This simulation-based educational activity is designed to train learners in the evaluation and management of a patient presenting with signs and symptoms of acute toxicologic illness, specifically theophylline overdose. The scenario involves an adult patient with a history of chronic obstructive pulmonary disease (COPD) who presents with tachycardia, nausea, vomiting, tremor, and hypotension after accidentally ingesting a toxic dose of theophylline instead of prednisone. Participants must perform a focused assessment, identify the underlying toxicologic cause through history, examination, and laboratory data, and initiate appropriate management strategies.
The case allows for adjustable complexity, ranging from a stable overdose presentation to progression into seizure activity or cardiac instability requiring advanced airway management and potential resuscitation. Learners are expected to demonstrate clinical reasoning, toxicology management principles, appropriate consultation (e.g., Toxicology and Nephrology), and escalation of care including gastrointestinal decontamination and possible hemodialysis. The activity incorporates structured debriefing to reinforce diagnostic decision-making and emergency management of medication overdose.
Target Learners
- Emergency Medicine residents
- Internal Medicine residents
- Family Medicine residents
- Third- and fourth-year medical students completing an Emergency Medicine rotation
Equipment Needed
- Simulation laboratory configured as an Emergency Department room
- High-fidelity simulation manikin or standardized patient with simulated vital signs
- Cardiac monitor (EKG capability)
- Pulse oximeter
- Blood pressure monitor
- Intravenous (IV) access supplies
- Endotracheal intubation manikin (for advanced scenario branches)
- Oxygen delivery equipment
- Simulated medications (e.g., benzodiazepines, antiemetics, activated charcoal)
- Audio-visual monitoring and recording system
- Medication dispensing area (e.g., simulated Pyxis)
- Debriefing space
Personnel Required
- Course Director (physician educator)
- Simulation education specialist
- Nurse confederate
- Respiratory therapist and/or critical care confederate
- Standardized patient or simulation technician
Estimated Time to Complete the Activity
- Pre-briefing: 10–15 minutes
- Simulation scenario: 15–25 minutes (depending on complexity branch)
- Debriefing session: 20–30 minutes
Total estimated time: 45–70 minutes