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Effect of Didactic and Simulation Teaching on Healthcare Providers Knowledge of Chemical Terror Agent Exposure Management
338
The Journal of Emergency Medicine
peroxidation by both decreasing oxidative stress and NO overproduction in the lungs, which resulted in the attenuation of lung injury after intestinal I/R induced sepsis in rats.
Toxicology e EFFECT OF DIDACTIC AND SIMULATION TEACHING ON HEALTHCARE PROVIDERS KNOWLEDGE OF CHEMICAL TERROR AGENT EXPOSURE MANAGEMENT. D. Rodgers, D.N. Kyriacou, W.C. McGaghie, Northwestern University, Feinberg School of Medicine, Chicago, IL; V.J. Siddall, L.D. Wade, Northwestern Memorial Hospital, Chicago, IL. Objective: To assess the optimal combination of didactic teaching and high-fidelity biosimulator training for students attending a course on the medical management of chemical terror agent exposures. Methods: Students attending a simulation-based course on chemical exposure management were randomly assigned to a class. Their class either received a ten-minute didactic presentation of core material in addition to the simulator or completed only the simulator training. The subjects were blinded to their group assignment. Pre and posttests were developed and validated from the core content of these subject areas. The protocol was approved by the local IRB and written informed consent was obtained. Students completed a written pretest of objective knowledge then each group completed two separate simulations of a patient exposed to organophosphate and chlorine agents. After completing the training, students completed a posttest. Results: A total of 63 students completed the training. The scores for the students who completed the simulations (n⫽37) rose from 59.7% (s.d. ⫽19.3) on the pretest to 70.5% (s.d. ⫽ 14.9) on the posttest. Scores for students who received the didactic presentation in addition (n⫽26) rose from 59% (s.d. ⫽ 20.9) to 77.7% (s.d. ⫽ 7.9). These improvements were statistically significant for both the control (p⫽0.0002) and the treatment group (p⬍0.0001) by paired T testing. Comparing the groups by unpaired T testing demonstrated a statistically significant (p ⫽ 0.01) increase in posttest scores in those who received the didactic presentation. Conclusions: Simulation teaching was effective in improving performance of a varied group of healthcare professionals on management of chemical exposure casualties. The addition of a didactic intervention demonstrated added benefit as measured on posttesting.
Number of Students Simulator
37
Simulator plus Didactic
26
Prestest (percent correct)
Posttest (percent correct)
59.7 70.5 Pre vs post sd ⫽ 19.3 sd ⫽ 14.9 p ⫽ 0.0002 50.1 77.7 Pre vs post sd ⫽ 20.9 sd ⫽ 7.9
p⬍0.0001
Comparing posttest results between groups by unpaired T testing significant with p⫽0.01.
e EVALUATION OF CARDIAC OXIDATIVE STRESS PARAMETERS AND MORTALITY IN A RAT MODEL OF ORGANOPHOSPHATE POISONING. N. Gunay, A. Kose, University of Gaziantep, Faculty of Medicine, Emergency Medicine, Gaziantep, TURKEY; M. Tarakcioglu, University of Gaziantep, Faculty of Medicine, Biochemistry and Clinical Biochemistry, Gaziantep, TURKEY; N.E. Gunay, The Ibni Sina Medical Center, Department of Biochemistry and Clinical Biochemistry, Kayseri, TURKEY; A.T. Demiryurek, University of Gaziantep, Faculty of Medicine, Departments of Pharmacology, Gaziantep, TURKEY. Objective: The mortality from acute organophosphate (OP) poisoning is attributed to respiratory failure and cardiac damage, but the relative contributions of these effects are unclear. The aim of the present study is to investigate the cardiac oxidative stress parameters and mortality in dichlorvos-induced poisoning in rats. Material and Methods: Control group received corn oil, dichlorvos group received 30 mg/kg of dichlorvos, atropine group (A) received 10 mg/kg atropine prior to dichlorvos, pralidoxime group (PAM) received 40 mg/kg pralidoxime prior to dichlorvos, and APAM group received 10 mg/kg atropine and 40 mg/kg of pralidoxime prior to 30 mg/kg dichlorvos. Venous blood samples and cardiac tissue samples were obtained. Biochemical analysis were performed to measure serum levels of cholinesterase (ChE), and to determine the tissue malondialdehyde (MDA) and glutathione levels. Results were analyzed with appropriate statistical tests. Results: Although the serum ChE level in dichlorvos group was lover than that of the control group (p⬍0.05), atropine and PAM, or combination of these pretreatments did not modify serum ChE levels. Tissue MDA and glutathione levels were not significantly changed between the groups. Mortality observed in dichlorvos group was 47%, and this incidence was 0% for all the other groups (p⬍0.05). Conclusion: Serum ChE levels were decreased with dichlorvos and these reductions were inhibited with A, PAM or A-PAM pretreatments. There was no evidence for increased oxidative stress due to dichlorvos, since MDA and glutathione levels remained unchanged. Our results do not suggest that lipid peroxidation was increased with OP. However, our data suggest that A, PAM or A-PAM pretreatments markedly reduced the mortality. In conclusion, our results implied that oxidative stress does not play a marked role in dichlorvos-induced poisoning in rats. This study was supported by a TUBITAK project (SBAG-HD112, 106S007), Ankara, Turkey.
e THE EFFECT OF ETHYL PYRUVATE ON THE DAPSONE-INDUCED METHEMOGLOBINEMIA. Y. Jo, S. Jung, G. Suh, Y. Youn, Emergency Medicine, Seoul National University Hospital, Seoul, SOUTH KOREA; J. Lee, Dongguk University, Goyang, SOUTH KOREA. Purpose: This study was done to evaluate the effect of ethyl pyruvate (EP) on the methemoglobinemia induced by dapsone. Methods: Male Sprague-Dawley rats weighing 250-300g were divided into the six groups and each group contained eight rats. Rats were starved for 6 hours and
The Journal of Emergency Medicine
peroxidation by both decreasing oxidative stress and NO overproduction in the lungs, which resulted in the attenuation of lung injury after intestinal I/R induced sepsis in rats.
Toxicology e EFFECT OF DIDACTIC AND SIMULATION TEACHING ON HEALTHCARE PROVIDERS KNOWLEDGE OF CHEMICAL TERROR AGENT EXPOSURE MANAGEMENT. D. Rodgers, D.N. Kyriacou, W.C. McGaghie, Northwestern University, Feinberg School of Medicine, Chicago, IL; V.J. Siddall, L.D. Wade, Northwestern Memorial Hospital, Chicago, IL. Objective: To assess the optimal combination of didactic teaching and high-fidelity biosimulator training for students attending a course on the medical management of chemical terror agent exposures. Methods: Students attending a simulation-based course on chemical exposure management were randomly assigned to a class. Their class either received a ten-minute didactic presentation of core material in addition to the simulator or completed only the simulator training. The subjects were blinded to their group assignment. Pre and posttests were developed and validated from the core content of these subject areas. The protocol was approved by the local IRB and written informed consent was obtained. Students completed a written pretest of objective knowledge then each group completed two separate simulations of a patient exposed to organophosphate and chlorine agents. After completing the training, students completed a posttest. Results: A total of 63 students completed the training. The scores for the students who completed the simulations (n⫽37) rose from 59.7% (s.d. ⫽19.3) on the pretest to 70.5% (s.d. ⫽ 14.9) on the posttest. Scores for students who received the didactic presentation in addition (n⫽26) rose from 59% (s.d. ⫽ 20.9) to 77.7% (s.d. ⫽ 7.9). These improvements were statistically significant for both the control (p⫽0.0002) and the treatment group (p⬍0.0001) by paired T testing. Comparing the groups by unpaired T testing demonstrated a statistically significant (p ⫽ 0.01) increase in posttest scores in those who received the didactic presentation. Conclusions: Simulation teaching was effective in improving performance of a varied group of healthcare professionals on management of chemical exposure casualties. The addition of a didactic intervention demonstrated added benefit as measured on posttesting.
Number of Students Simulator
37
Simulator plus Didactic
26
Prestest (percent correct)
Posttest (percent correct)
59.7 70.5 Pre vs post sd ⫽ 19.3 sd ⫽ 14.9 p ⫽ 0.0002 50.1 77.7 Pre vs post sd ⫽ 20.9 sd ⫽ 7.9
p⬍0.0001
Comparing posttest results between groups by unpaired T testing significant with p⫽0.01.
e EVALUATION OF CARDIAC OXIDATIVE STRESS PARAMETERS AND MORTALITY IN A RAT MODEL OF ORGANOPHOSPHATE POISONING. N. Gunay, A. Kose, University of Gaziantep, Faculty of Medicine, Emergency Medicine, Gaziantep, TURKEY; M. Tarakcioglu, University of Gaziantep, Faculty of Medicine, Biochemistry and Clinical Biochemistry, Gaziantep, TURKEY; N.E. Gunay, The Ibni Sina Medical Center, Department of Biochemistry and Clinical Biochemistry, Kayseri, TURKEY; A.T. Demiryurek, University of Gaziantep, Faculty of Medicine, Departments of Pharmacology, Gaziantep, TURKEY. Objective: The mortality from acute organophosphate (OP) poisoning is attributed to respiratory failure and cardiac damage, but the relative contributions of these effects are unclear. The aim of the present study is to investigate the cardiac oxidative stress parameters and mortality in dichlorvos-induced poisoning in rats. Material and Methods: Control group received corn oil, dichlorvos group received 30 mg/kg of dichlorvos, atropine group (A) received 10 mg/kg atropine prior to dichlorvos, pralidoxime group (PAM) received 40 mg/kg pralidoxime prior to dichlorvos, and APAM group received 10 mg/kg atropine and 40 mg/kg of pralidoxime prior to 30 mg/kg dichlorvos. Venous blood samples and cardiac tissue samples were obtained. Biochemical analysis were performed to measure serum levels of cholinesterase (ChE), and to determine the tissue malondialdehyde (MDA) and glutathione levels. Results were analyzed with appropriate statistical tests. Results: Although the serum ChE level in dichlorvos group was lover than that of the control group (p⬍0.05), atropine and PAM, or combination of these pretreatments did not modify serum ChE levels. Tissue MDA and glutathione levels were not significantly changed between the groups. Mortality observed in dichlorvos group was 47%, and this incidence was 0% for all the other groups (p⬍0.05). Conclusion: Serum ChE levels were decreased with dichlorvos and these reductions were inhibited with A, PAM or A-PAM pretreatments. There was no evidence for increased oxidative stress due to dichlorvos, since MDA and glutathione levels remained unchanged. Our results do not suggest that lipid peroxidation was increased with OP. However, our data suggest that A, PAM or A-PAM pretreatments markedly reduced the mortality. In conclusion, our results implied that oxidative stress does not play a marked role in dichlorvos-induced poisoning in rats. This study was supported by a TUBITAK project (SBAG-HD112, 106S007), Ankara, Turkey.
e THE EFFECT OF ETHYL PYRUVATE ON THE DAPSONE-INDUCED METHEMOGLOBINEMIA. Y. Jo, S. Jung, G. Suh, Y. Youn, Emergency Medicine, Seoul National University Hospital, Seoul, SOUTH KOREA; J. Lee, Dongguk University, Goyang, SOUTH KOREA. Purpose: This study was done to evaluate the effect of ethyl pyruvate (EP) on the methemoglobinemia induced by dapsone. Methods: Male Sprague-Dawley rats weighing 250-300g were divided into the six groups and each group contained eight rats. Rats were starved for 6 hours and