Urgent Syncope Evaluation for the Young Patient in the Emergency Department: A Emergency Medicine Resident Simulation Case (1090-004019) (Research Abstract Oral: Other)
Start time: Tuesday, January 26, 2021, 9:30 AM End time: Tuesday, January 26, 2021, 10:30 AM Session Type: Research Abstracts (Completed Studies)
A common complaint in the Emergency Department is syncope. While many of these patients are not found to have life threatening features, identification of those with concerning pathology is of utmost importance. This simulation case was designed to assess ability of emergency medicine residents interpret electrocardiograms (ECG) suggestive of life-threatening conditions. Objectives for case included: 1.Understanding and evaluation of young patients with arrhythmia that need urgent follow up. 2.ECG evaluation and interpretation in young patients with syncope and examine for concerning features. 3.Ensure resident is able to identify findings on the ECG concerning for actionable arrhythmias including hypertrophic cardiomyopathy (HOCM), arrhythmogenic right ventricular dysplasia (ARVD), Brugada, Wolf Parkinson White(WPW) and prolonged QT syndrome. 4.Understand and initiate emergent management for Ventricular Tachycardia 5.Correctly disposition patient with symptomatic serious arrhythmia
We performed a simulation case for our emergency medicine residents to evaluate their ability to recognize and treat concerning causes of syncope in young patients. Our case was a 20 year old presenting with syncope. The case progresses to symptomatic ventricular tachycardia requiring treatment with synchronized cardioversion. The ECG shows an epsilon wave suggestive of arrhythmogenic right ventricular dysplasia. During the debriefing of the case, we review characteristic ECG findings of other concerning causes of syncope in a young patient. Our critical actions include identification of abnormal ECG with an epsilon wave, timely treatment of symptomatic VT and appropriate disposition to CCU. We asked the participants to respond on a Likert Scale of 5 questions to assess their comfort with identification, and management of these types of patients after performing the simulation.
We received 19 responses from our cohort of residents 1.Does this case improve your understanding and evaluation of young patients for arrhythmia that needs urgent follow up? 17/19 selected Agree or Strongly Agree, 2. Evaluate and interpret an ECG in young patients with syncope and examine for concerning features. 16/19 selected Agree or Strongly Agree 3. Identify findings on the ECG concerning for actionable arrhythmias including Hypertrophic Cardiomyopathy (HCM), Arrhythmogenic Right Ventricular Dysplasia (ARVD), Brugada, electrolyte abnormalities and prolonged QT syndrome. 14/19 selected Agree or Strongly Agree 4. Understand and initiate emergent management for Ventricular Tachycardia. 16/19 selected Agree or Strongly Agree 5. Correctly disposition patients with symptomatic ARVD with arrhythmia. 15/19 selected Agree or Strongly Agree
The major learning objectives for this case showed that utilizing a simulation case which illustrates a rare but serious diagnosis for young patients with syncope can serve as a basis to review emergent findings on ECG and strengthen their knowledge obtained during training in an Emergency Medicine Residency. In addition, there are no currently published simulation cases that address the evaluation and diagnosis of ARVD in the Emergency Department setting. Our results were promising, with up to 84% of residents responding that this case strengthened their ability to interpret and identify ECGs with concerning features in patients with syncope.