575 - Multi-Institutional Pediatric Sedation Complication Simulation

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 575
Publication Number: 575.364

Presenting Author(s)

AD

Amanda S. Dupont, D.O.

Pediatric Emergency Medicine Fellow
Medical College of Wisconsin
Mequon, Wisconsin, United States

Background: Ketamine and propofol are both commonly used agents for procedural sedation in the pediatric emergency department (PED). While these medications routinely provide safe sedations, there are side effects including apnea, laryngospasms, and hypotension that providers should be able to recognize and manage.

Objective: Currently, to our knowledge, no simulation cases exist in the literature on this topic. This case was created to improve background knowledge of procedural sedations for providers in the PED.

Design/Methods:

Two procedural sedation simulation cases were created for learners, pediatric emergency medicine (PEM) fellows and PEM faculty that work in the PED: case 1 was a 12-year-old male with a shoulder dislocation requiring reduction under propofol sedation and case 2 was a forearm fracture requiring reduction under ketamine sedation. Learner actions for each case included setting up equipment for the sedation, selecting correct dosing and re-dosing of medications, and managing complications. Additionally, with case 2 the learners were required to assign an ASA score and select the appropriate patient for PED sedation amongst three patients based on vital signs, history and physical exam. A debrief occurred immediately following the two cases. Post-debrief, a short didactic presentation was created and shared with learners to reinforce concepts discussed in the debrief. Participants completed an evaluation of the simulation following the session.

Results: Fifty-eight residents and fellows across four sites participated in these simulations. The simulation was rated by participants on a 5-point Likert scale regarding the simulations and the debriefing session. Learners rated the scenario as clinically relevant (M=4.37) and effective at improving their comfort level in caring for critically ill patients (M=4.36). Learners felt the debrief provided valuable learning (M=4.4) and was a safe and supportive learning environment (M=4.5).

Conclusion(s):

These procedural sedation simulation cases can be utilized as resources for learners in any pediatric or adult ED and be tailored to any training background or level of learner providing procedural sedation. We have integrated feedback from learner evaluations to improve future sessions.