Dataset Information

Isoniazid Overdose: A Pediatric Simulation Case.

ABSTRACT:

Introduction

Unintentional toxic ingestions are a common occurrence in the pediatric population, and it is therefore important for resident physicians to learn to both recognize and effectively manage these events. Seizures caused by isoniazid overdose are a well-described clinical entity for which pyridoxine serves as an effective antidote. We developed a pediatric simulation case using a high-fidelity patient simulator to engage learners in a case of status epilepticus in a toddler caused by accidental isoniazid ingestion.

Methods

The learning objectives of this activity are for participants to recognize that toxic ingestion has occurred, execute appropriate initial management of status epilepticus, and administer pyridoxine as an antidote. Equipment and personnel needed for this activity include a high-fidelity patient simulator, simulated medical supplies, a patient simulator operator, and one actor.

Results

This simulated case debuted among resident physicians at a simulation competition event within the emergency medicine residency program of an academic medical center. Feedback elicited after the event included a high proportion of respondents agreeing that the cases used were "sufficiently complex" and "relevant for my clinical practice."

Discussion

Despite some barriers to effective implementation, this simulation case was well received and may serve as a valuable educational tool for training resident physicians to effectively manage toxic ingestions. The effectiveness of this simulation in accomplishing its specific learning objectives was not formally assessed, but participant evaluations suggest that it was well received by its target audience.

SUBMITTER: Lai J

PROVIDER: S-EPMC6338183 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Publications

Isoniazid Overdose: A Pediatric Simulation Case.

Lai Jason J Thompson Ryan R

MedEdPORTAL : the journal of teaching and learning resources 20170501

<h4>Introduction</h4>Unintentional toxic ingestions are a common occurrence in the pediatric population, and it is therefore important for resident physicians to learn to both recognize and effectively manage these events. Seizures caused by isoniazid overdose are a well-described clinical entity for which pyridoxine serves as an effective antidote. We developed a pediatric simulation case using a high-fidelity patient simulator to engage learners in a case of status epilepticus in a toddler cau ...[more]

PMID: 30800775

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Project description:IntroductionThis activity is designed for midlevel and senior anesthesia trainees to experience the complexities of one-lung ventilation in pediatrics in a high-fidelity simulated environment. With the use of video-assisted thoracoscopic surgery (VATS) becoming increasingly common in pediatrics, we identified this area as an opportunity for the development of a dedicated educational simulation activity.MethodsOur simulated patient is a 3-year-old girl with empyema presenting for decortication via VATS who subsequently develops hypoxemia. The main challenges for the trainee include airway selection and insertion, lung isolation with fiber optic confirmation, and management of hypoxemia in the setting of one-lung ventilation. A pediatric medical simulator suitable for practicing resuscitation is required, and a tracheobronchial tree model is highly desirable. Basic knowledge of thoracic and pediatric anesthesia is required, but specific experience with pediatric lung isolation is not.ResultsLearners who experienced the content of this simulation expressed a strong sentiment of value. All pilot trainees were surveyed and indicated they either agree or strongly agree (4 or 5, respectively, on a 5-point Likert scale) that "This simulation enhanced my understanding of how to select lung isolation devices for pediatric patients" and "This simulation enhanced my understanding of how to manage hypoxia in context in one-lung ventilation." Comments were overall positive, including "I am better prepared to manage pediatric one lung ventilation cases."DiscussionAt the University of Iowa, this activity is part of a core curriculum of simulation training that resident physicians in anesthesiology experience during their training. It functions as a tool for education, evaluation, and self-identification of weaknesses in the learner's knowledge base as it relates to the perioperative management of pediatric one-lung ventilation, as well as for reinforcing material learned in the classroom and operating room. Numerous anesthesiology residents and faculty have pilot-tested this simulation, and necessary modifications have been made based on their feedback.

Project description:IntroductionCurrent ethical practice allows for adult patients with decision-making capacity to refuse blood transfusion, even at the cost of high morbidity or mortality. However, for an adult patient who is of the Jehovah's Witness faith, an unwanted blood transfusion confers a psychospiritual cost to the patient and a financial cost to health care entities. The ethical boundaries are increasingly ambiguous with minors who are members of the Jehovah's Witness faith. This simulation experience intends to identify and address knowledge gaps in the care of minors in an emergent setting using a biomedical ethics framework.MethodsThis scenario provides an immersive simulation experience involving a 12-year-old Jehovah's Witness patient requiring emergent laparotomy for splenic hemorrhage. Patient interview (via simulation manikin with instructor voice) and care handoff take place in an operating room setting. The learner ascertains the patient's and family's refusal of blood products. Induction of general anesthesia results in profound patient hypotension secondary to acute blood-loss anemia. Pulseless electrical activity results if packed red blood cells are not administered. Ethical principles require the learner to impose an unwanted lifesaving therapy on a minor patient over the objections of family members. Secondly, the anesthesia provider must advocate for transfusion on these ethical grounds against a well-meaning but ultimately misguided surgeon who opposes transfusion. An included learner evaluation form based on ACGME core competencies facilitates postsimulation debriefing.ResultsParticipants were primarily anesthesia residents and fellows. Anecdotally, the residents said that it "felt good to be an attending" and that the simulation helped them appreciate how important conflict resolution skills are in the OR setting. Additionally, faculty appreciated the ability to assess the development of crucial assertiveness skills, with the option of remediating incorrect behavior during the debriefing.DiscussionThis simulation experience provides experience in the emergent medical management of a pediatric trauma patient while also incorporating specific ethical consent issues unique to pediatric and trauma patient populations. Furthermore, this experience develops professionalism skills and practice in assertive patient advocacy.

Dataset Information

Isoniazid Overdose: A Pediatric Simulation Case.

Introduction

Methods

Results

Discussion

Publications

Isoniazid Overdose: A Pediatric Simulation Case.

Similar Datasets

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