This simulation-based curriculum is designed to train healthcare providers to recognize and manage pediatric cholinergic toxicity, particularly when it results in life-threatening respiratory failure. The course integrates both medical management and team communication principles within a high-fidelity simulation environment. Participants engage in a scenario requiring identification of cholinergic toxidrome symptoms (e.g., DUMBBELS: defecation, urination, miosis, bronchorrhea, bronchospasm, emesis, lacrimation, salivation), rapid patient assessment, airway management, administration of antidotes such as atropine and pralidoxime, and implementation of appropriate decontamination procedures. Emphasis is also placed on early recognition of clinical deterioration, mobilization of a resuscitation team, and effective communication using TeamSTEPPS principles to improve crisis resource management. The course allows learners to practice decision-making in a time-sensitive emergency reflective of real-world pesticide or organophosphate exposure scenarios (Course Overview, p.4).
Target Learners
According to the Target Trainees section (p.5), the primary learners include:
- Pediatric residents
- Emergency medicine residents
- Fellows
- Faculty physicians
- Nursing staff
The training is intended for interdisciplinary clinical teams who may be involved in pediatric emergency response and resuscitation.
Equipment Needed
As outlined in the Equipment Set-Up section (pp.17–18), required materials include:
Simulation Environment
- Pediatric patient simulator (e.g., SimBaby)
- Hospital bed and gown
- Cardiorespiratory monitor (HR, BP, RR, SpO₂, temperature)
- Teaching crash cart and defibrillator
Airway & Respiratory Equipment
- Oxygen supply
- Bag-mask ventilation system (various sizes)
- Nasal and oral airways
- Endotracheal tubes (sizes 3.0–5.0) with stylets
- Laryngoscope with Miller and Mac blades
- Suction apparatus
- CO₂ colorimeter
- Nasogastric tubes
IV & Monitoring Supplies
- IV/IO access equipment
- Syringes and IV tubing
- Blood sampling devices
- Pediatric weight estimation tools (e.g., Broselow tape)
Medications
- Atropine
- Pralidoxime
- Epinephrine
- Rocuronium
- Succinylcholine
- Midazolam
- Etomidate
- Ketamine
- Normal saline or lactated Ringers
Personal Protective Equipment
- Gowns
- Gloves
- Masks
- Face shields
Estimated Time to Complete Activity
The training session duration is approximately 1 hour (p.4).
Typical implementation includes:
- 0–3 minutes: Prelude and team briefing
- 3–19 minutes: Simulation scenario (Acts 1–4; see Scenario Timeline diagram, p.21)
- Remaining time: Debriefing and evaluation
Sessions are generally conducted with 3–7 participants and offered up to twice annually.