Pediatric Polytrauma Fire Victim Simulation
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1Third-Year Fellow, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Warren Alpert Medical School of Brown University.
Insights
This simulation case effectively trained emergency medicine residents to manage pediatric trauma with combined mechanical and metabolic injuries. Learners showed increased confidence in treating complex cases involving carbon monoxide (CO) and cyanide (CN) toxicities and smoke inhalation.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Toxicology
Background:
- Pediatric trauma is a leading cause of mortality.
- Existing literature lacks combined cases of mechanical trauma with cyanide (CN) toxicity, carbon monoxide (CO) toxicity, and smoke inhalation.
- Fire-related injuries present complex multisystem challenges.
Purpose of the Study:
- To evaluate a simulation case for managing pediatric trauma with combined mechanical and metabolic concerns.
- To assess emergency medicine resident confidence in managing airway, burns, hemoperitoneum, and CO/CN toxicities post-simulation.
Main Methods:
- A 45-minute simulation case was developed for emergency medicine residents and fellows.
- Participants managed a simulated pediatric patient extracted from a van fire with trauma and metabolic issues.
- Learning objectives included airway management, burn care, hemoperitoneum, and CO/CN toxicity treatment.
Main Results:
- Forty learners participated, many with limited prior experience in these specific scenarios.
- All participants found the case relevant to their work.
- Post-simulation, 100% were confident managing CO toxicity and surveys; 97% were confident with smoke inhalation, difficult airways, and CN toxicity.
Conclusions:
- The simulation case is a valuable tool for teaching pediatric trauma and fire-related metabolic derangements.
- It provides a rare but crucial opportunity to practice multisystem trauma management for emergency providers.
- The case successfully enhanced learner confidence in managing complex pediatric emergencies.
Introduction:
Pediatric trauma has long been one of the primary contributors to pediatric mortality. There are multiple cases in the literature involving cyanide (CN) toxicity, carbon monoxide (CO) toxicity, and smoke inhalation with thermal injury, but none in combination with mechanical trauma.
Methods:
In this 45-minute simulation case, emergency medicine residents and fellows were asked to manage a pediatric patient with multiple life-threatening traumatic and metabolic concerns after being extracted from a van accident with a resulting fire. Providers were expected to identify and manage the patient's airway, burns, hemoperitoneum, and CO and CN toxicities.
Results:
Forty learners participated in this simulation, the majority of whom had little prior clinical experience managing the concepts highlighted in it. All agreed or strongly agreed that the case was relevant to their work. After participation, learner confidence in the ability to manage each of the learning objectives was high. One hundred percent of learners felt confident or very confident in managing CO toxicity and completing primary and secondary surveys, while 97% were similarly confident in identifying smoke inhalation injury, preparing for a difficult airway, and managing CN toxicity.
Discussion:
This case was a well-received teaching tool for the management of pediatric trauma and metabolic derangements related to fire injuries. While this specific case represents a rare clinical experience, it is within the scope of expected knowledge for emergency medicine providers and offers the opportunity to practice managing multisystem trauma.
