Wolff-Parkinson-White Syndrome: A Case for High-Fidelity Simulation in Emergency Medicine

Abstract

Abstract Introduction This educational resource provides the information and materials for a high-fidelity simulation case suitable for resident physicians in emergency medicine. This case was implemented at the Wake Forest University School of Medicine for upper-level emergency medicine residents completing required educational time in our Emergency Department Simulation Program. Methods This high-fidelity patient simulation case involves a young man with palpitations and mild shortness of breath. An electrocardiogram (ECG) in the emergency department demonstrates a wide complex tachycardia and a review of old records finds a previous ECG with findings diagnostic for Wolff-Parkinson-White (WPW) syndrome. Inappropriate blockage of the atrioventricular (AV) node with pharmacologic agents will lead to patient deterioration into ventricular fibrillation, as this patient with WPW is in atrial fibrillation. Appropriate treatment with procainamide or amiodarone will allow stabilization of the tachycardia. Debriefing materials are provided to illustrate and stimulate discussion of the important concepts for diagnosing and treating patients with WPW. Results This scenario has been presented for small groups of three to four participants and has been field tested approximately 15 times over the past 2 years. All participants have been PGY1, PGY2, and PGY3 emergency medicine residents. Discussion This educational resource provides the information and materials for a high-fidelity simulation case suitable for resident physicians in emergency medicine. Lessons learned from 2 years of use are incorporated in this existing resource.

Keywords

• Atrial Fibrillation
• Nodal Reentry
• Wide Complex Tachycardia
• Wolff-Parkinson-White Syndrome
• WPW
• Palpitations