Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Pediatric Diabetic Ketoacidosis
Cale Roberts,
Ashley Keilman,
Jean Pearce,
Alissa Roberts,
Kevin Ching,
Jenny Kingsley,
Alexander Stephan,
Isabel Gross,
Daisy Ciener,
Julie Augenstein,
Anita Thomas
Affiliations
Cale Roberts
Pediatrics Resident, Department of Pediatrics, 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
Jean Pearce
Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin
Alissa Roberts
Assistant Professor, Department of Pediatrics, Division of Endocrinology and Diabetes, University of Washington School of Medicine and Seattle Children's Hospital
Kevin Ching
Associate Professor of Clinical Pediatrics, Division of Emergency Medicine, Weill-Cornell Medicine
Jenny Kingsley
Assistant Professor, Department of Anesthesia and Critical Care Medicine, Division of Pediatric Critical Care, Keck School of Medicine, University of Southern California and Children's Hospital of Los Angeles
Alexander Stephan
Assistant Professor, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York Presbyterian/Weill Cornell Medical Center
Isabel Gross
Assistant Professor of Pediatrics, Department of Pediatric Emergency Medicine, Yale University School of Medicine
Daisy Ciener
Program Director of 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
Anita Thomas
Director of Pediatric Emergency Medicine Fellow Simulation and Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
Introduction Diabetic ketoacidosis (DKA) is a life-threatening illness which classically presents with polyuria, polydipsia, and polyphagia that can rapidly progress to severe dehydration and altered mental status from cerebral edema. Younger patients may present with subtle or atypical symptoms that are critical to recognize and emergently act upon. Such patients are often cared for by teams in the emergency department (ED) requiring multidisciplinary collaboration. Methods This simulation case was designed for pediatric emergency medicine fellows and residents. The case was a 14-month-old male who presented to the ED with respiratory distress and dehydration. The team was required to perform an assessment, manage airway, breathing and circulation, and recognize and initiate treatment for DKA including judicious fluid administration and an insulin infusion. The patient developed altered mental status with signs of cerebral edema requiring the initiation of cerebral protection strategies. We created a debriefing guide and a participant evaluation form. Results Forty-two participants completed this simulation across seven institutions including attendings, residents, fellows, and nurses. The scenario was rated by participants on a 5-point Likert scale and was generally well received (M = 5.0). Participants rated the simulation case as effective in teaching how to recognize (M = 4.8) and manage (M = 4.5) DKA with cerebral edema in a pediatric patient. Discussion This simulation represents a resource for learners in the pediatric ED in the recognition and management of a toddler with DKA and can be adapted to learners at all levels and tailored to various learning environments.
