13 August 2021: Original Paper
Cultivating Empathy and Soft Skills Among Intensive Care Residents: Effects of a Mandatory, Simulation-Based, Experiential Training
Giulia Lamiani 1ACDEFG* , Giovanni Mistraletti 23ABCD , Carlotta Moreschi 1CEF , Elisa Andrighi 4ABF , Elena Vegni 14ADEFDOI: 10.12659/AOT.931147
Ann Transplant 2021; 26:e931147
Table 2 Case scenario portrayed during PERCS-ICU course.
| is a 43-year-old artisan ice cream maker, married to , and with two daughters, aged 13 and 10. He started suffering slight and occasional headaches when he was 16, after a bad fall on his bike. A few days ago, he started complaining of a stronger headache. Last Tuesday, while he was in the back of his shop, he began to have a severe headache and suddenly started to vomit. His wife found him in the bathroom, sitting on the floor: he could not speak properly or move his right hand. In the sink, there were signs of vomiting and he could not explain what was happening. His wife called the medical emergency service right away.Once he arrived at the Hospital Emergency Room, was sedated and intubated. He was transported to the radiology department to perform a series of tests. The head CT scan with contrast medium showed dramatic bleeding, without any indication for neurosurgery. was then admitted to the intensive care unit to stabilize his respiratory and cardiovascular condition, which was also severely impaired ’s neurological clinical condition was extremely severe: GCS=3, absence of all brain stem reflexes, except for the carenal reflex, preservation of spontaneous respiratory drive.The intensivist physician meets ’s wife to present her with the dramatic clinical conditions (massive subarachnoid hemorrhage) and the prognosis (severe or very severe neurological disability, if he survives to the acute phase, and probable death).In the subsequent days, the neurological condition evolves: the epileptic crises worsen and require use of high-dose sedatives (midazolam, propofol), in addition to antiepileptic drugs. Signs of cardiovascular dysautonomia (arterial hypertension, sinus bradycardia) appear. After 4 days of hospitalization, the two intensivist physicians on duty meet the patient’s wife, , together with the patient’s brother, , during the scheduled family meeting. They must present the decision-making process that led them to decide NOT to perform the tracheostomy, as the most clinically proportionate treatment for the patient. No recovery is now possible and the patient will likely die within the next hours/days.The following day, a sudden neurological deterioration occurs: in the early hours of the night, loses his spontaneous respiratory drive. Various cardiovascular and hormonal signs of neurological dysautonomia gradually appear. The doctor on duty immediately suspends all sedatives in progress and thus the next morning the patient’s status is absence of all brain functions. An EEG is performed and the brain criteria for death are clinically verified.The Medical Direction is then activated, to set up the Commission to assess death by brain criteria. At the same time, someone calls the patient’s wife, asking her to come to the hospital because her husband is worsening.Upon arrival of the family members, about an hour after the neurological observation began (in Italy, the law requires two subsequent and full evaluations, six hours apart) ’s death is notified to his wife and brother. Two hours from the beginning of the observation, the two intensivist physicians on duty meet the family members to explore their wishes regarding organ and tissue donation. |