A Low Cost Escharotomy Simulation Model for Residency Education

ABSTRACT:Audience: This escharotomy model is designed to instruct emergency medicine residents, medical students, and community physicians.Introduction: Burns account for over 40,000 hospitalizations and 3,400 deaths in the United States each year.1 Circumferential burns commonly lead to constrictive eschar formation, which may cause underlying tissue ischemia and necrosis.2 Escharotomies are a life or limb saving procedure, and therefore proper technique is essential to the training of emergency medicine residents. However, they are an infrequently encountered procedure and consequently are often performed with inadequate tissue decompression as well as incidental damage to the surrounding nerves and vessels.3 Simulation has been demonstrated to be an effective tool in successfully improving resident procedural skills.4Objectives: By the end of this educational session, the learner will be able to: 1) Understand the indications for an escharotomy. 2) List equipment needed to perform an escharotomy. 3) Demonstrate how to perform an escharotomy. 4) Perform an escharotomy and experience the sensation of cutting through simulated burned tissue. 5) Understand post-escharotomy management and referral to specialist.Methods: Attempts have been made previously to build low cost models for teaching escharotomy. We designed a cost-effective model that could be modified to fit any high or low fidelity simulator. A yoga mat is applied to a mannequin torso and extremities to simulate underlying muscle and is then covered with cloth tape and rubber bands. The final stage of building the model includes charring it to simulate the burned tissue. During the simulation session, learners are then able to realistically feel the sensation of incising through the eschar in order to release the compressive effects of the burned tissue. Underlying intravenous tubing provides realistic bleeding from the incised lower tissues.Topics: Escharotomy, burn, eschar, emergency procedure