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Infant Botulism
Victoria Morris1, Robert Wians1, Jessica Wilson1
1McGovern Medical School at the University of Texas Health Science Center, Department of Emergency Medicine, Houston, TX.
Insights
Infant botulism, a rare cause of infant hypotonia and respiratory failure, requires prompt recognition and antitoxin administration. This simulation improved resident and fellow preparedness for managing this critical condition.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
Background:
- Infant botulism is a rare, serious condition causing hypotonia, vomiting, and respiratory failure.
- Early recognition of descending paralysis and respiratory distress is crucial for preventing adverse outcomes.
Purpose of the Study:
- To assess the effectiveness of a simulation in preparing emergency medicine and pediatric emergency medicine (PEM) trainees to manage infant botulism.
- To enhance learners' ability to diagnose, manage, and initiate treatment for infant botulism.
Main Methods:
- A high-fidelity simulation case involving infant botulism was conducted with emergency medicine residents and PEM fellows.
- Learners practiced differential diagnosis, airway management, antitoxin mobilization, and supportive care.
- Feedback was collected using a 5-point Likert scale questionnaire post-simulation.
Main Results:
- The simulation and debriefing received mostly favorable feedback from participants.
- Most participants strongly agreed or agreed that the simulation would improve their performance in real clinical scenarios.
Conclusions:
- Simulation-based training is effective in improving resident and fellow preparedness for managing rare, high-acuity cases like infant botulism.
- This approach enhances diagnostic skills, management strategies, and confidence in handling critical pediatric emergencies.
Audience:
Emergency medicine and pediatric residents, and pediatric emergency medicine (PEM) fellows.
Introduction:
Botulism is a rare but serious cause of infant hypotonia, vomiting, and respiratory failure. The differential diagnosis and management of a hypotonic infant with progressive weakness leading to respiratory failure is a rare presentation with high morbidity and mortality.1 Infants with botulism generally present with vague complaints that progressively worsen over time.2 Recognition of descending paralysis in an infant as well as signs of respiratory failure are key to preventing an adverse outcome. A key component of botulism treatment is recognizing the need to mobilize local resources to obtain BabyBIG® (botulism immune globulin). This process can and should begin in the emergency department.
Educational Objectives:
After this simulation learners should be able to: 1) develop a differential diagnosis for the hypotonic infant, 2) recognize signs and symptoms of infant botulism, 3) recognize respiratory failure and secure the airway with appropriate rapid sequence intubation (RSI) medications, 4) initiate definitive treatment of infant botulism by mobilizing resources to obtain antitoxin, 5) continue supportive management and admit the patient to the pediatric intensive care unit (PICU), 6) understand the pathophysiology and epidemiology of infant botulism, 7) develop communication and leadership skills when evaluating and managing critically ill infants.
Educational Methods:
This simulation case was performed using a high-fidelity Laerdal SimBaby with intubating capabilities and real-time vital sign monitoring. Additionally, this case can be performed with low fidelity manikins with supplemental scripting and visual stimuli. With minor adjustments, this case could be modified into an oral boards case.
Research Methods:
We obtained feedback from a convenience sample of random participants after the simulation case and debrief were completed. The sample of emergency medicine residents (N=21) and PEM fellow (N=1) completed 5 questions on a 5-point Likert scale.
Results:
The emergency medicine residents and PEM fellow had mostly favorable feedback regarding the simulation and debriefing. Most strongly agreed or agreed that this would improve their performance in an actual clinical setting.
Discussion:
Infant botulism is a rare condition, presenting as vague non-specific complaints that worsen over time. It is important to differentiate infant botulism from other causes of weakness, hypotonia, and respiratory failure. This case presents learners with a high acuity, rare case of infant botulism and allows them to work through a complex pediatric patient encounter in a psychologically safe space. The presence of a standardized patient to play the patient's parent is key to assess learners' nontechnical communication skills and to increase fidelity during the simulation.
Topics:
Infant botulism, pediatric emergency medicine, respiratory failure, hypotonia, toxicology.
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