This simulation-based learning activity presents an adolescent patient with altered mental status secondary to suspected calcium channel antagonist (CCA) overdose. Participants are expected to recognize the clinical presentation of toxic ingestion and initiate appropriate stabilization and management, including airway support, circulatory resuscitation, seizure management, and pharmacologic treatment such as calcium infusion and high-dose insulin therapy. The case also emphasizes team-based communication, consultation with toxicology or poison control services, and appropriate patient disposition to a pediatric intensive care unit. The activity is designed to improve clinical recognition and management of high-acuity, low-frequency pediatric toxicologic emergencies in a controlled learning environment.
Target Learners
This activity is intended for healthcare professionals involved in pediatric emergency care, including:
- Pediatric residents
- Emergency medicine residents
- Pediatric emergency medicine fellows
- Pediatric and emergency medicine physicians
- Nursing staff
- Respiratory therapists
- Allied healthcare professionals involved in emergency or pediatric care
Equipment Needed
Implementation of this simulation requires:
Simulation Equipment
- High-fidelity mannequin (e.g., Laerdal SimMan 3G)
- Simulation software and program files
- Central line task trainer
- Peripheral IV access supplies
- Cardiac monitor
- Defibrillator
Resuscitation and Airway Equipment
- Oxygen delivery devices
- Bag-valve-mask (BVM)
- Rapid sequence intubation equipment
- Code cart
Medications
- Activated charcoal
- RSI medications (e.g., etomidate, succinylcholine, rocuronium, midazolam)
- Insulin
- Glucose (D25)
- Calcium chloride and/or calcium gluconate
- Vasopressors (e.g., norepinephrine, dopamine)
- Benzodiazepines
Additional Props
- EKG printouts (sinus bradycardia and complete heart block)
- Notecards with laboratory results and exam findings
- Simulated patient phone with relevant text message
- Optional device to simulate seizure activity
Estimated Time to Complete
- Active simulation scenario: 10–15 minutes
- Post-scenario debriefing: ~30 minutes
Total estimated activity time: approximately 40–45 minutes