Pediatric Emergency Medicine Simulation Curriculum: Bronchiolitis

Abstract

Abstract This scenario teaches learners to recognize and manage a critically ill patient with bronchiolitis in the emergency setting. A subset of patients with bronchiolitis experience severe respiratory symptoms requiring aggressive ventilatory support. Many of these patients have required endotrachial intubation. Recently, more of these patients have been managed with high flow nasal canula (HFNC) oxygen therapy, with retrospective studies showing decreased rates of intubation of bronchiolitic patients when this therapy has been adopted. This curriculum involves a common disease process with potential serious complications. This resource is simulation based, designed for manikin-based simulation equipment, with an integrated team-communication focus. Learners will participate in a simulation scenario and be asked to identify the signs and symptoms of bronchiolitis and their management. Two versions of this scenario are presented. The first version presents respiratory distress secondary to bronchiolitis which meets criteria for the use of high flow nasal canula oxygen therapy or nasal continuous positive airway pressure. The second version of the scenario presents respiratory failure secondary to bronchiolitis which requires intubation. The selection of which version is used should be based on individual learning objectives and availability of different therapies. There are also optional sections of both versions of the scenario requiring the recognition and management of tension pneumothorax. At the end of training, the learners should be able to recognize the seriousness of the situation and manage a full resuscitation team. The primary complications for the team to recognize and manage are respiratory distress and impending respiratory failure. This curriculum involves a common disease process with potential serious complications. It incorporates a novel treatment modality, while providing an alternative scenario for centers where use of high flow nasal cannula (HFNC) is not standard of care. It can be used both for teaching and as a tool to evaluate the implementation of HFNC. It is adaptable to the training level of the learner. Finally it utilizes simulation to promote and teach teamwork and effective communication skills.

Keywords

• Infant
• Simulation
• Bronchiolitis
• Respiratory Distress
• Tension Pneumothorax
• Emergency Medicine