In 2008, the Clinical Skills Teaching Center of School of Medicine, Datong University, Shanxi Province introduced a highly simulated human simulation system for cardiopulmonary resuscitation skills training. We not only pay attention to the cultivation of students' operational ability, but also integrate the communication concept into the process of first aid teaching and training, pay attention to cultivating students' multi-directional communication ability, and enhance students' ability to cope with practical work, which has received good teaching results.
I. Objectives and methods
(1) object.
Four classes 128 five-year clinical medical students have all completed the theoretical course of emergency medicine. All the clinical teachers who participated in the teaching have more than 10 years of teaching experience and have experience in first aid in tertiary hospitals. The teaching hours of applying the high simulation cardiopulmonary resuscitation simulator system and the common simulator reach 100 hours or more.
(2) method.
1. Teaching and assessment methods.
The teaching time is 4 hours/class hour. Interactive high-simulation computer simulation system of cardiopulmonary resuscitation (model rescue angel 200) is produced by Tianjin Tian Yan Medical Science and Technology Development Co., Ltd. The teaching method adopts "brief theoretical review+teacher's demonstration operation+multimedia video+student's practical operation", and every two students are a first-aid unit. In the process of demonstration operation, the teacher emphasizes doctor-patient communication, doctor-patient communication and communication with superior doctors. The specific content, methods and skills of communication run through the teaching process, and students are tested in the operation process. Strengthen the training of communication skills by case introduction and role play, and summarize and communicate before class. During the examination, students are required to carry out cardiopulmonary resuscitation according to the simulated first-aid scene, and students are required to embody the communication concept and skills in the first-aid process, combined with the evaluation of the success of resuscitation and the quality of operation, which will be graded by the teacher.
2. Questionnaire survey.
After the course, an open questionnaire survey was conducted on the teaching effect of communication skills. The questions include "What is the significance of cultivating communication skills in CPR skill training" and "How to enhance communication skills in CPR simulator teaching". All the respondents were 128 medical students, and the questionnaire recovery rate was 100%. When filling in the questionnaire, teachers should avoid giving students any hints, and students should avoid mutual influence to ensure that students can make choices independently.
Second, bear fruit.
Through the teacher's explanation and demonstration of the importance of communication, students can actively implement the concept of communication in the process of cardiopulmonary resuscitation, especially role-playing stimulates students' enthusiasm for learning communication skills, exercises students' thinking and expression skills, and makes the classroom atmosphere active and interactive. The results of the questionnaire survey show that 89.8% of the students admitted that they didn't have a good understanding of communication before training. Through the communication concept instilled by teachers in training and simulation exercises, they realized that communication is also a basic skill of doctors. 95.3% of the students think that this training mode running through the communication concept is closer to the clinical practice and meets the training requirements of the new medical model for medical students, and 78. 1% of the students think that communication ability will be assessed.
Third, discuss
Communication is a process in which people transmit certain information from the sender to the receiver in some way or way in the process of communication, and gain understanding. This is a two-way interactive process. One of the minimum basic requirements of global medical education put forward by the International Medical Education Committee is communication ability. Cultivating medical students' communication skills is as important as cultivating their clinical skills, and it is a necessary factor to become qualified doctors in the future. In the first aid teaching of cardiopulmonary resuscitation, we should pay attention to cultivating students' communication ability, carry out the communication concept from beginning to end, and pay equal attention to skill operation, so as to correct the learning habit that most students only pay attention to operation skills and ignore communication ability in the future.
Medical study has made clear the new goal direction and strived to adapt to the new medical model.
Patients with cardiac arrest and respiratory arrest are the most critical in the emergency department, with dying lives and poor prognosis. Because the patient has lost consciousness, the two sides of doctor-patient communication are the doctor and the patient's family, and the patient's family often lacks mental preparation to deal with emergencies, and the contradiction between doctors and patients is particularly prominent. At this time, the medical staff should be active and decisive, race against time, quickly put into first aid work, immediately carry out cardiopulmonary resuscitation, and carry out various operations in an orderly and tense manner, so that the family members of patients can have trust and respect for the medical staff through body language, at the same time, quickly assess the condition, convey the information that the patient is in an endangered state to the family members in time with a serious expression and appropriate language, and clearly explain the change of the condition, the rescue measures being taken and the next treatment plan, so as to obtain their understanding and cooperation and fulfill informed consent.
In the teaching practice of the simulated human, we found that some students think that the simulated human is a fake training tool, and their training attitude is not serious, they operate at will, and even fight with each other, so they can't develop a rigorous work style. Therefore, in the teaching of cardiopulmonary resuscitation (CPR) simulator, teachers require medical students to regard the simulator as a person with complex social attributes, instead of treating CPR in isolation, but to organically link first aid courses with communication concepts and master communication skills. At the beginning of communication, we should think about five questions: what kind of social role we play, what is the purpose of communication and conversation, what is the occasion of communication, who is the object of communication, and how the other party may react. The key is to see clearly and adapt to the occasion and object. In the specific communication process, body posture, language, expression and eyes should consistently convey sincerity and care. Through communication, patients' families gradually accept the reality and make full psychological preparation; Care and help them with kind language and gentle attitude, and try to control their emotional impulses. Through case analysis and role-playing, medical students can understand and experience the psychological feelings and language expressions of different roles and communicate in simulated scenes. Medical students can personally interpret the different positions held by doctors and patients, learn to put themselves in their own shoes, and understand the medical and non-medical factors that may lead to conflicts and even disputes between doctors and patients. Whether the language, tone, way and method of communication are appropriate directly affects the success of communication. The application of role-playing method in the training of simulated human is helpful for medical students to overcome their nervousness, effectively exercise their language expression ability, cultivate their ability to deal with emergencies, and truly become participants and even organizers of CPR first aid. In this way, medical students can correctly and appropriately use the communication concepts and methods they have learned in the face of critical situations, improve the treatment effect and medical quality, reduce the contradiction between doctors and patients, and benefit for life in future clinical work.
In the clinical emergency work of cardiopulmonary resuscitation, the medical team needs to have rapid response ability, strict organizational hierarchy and strict and orderly rhythm. The rescue and treatment of some critically ill patients also need the coordination of many departments. Although the highly simulated human body can simulate the operation process and reflect the effect of first aid, it can not reflect the communication between doctors and nurses in first aid, and it still needs the guidance of teachers, and students need to master the communication skills with nurses, superior doctors and other relevant departments. First of all, medical students should have a humble attitude of respecting superior doctors, communicate with superior doctors at any time, and send relevant information of patients and their families in time, such as
Truthful reporting is helpful to the treatment of patients' illness, and at the same time, it is necessary to make clear the occasion of speech to avoid misunderstandings and disputes among patients' families. When it is necessary to communicate with the patient's family, you should ask for instructions before communicating, especially if the condition cannot be explained in time, you should ask for instructions from a superior doctor before communicating. Secondly, good communication with nurses can get the coordination and cooperation between doctors and nurses. Before communication, doctors and nurses should discuss with each other, and then explain to their families after a unified understanding, so as to avoid their own explanations of contradictions and make their families worry and distrust. Third, cultivate the communication ability between medical students and relevant departments. Patients with cardiopulmonary resuscitation may need personnel from relevant departments to perform operations such as tracheal intubation, tracheotomy and deep vein intubation. The tone of calling for advice, how to express it concisely and accurately, and how to get along with the consultant smoothly.
Teachers are needed to explain and guide the work.
Cultivating medical students' communication ability is an important content of emergency medicine teaching. Clinical teachers should constantly carry out teaching reform, so that students can fully realize the importance of communication in the teaching process, and constantly improve their communication skills in practice, so as to lay a good foundation for having comprehensive clinical first aid skills in the future.
DB-CPR290 advanced language prompt automatic computer cardiopulmonary resuscitation simulator.
High-simulation cardiopulmonary resuscitation simulator
Cardiopulmonary resuscitation, international term: cardiac resuscitation. Abbreviation: cardiopulmonary resuscitation. Cardiac arrest (such as heart disease, heart and lung infarction, electric shock, drowning, poisoning, mine disaster, aerial work, traffic accidents, travel accidents, natural disasters, accidents, etc.). ), and the first witness at the scene took emergency rescue measures such as calling for help and cardiopulmonary resuscitation. On-site cardiopulmonary resuscitation takes three steps: A, B, C and C: A- airway opening. B- artificial respiration. C- artificial circulation (chest compression), and D- automatic external defibrillation can be used if conditions permit. On-site rescue personnel must implement the standardized procedures of cardiopulmonary resuscitation (CPR)A, B, C and D in order to save the patient's life in the shortest time. Therefore, both medical workers and the general public need to learn CPR techniques. To learn this technology, it is necessary to establish teacher training and have corresponding supporting equipment. Shanghai Dingbang Company provides you with a training model for simulating human cardiopulmonary resuscitation.
Model: DB-CPR290
Product name: advanced language prompt automatic computer cardiopulmonary resuscitation simulator
Price: 8000 yuan
Implementation standard of cardiopulmonary resuscitation simulator:
American Heart Association (AHA)20 10 International Cardiopulmonary Resuscitation (CPR) and Cardiovascular Emergency (ECC) Guidelines
Performance characteristics:
This product is designed according to the requirements of international cardiopulmonary resuscitation standards, adopts a new computer automatic controller, is equipped with the latest man, and is packed in a luxury hard plastic box. It is the third generation computer-controlled CPR simulator in our company.
Main functions:
Simulated standard airway release
Hand-held chest compression
Operation mode: beginner's practice, single-person examination and double-person examination.
Display function: digital display of the correctness of students' operation, error counting and 120 second timing.
Automatic prompt of running program language and setting of running frequency.
Simulate the automatic pulsation of human carotid artery during operation or after successful operation.
After the inspection operation is successful, the pupil automatically shrinks from mydriasis to normal.
After the examination operation is successful, the heart will automatically restore the heartbeat sound.
Performance printing function: performance report printing.
Standard setting configuration:
Full-body manikin for advanced resuscitation;
Advanced computer monitor;
The human body pushes the hard plastic box with luxurious hands;
Restore the operating pad;
A box of barrier masks (50 pieces/box);
The five lung bags can be replaced;
Two rolls of thermal paper;
User manual.
Scope of application of cardiopulmonary resuscitation simulator:
Applicable to health schools, hospitals, China Red Cross, Ministry of Health, Ministry of Education, Ministry of Public Security, Ministry of Civil Affairs, Ministry of Land and Resources, Ministry of Construction, Ministry of Railways, Ministry of Communications, Civil Aviation Administration, State Administration of Work Safety, State Forestry Administration, National Tourism Administration, China Electric Power Enterprise Federation, China Business Federation and other departments that need on-site first aid and rescue training.
For example:
1. Training operation of first aid skills in health schools;
2. All kinds of hospital emergency operation skills training;
3. Popularize community first aid skills training;
4. First aid skills training for tourist accidents;
5. First aid skills training for accidental drowning in swimming;
6. Mine accident first aid skills training;
7. First aid skills training for factory accidents;
8. Traffic accident first aid skills training;
9. Emergency first aid skills training;
10. forest fire accident first aid skills training;
1 1. First-aid skills training for public security police such as public security patrol, community police, fire fighting and armed police, as well as military regions and troops (logistics and health);
12. First-aid skills training for land and resources departments, police officers, railway Red Cross, water and electricity, passenger transport and other departments;
13. First-aid skill training in flight attendant training center and ground training department;
14. First-aid skills training of national power system safety supervision departments (electric power bureau, electric power bureau, power supply bureau, power plant, power station) and assessment departments (stations) in electrician training;
15. First-aid skills training in electric power schools;
16. First aid skills training for safety supervision departments of commercial systems (department stores, hypermarkets, exhibitions, etc.). At all levels in China, it belongs to the China Business Federation;
Cardiopulmonary resuscitation instructions
A, cardiopulmonary resuscitation simulator installation process:
First, take out the simulated human from the suitcase, and the simulated human lies flat on the operating table. Then connect the computer monitor to the power cord, take out the external power cord from the suitcase and connect it to the human body. Then connect the computer monitor to the 220V power supply, and the connection process is completed.
Second, the function setting and usage before operation:
After completing the connection process, turn on the power switch on the back of the computer monitor. At this time, the display will send out a voice prompt: "Welcome to use our products, please select the working mode". This product has three working modes:
① Training: Users can perform artificial respiration and chest compressions at will, and be familiar with their techniques.
② Universality: The assessment mode set according to the latest standards, but the requirements for operating time are wider than those of the professional mode, which is suitable for non-professional ambulance personnel.
③ Professionalism: The assessment mode set according to the latest standards is suitable for professional ambulance personnel.
After selecting the working mode, there is a voice prompt: "Please select the working time". "Training" mode has no time limit, and users can operate according to their own situation. The start time of "Popularization" mode is 150 seconds, and users can also modify the assessment time. The starting time of "Professional" working mode is120s, and users can also modify the assessment time. Tip: According to the latest standards, the operation time of professionals is generally 120 seconds. After the time is set, the voice prompts: "Please press the start button". At this time, you can start running time by counting down.
Other key functions:
Reset key function: once the working mode is selected, it will run according to the program. If the operation is unsuccessful or needs to be re-operated for other reasons, please press the reset key to re-operate in the previously set mode. If it is necessary to change the working mode, please press and hold the reset key for more than 5 seconds and re-select the working mode.
Print key function: when the training or assessment operation time is over, you can print the long and short scores. Press, blow the correct number of errors, the required operation time and other functions to print, and evaluate and archive the test results. Before operation, check the print outlet to see if the printing paper is exposed to the print port. If not, press the print button to expose the printing paper to the print port, so that the results can be printed smoothly after the operation. When changing the printing paper, you can open the back cover, take out the printer and change the printing paper.
Three, in the process of operation, we must master the standard actions and matters needing attention:
1. Airway opening: The simulated person lies flat, and the operator holds the nose of the simulated person with one hand, and the other hand lifts his head from the back of his neck or chin and leans back 70-90 degrees, thus forming an airway opening for artificial respiration.
2. Prompt of artificial respiration function: When the tidal volume of the operator's blowing reaches 500-600 ml during mouth-to-mouth artificial respiration, the green light-emitting tube (correct area) of the human body blowing bar code light shows that the liquid crystal correctly counts as 1 time. When the tidal volume of the operator's blowing is less than 500 ml or more than 600 ml, the yellow LED (insufficient) or red LED (excessive) of the human body blowing bar code light shows that the liquid crystal count of blowing error is 1 time, and there are voice prompts such as "insufficient blowing" or "excessive blowing". It is necessary to correct mistakes before operation.
3, chest compression function tips: first find the correct position of the chest: the middle part of the sternum (where the xiphoid process of the chest is upward) is the correct compression area, and the hands are crossed and stacked together, and the arms are perpendicular to the chest compression area of the simulated person, so as to perform chest compression. If the pressing position is correct, the pressing pressure is correct (the correct pressing depth is 4-5cm), the human body presses the green LED (the correct area) of the bar code light to display, and presses LCD 1 time correctly. If the pressing position is wrong, there will be a voice prompt: "Wrong pressing position". If the pressing position is correct and the pressing intensity is wrong, the yellow LED (insufficient) or red LED (excessive) of the bar code light will be displayed, and a voice prompt will be given, such as "insufficient pressing" or "excessive pressing". Press the wrong liquid crystal 1 time. Please correct the error before operation.
Operation mode: (Special note: According to the latest revised international rescue standard, the standard steps of single-person cardiopulmonary resuscitation rescue are fully implemented, and the compression frequency is 100 times/minute. )
1, training: This operation is the basic essentials and steps for students to master the operation. After setting the function, students can perform artificial respiration or chest compressions. Correct operation and error have various functions, such as LCD display and voice prompt.
2. Popularization: assessment criteria set for non-professionals. After training and operation, students can take the exam on the basis of mastering first aid operation. Students must follow the standard examination procedure. First, simulate the airway opening, carry out mouth-to-mouth artificial respiration, and blow correctly twice. Then according to international standards, the ratio of compression to blowing is 30: 2, that is, 30 correct chest compressions (excluding the number of wrong compressions) and 2 correct artificial respiration (excluding the number of wrong compressions) are used for chest compressions and artificial respiration. It is required to complete five 30: 2 cycles in a row within the time set by the assessment. Finally, the correct number of presses is displayed as 150, and the correct number of blows is displayed as 12 (including the first two blows when the airway is open). You can successfully complete the evaluation. If the above operations cannot be completed within the set time, the first aid fails and needs to be re-examined. When the examination is successfully completed, there will be a voice prompt: "First aid is successful". With the music, the carotid artery continues to beat, and the pupil will automatically return to normal from the original mydriasis. At this point, the simulator has been saved, and you can press the print button to print the operation report for examination and archiving.
3. Specialty: the assessment standard set for professionals. After training and operation, students can take the exam on the basis of mastering first aid operation. Students must follow the standard examination procedure. First, simulate the airway opening, carry out mouth-to-mouth artificial respiration, and blow correctly twice. Then according to international standards, the ratio of compression to blowing is 30: 2, that is, 30 correct chest compressions (excluding the number of wrong compressions) and 2 correct artificial respiration (excluding the number of wrong compressions) are used for chest compressions and artificial respiration. It is required to complete five 30: 2 cycles in a row within the time set by the assessment. Finally, the correct number of presses is displayed as 150, and the correct number of blows is displayed as 12 (including the first two blows when the airway is open). You can successfully complete the evaluation. If the above operations cannot be completed within the set time, the first aid fails and needs to be re-examined. When the examination is successfully completed, there will be a voice prompt: "First aid is successful". With the music, the carotid artery continues to beat, and the pupil will automatically return to normal from the original mydriasis. At this point, the simulator has been saved, and you can press the print button to print the operation report for examination and archiving.
According to the assessment standard of single person assessment, the standardized steps of computer program operation are as follows:
Step 1 —— First, lay the simulated human body flat, with the head leaning back 70-90 degrees to form an airway to let it go, and manually blow correctly twice (correct blowing is shown as 2 on the display screen).
Step ② —— Then perform single person's correct chest compressions for 30 times (the display screen shows that the compressions are 30).
Step ③ —— One person performs correct manual blowing twice again (the correct blowing on the display shows 4, including the second blowing in step ①).
Step ④ —— Correct chest compressions for 30 consecutive times and correct artificial respiration for 2 times (30: 2), with a total of 5 cycles (including 1 cycle in steps ② and ③).
Step ⑤-Finally, the monitor shows that the correct pressing is 150 and the correct blowing is 12. That is, a single person successfully operates according to the program, and then the voice prompts: "Operation is successful", music is automatically played, the carotid artery continuously beats, the heart beats, the heartbeat sound is restored, and the pupil is automatically narrowed from the original mydriasis, indicating that the person is saved.
maintain
1. Simulate disinfection after human use. For example, face, nose and mouth, chest skin, breathing tube and air inlet valve can be scrubbed and disinfected with cleaning liquid.
2. If the airbag is broken and needs to be replaced again, you can open the chest skin, take out the nail cap connecting the cushion skin above the airbag with the sensor blowing pull rod, take off the cushion skin, unscrew the connecting nut of the airbag, replace the new airbag according to the sample, assemble it as it is, and restore it to its original state.
3. Place the simulated human and computer monitor in a ventilated and dry place, and never in a damp or exposed place, so as not to affect the service life.
Matters needing attention
One, mouth-to-mouth artificial respiration, must be padded with sterile gauze towel, one person, to prevent cross infection.
2. Hands should be kept clean during operation. Women should wipe lipstick and lipstick to prevent the skin of face and chest from getting dirty, and original ballpoint pens or other colored strokes are not allowed.
Third, when you press it, you must press it according to the working frequency rhythm, not for a while, so as to avoid the disorder of the program. If the program is out of order, please turn off the main power switch of the computer monitor immediately, and then turn it on again, so as not to affect the service life of the computer monitor.