Objectives: 

The use of realistic simulations is a powerful tool for medical students to learn and practice the pathophysiology of clinical situations. Based on Simman (Laerdal Inc.) we have built a scenario to simulate a septic shock. Students must be able to interpret and evaluate the different physiological variables that are critical for the intensive care and treatment of this severe situation. The activities developed in our simulated scenario provide a constant feedback to the student and allows a well establish problem based learning environment that can be repeated and corrected many times.

Materials: 

Program Human (T. Coleman, Univ. Mississippi, USA, available on the internet at Skidmore College; http://placid.skidmore.edu/human) to simulate different levels of shock. Clinical cases of typical septic shock conditions. For SimMan simulations, we used real ECG electrodes, blood pressure cuff, assorted material for IV, RCP protocol, defibrillator and manual ventilation.

Results: 

During the simulation, students were exposed to clinical situations of different severity, so we could assess and test their knowledge on cardiovascular, respiratory and metabolic physiology; their ability to identify the time course of physiological variables and the rationale from the physiological perspective to stablish an appropriate protocol for diagnostics and treatment. We focus our attention to correlate the cardiovascular conditions (blood pressure, heart rate, central venous pressure, blood O2 and CO2 contents, perfusion of different organs) with the severity of the shock. By using this approach we believe that students can recognize the point of no return, which is critical for the outcome of the patient.

Conclusions: 

The combination of a detailed knowledge of the time course of physiological variables in conjunction with a realistic manikin and clinical cases help the medical student to better understand and treat the critical situation of a septic shock.

First two authors contributed equally