (septic abortion) and subsequent complications (DIC) is crucial to minimize morbidity and mortality.\n \n \n \nEducational Objectives\n: At the conclusion of the simulation session, learners will be able to:\n \n1) Obtain a relevant focused history including pregnancy history, medication use, and past medical history. 2) Develop a differential for fever and vaginal bleeding in a pregnant patient. 3) Discuss management of septic abortion, including empiric broad-spectrum antibiotics and obstetric consultation for source control with dilation and curettage (D&C).  4) Discuss expected laboratory findings of disseminated intravascular coagulation (DIC). 5) Discuss management of DIC, including identification of underlying etiology and supportive resuscitation with blood products. 6) Review the components of blood products. 7) Identify appropriate disposition of the patient to the intensive care unit (ICU).\n \n \n \nEducational Methods:\n This session was conducted using high-fidelity simulation followed by a debriefing session and discussion about the diagnosis, differential, and management of both septic abortion and DIC. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. In this technique, the facilitator described something they observed in the case, outlined their reasoning as a facilitator why this observation was important or why they had questions, and then asked the learners to share their frame of reference at the time. An example: “I heard the team leader state that the platelets were normal, but then another resident disagreed.  No one paused to come to a consensus. I’m wondering why this wasn’t explored further in real time. Tell me more.” This scenario may also be run as an oral boards  case or adapted for other learners such as critical care fellows.\nResearch Methods: \nOur residents were provided a survey at the completion of the debriefing session so they could rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. The local institution’s simulation center’s electronic feedback form is based on the Center of Medical Simulation’s Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form,1 with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7.\n \n \n \nResults: \nThirteen learners completed a feedback form out of seventeen participants.  This session received all six and seven scores (consistently effective/very good and extremely effective/outstanding, respectively) other than two isolated 4 scores.\n \n \n \n \nDiscussion: \nThis is a cost-effective method for reviewing septic abortion and DIC. The case may be modified for appropriate audiences, such as simplifying the case to septic abortion without DIC. You can also consider not showing an initial temperature with the initial set of vitals unless it is specifically asked for by the participants. We encourage readers to utilize bleeding moulage techniques as a visual stimulus to increase psychological buy-in.\n \n \n \nTopics: \nMedical simulation, septic abortion, pregnancy complications,  hematology emergencies, obstetric emergencies, disseminated intravascular  coagulation,  emergency medicine.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [],
    "section": "Simulation",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3zb5x5dc",
    "frozenauthors": [
        {
            "first_name": "Lauren",
            "middle_name": "",
            "last_name": "Moore",
            "name_suffix": "",
            "institution": "The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, OH",
            "department": ""
        },
        {
            "first_name": "Jennifer",
            "middle_name": "",
            "last_name": "Yee,",
            "name_suffix": "",
            "institution": "The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, OH",
            "department": ""
        }
    ],
    "date_submitted": "2024-05-01T19:42:49+02:00",
    "date_accepted": "2024-05-01T19:42:49+02:00",
    "date_published": "2024-04-30T09:00:00+02:00",
    "render_galley": null,
    "galleys": [
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            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_jetem/article/52125/galley/39404/download/"
        }
    ]
}