Hypothermia and Arrhythmias: A Pediatric Trauma Simulation Case for Residents, Fellows, and Advanced Practice Providers.

Abstract

Introduction: In the United States, approximately 1,000 people die from hypothermia annually. Among infants and children, mortality ranges from 0.2 to 1 death per million, potentially underestimated due to missed diagnoses. Most hypothermia simulations focus on submersion injuries with mild hypothermia. This novel simulation introduces a case of moderate hypothermia with bradycardia and tachycardia dysrhythmias, prolonged QTc interval, and hypoglycemia in a teenager who was ejected from a car into a snowbank and discovered by a neighbor the next morning. This case enables residents, fellows, and advanced practice providers to recognize and manage hypothermia while adhering to pediatric resuscitation principles.

Methods: Based on a real case, this scenario involved a high-fidelity teenage manikin in an emergency department resuscitation room or simulation lab. The 25-minute simulation was followed by a 15-20-minute debriefing. Required personnel included a simulation programmer and case instructor. Emergency medicine residents, pediatric emergency medicine fellows, surgery residents, pediatric surgery fellows, and advanced practice providers were tasked with identifying moderate hypothermia and managing hypoglycemia and arrhythmias using vasopressors, dextrose, magnesium sulfate, and synchronized cardioversion. A formal debriefing session and written evaluation completed the learning experience.

Results: Over a 4-month period, 41 learners participated. All participants completed the evaluation, reporting increased comfort in managing hypothermia, with an average score of 4.8/5. The debriefing was rated highly, with an average score of 4.9/5.

Discussion: The simulation effectively enhances learners' competence in recognizing and managing moderate hypothermia and its associated risks.