Pediatric Emergency Medicine Didactics and Simulation (PEMDAS) Telesimulation Series: Hyperleukocytosis
Abby Koff,
Rebekah Burns,
Marc Auerbach,
Brittany Lee,
Jean Pearce,
Daisy Ciener,
Julie Augenstein,
Claudia Yeung,
Anita Thomas
Affiliations
Abby Koff
Pediatrics Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
Rebekah Burns
Associate Professor of Pediatrics, Division of Emergency Medicine, and Associate Director of the Pediatric Clerkship Outpatient Core, University of Washington School of Medicine
Marc Auerbach
Professor of Pediatrics (Emergency Medicine) and Emergency Medicine, Yale Medical School; Director of Pediatric Simulation, Yale Center for Medical Simulation
Assistant Professor, Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin
Daisy Ciener
Program Director of the Pediatric Emergency Medicine Fellowship and Assistant Professor of Clinical Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center
Julie Augenstein
Base Hospital Medical Director, Quality and Safety Medical Director, and Attending Physician, Phoenix Children's Hospital; Clinical Assistant Professor of Child Health and Emergency Medicine, Mayo Clinic College of Medicine and Science and University of Arizona College of Medicine
Claudia Yeung
Associate Program Director, Pediatric Emergency Medicine Fellowship, Phoenix Children's Hospital; Clinical Assistant Professor, University of Arizona School of Medicine - Phoenix; Clinical Assistant Professor, Creighton University School of Medicine; Clinical Instructor, Mayo School of Medicine; Adjunct Clinical Assistant Professor, A. T. Still University School of Osteopathic Medicine
Anita Thomas
Director of the Pediatric Emergency Medicine Fellow Simulation and Assistant Professor, Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
Introduction Hyperleukocytosis, an infrequent presentation of new-onset leukemia, is a medical emergency requiring prompt recognition and treatment. It can include altered mental status, fever, critical electrolyte derangements, and coagulopathies. Due to the COVID-19 pandemic, this simulation was created as a telesimulation in order to adhere to mandatory physical distancing guidelines while addressing learning objectives. Methods This simulation was designed for pediatric emergency medicine fellows and featured a pediatric patient presenting with fever, altered mental status, and respiratory distress. After an initial assessment and appropriate workup, the patient developed tumor lysis syndrome, coagulopathies, and new-onset neurologic changes requiring appropriate interventions. A debriefing guide and participant evaluation form were utilized. Results This telesimulation was implemented at five different institutions, with evaluation surveys completed by 22 pediatric emergency medicine fellows. The scenario was rated on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) and was generally well received, with participants rating the simulation as effective in teaching the recognition (M = 4.8) and management (M = 4.6) of hyperleukocytosis. Participants felt that virtual telesimulation was effective compared to other distance learning methods (M = 3.9). Discussion This simulation-based curriculum allows learners to practice identifying and managing hyperleukocytosis. We found that it was well received in both in-person and virtual formats.
