The Sim Corner is the latest and greatest cases our wonderful Sim Team has run for our residents with the teaching points of each case.
CASE 1: Neonatal Sepsis
3 week old infant arrives with mom for lethargy and poor appetite
Initial vitals: HR 200, RR 68, BP 55/30, O2 Sat 88%, Temp 102.8F
Our Dr. Ramin Chitsaz intubating
Exam: lethargic, responds minimally to pain with weak grunt, pale, diaphoretic, weak pulses and cap refill 5 seconds, sunken fontanelle, tachycardic, clear lungs
Flow of case:
Patient arrives lethargic, hypotensive, hypoxic, tachycardic and febrile
> becomes less responsive and more hypoxic
> hypoxia increases despite supplemental oxygen
> bradycardic <60
> PALS for bradycardia and poor perfusion: CPR, epinephrine, airway management
> patient improves after intubated and epinephrine administered
> admitted to PICU for sepsis
Learning Objectives
Demonstrate appropriate sepsis management:
o 20ml/kg bolus
o Broad spectrum antibiotics: Ampicillin + Gentamicin OR Ampicillin + Cefotaxime
o Work up: blood cultures, cmp, cbc, lactic acid, UA, urine cultures, CSF studies
Understand how to use broselow tape
o Child should be lying flat
o Head of the child in line with the read marker on the tape
o The color that the feet lands on will have all the correct drug dosing for child of that size
Demonstrate ability to perform PALS
o CPR begins when HR <60 in pediatric patient
o Administer epinephrine 0.01mg/kg (0.1ml/kg) of 1:10,000 Can be repeated every 3–5 min
o Administer atropine (0.02mg/kg) if suspected vagal response or if primary AV block maximum single dose of 0.5mg
Written by Emily DeDonato, Simulation Fellow, MD
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