Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Serotonin Syndrome
Corinne Shubin,
Shweta Iyer,
Jean Pearce,
Benjamin Lang,
Isabel Gross,
Daisy Ciener,
Suzan Mazor,
Ashley Keilman,
Anita Thomas
Affiliations
Corinne Shubin
Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
Shweta Iyer
Assistant Professor, Pediatrics and Emergency Medicine, Weill Cornell Medical College
Jean Pearce
Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin
Benjamin Lang
Pediatrics Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
Isabel Gross
Clinical Instructor, Department of Pediatrics, Division of Emergency Medicine, Yale University School of Medicine and Yale New Haven Children's Hospital
Daisy Ciener
Assistant Professor, Clinical Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center
Suzan Mazor
Director of Pediatric Toxicology, University of Washington School of Medicine and Seattle Children's Hospital; Associate Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
Ashley Keilman
Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
Anita Thomas
Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
Introduction Serotonin syndrome is caused by an accumulation of serotonin in the body from drug interactions or overdose of serotonergic medications, including commonly used antidepressants. Symptoms can be life-threatening and encompass both neurologic and cardiovascular toxicity, including agitation, seizure, tachycardia, rhabdomyolysis, and hyperthermia. Methods This simulation case was developed for pediatric emergency medicine fellows and emergency medicine residents in the pediatric emergency department and can be altered to accommodate other learners. The case involved a 16-year-old male, represented by a low- or high-fidelity manikin, who presented with altered mental status/agitation after an overdose of antidepressant medication. The team of learners was required to perform a primary and a secondary assessment; manage airway, breathing, and circulation; and recognize and initiate treatment for serotonin syndrome. The patient had a seizure resulting in airway compromise requiring advanced airway support, as well as developed rhabdomyolysis requiring aggressive fluid hydration. We created a debriefing guide and a participant evaluation form. Results Fifty-seven participants across five institutions completed this simulation, which included residents, fellows, faculty, and students. The scenario was rated by participants using a 5-point Likert scale and was generally well received. Participants rated the simulation case as effective in learning how to both recognize (M = 4.9) and manage (M = 4.8) serotonin syndrome. Discussion This pediatric emergency simulation scenario can be tailored for a range of learner backgrounds and simulation environments. We used the participant evaluation form to improve future iterations of the simulation.
