Teaching Pediatric Emergencies with Medical Simulation

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Teaching Pediatric Emergencies with Medical
Simulation
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Who Are We?
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Who are YOU?......Who Will you be
teaching?....
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Target the audience

• MDs
• RNs / NP / PAs
• EMS
• Questionnaires before hand

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What do EM docs want to know?

• Dependent factors
• Training background
• How often do they see children?
• Availability of consultants?
• How long they have been out of training?

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What EM docs told us they want to know.
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Emergency Medicine Topics

• Common
• Whats different?
• Asthma / Bronchiolitis / Croup
• Shock
• DKA
• Seizures
• Not so common
• But essential
• Congenital Heart Disease
• Recognition of Abuse
• Metabolic Disorders

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Equipment
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Equipment unavailability

• infant warming device 59.4
• pediatric pulse oximeter 18.0
• intraosseous needle 15.9
• infant blood pressure cuff 14.8
• pediatric defibrillator paddles 10.5
• pediatric drug dose guidelines 6.6
• infant bag-valve-mask device 3.5
• infant laryngoscope blade 3.5
• 3-mm endotracheal tube 2.5

McGillivray D, Ann Emerg Med. 2001
Apr37(4)388-9.
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Tools forDosing and Equipment sizing

• Bring their own
• Supply them with / Suggest options
• Broselow-Luten
• PALS code card
• Hospital code card
• PDA
• etc.

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Drug Dosing Tools
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What do Pediatricians in Office Practice Want to
know?

• Dependent factors
• How far they are from help?
• How helpful is the help?
• How many physicians/RNs/Secretaries are available
  to help?

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What office based Pediatricians told us they want
to know.
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Emergencies in RI/MA Offices
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Pediatrician Topics

• Reactions to Immunizations
• Asthma / Croup / Bronchiolitis
• Shock
• Seizure Management

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Pediatricians

• Equipment
• What they have
• What they should have
• Where should they keep it
• Code cart vs. Code room

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Medication Administration

• Methods of Dosing
• Nasal
• Rectal
• IM
• Tools for Dosing
• Broselow
• Dosing card (Simplified)

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Our Goal

• Facilitate Success in the Simulation
• Improve knowledge base for case diagnosis and
  treatment
• Improve Procedural skills
• Introduction to SIM environment
• Well designed, well run realistic and relevant
  scenarios

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Course Organization

• Didactic lectures
• Skills Stations
• Introduction to Simulation environment
• Medical Simulation Cases
• Debriefing

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Skills Stations

• Emergency Medicine
• Advanced Airway skills
• BVM
• OP/NP airways
• In-line meds (albuterol)
• Intubation
• differences

• Office Pediatrics
• Basic Airway skills
• BVM
• OP/NP airways
• In-line meds (albuterol)
• LMAs

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Skills Stations

• Emergency Medicine
• Access skills
• IV
• IO / Easy IO
• Nasal
• IM
• Rectal
• Meds
• ALL

• Office Pediatrics
• Access skills
• IO / Easy IO
• Nasal
• IM
• Rectal
• Meds
• Epi
• Midazolam
• Glucose

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Task Trainer Mania
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Skills stations

• Mannequin
• NP/OP airway
• LMA ?
• BVM
• Intubation
• IO
• IV ?

• Task Trainer
• LMA
• IO
• IV
• Better but
• US guided IV
• LP

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Task Trainers

• Play before you pay!

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Course Organization

• Didactic lectures
• Skills Stations
• Introduction to Simulation environment
• Medical Simulation Cases
• Debriefing

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Mannequin / Simulation Rules of
EngagementExpectations

• Physical Findings
• Communication
• Procedures
• Patient Monitoring
• Props

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Mannequin / Simulation Limitations

• Physical Findings (simulated)
• Pulses
• Locations vary
• Auscultation
• Speaker location
• Realism of sounds
• Physical Findings (not simulated)
• Perfusion
• Rashes
• Neurologic exam

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Mannequin / Simulation Limitations

• Communication
• With Facilitators
• Family members
• Confederates / Staff
• With Mannequin / Patient

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Mannequin / Simulation Limitations

• Procedures on Mannequin
• Monitors
• Props
• Lab values
• EKGs
• X-rays

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Course Organization

• Didactic lectures
• Skills Stations
• Introduction to Simulation environment
• Medical Simulation Cases
• Debriefing

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Simulation Case Resources

• Pediatric Codes
• M. Roback S. Teach
• ACEP 2005
• Manual Of Neonatal Mock Codes
• Anne Hansen
• BC Decker Inc. , Jan 2006

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http//aamc.org/mededportalfind resources
keyword simulation
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Let em sink or help em swim?
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Course Organization

• Didactic lectures
• Skills Stations
• Whats doable on the mannequin
• Medical Simulation Cases
• Debriefing
• Quick re-run
• Full re-run
• Video

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THANKS!