Pediatric Simulation: A Seizing Infant in the PACU – Differential Diagnosis and Treatment

This simulation-based educational activity is designed to train anesthesia learners in the recognition and management of acute seizure activity in an infant recovering in the post-anesthesia care unit (PACU). The scenario presents a progressively deteriorating pediatric patient requiring rapid assessment, airway management, seizure control, and implementation of pediatric resuscitation protocols. Participants must apply Basic Life Support (BLS) and Pediatric Advanced Life Support (PALS) algorithms while simultaneously identifying and managing local anesthetic systemic toxicity as the underlying etiology of seizure activity.

In addition to technical management of airway compromise, cardiac arrhythmias, and pharmacologic seizure treatment, the simulation emphasizes non-technical crisis resource management skills such as closed-loop communication, team leadership, task delegation, and management of incomplete or conflicting clinical information. The activity culminates in post-resuscitative stabilization and transfer planning to the intensive care unit (ICU), reinforcing both clinical decision-making and interdisciplinary teamwork in a high-acuity pediatric setting.

Target Learners 

• Anesthesia Residents 

• Anesthesia Fellows 

• Anesthesia Faculty 

• Other perioperative clinicians involved in pediatric anesthesia care  

Equipment Needed 

• High-fidelity infant simulation manikin 

• Simulation technician/operator 

• Airway management equipment (e.g., bag-valve mask, oral intubation tools) 

• Intravenous access supplies 

• Fluid administration kit 

• Code cart 

• Monitoring equipment appropriate for PACU setting 

• Simulation space configured to replicate a Post-Anesthesia Care Unit (PACU) 

Personnel Required: 

• Facilitator 

• Simulation technician 

• Distractor/confederate (e.g., nurse role) 

• Minimum of three learner participants (e.g., team leader, airway manager, chest compressor) 

Estimated Time to Complete the Activity