Coastal Simulation Program

Scenario Name: Pediatric Seizure (Possible

Meningitis)

Learning Objectives:
By the end of the debriefing the participants should be able to:

Knowledge & Skills:

1. Assess and manage the ABCs in seizing patient

2. Discuss pharmacologic treatment of status epilepticus (including IV, IO, and Rectal route)
3. Recognize the potential complications of anti-epileptic medications (potential for continued seizuring
with paralytic on board)
4. Recognize and act to protect self from exposure to infection when caring for seizing children (PPE
equipment)

Attitudes and Judgement:

1. Communicate respectfully
2. All learners articulate that they felt free to voice their thoughts
3. All learners actively participated in the scenario
4. Acknowledge the value of full parent participation
5. Demonstrate effective communication during the scenario: constructing clear messages, closed loop
communication, sharing mental model

Developed by Michelle Connell, LGH Vancouver Coastal Health, June 2016

Patient Description: Skills required prior to simulation/learner
Name: assessment:
Age: 7 months old
Weight: 7.5 KG Psychomotor:
Immunizations: NO Immunizations
Hx of current condition:
Febrile for 2 days, parents noticed seizure like Cognitive:
activity for approx. 5 minutes. Parents live
across the street and brought child in
themselves. Triage nurse takes a critical first Teamwork:
look and notes the baby is hot to touch, mottled
extremities, and decreased LOC.
Who are my learners?
Social Hx: Emergency dept nurses, physicians, respiratory
Diagnosis: therapists and social worker
Febrile Seizure, r/o meningitis

Monitors:
Telemetry, Defib Monitor, o2 sats probe, thermometer

Physical Props/Equipment: References, Resources, Protocols, Algorithms, or

IV, IO, Feeding Tube for Rectal Valium, Evidence Informed Practice Guidelines:
Pediatric Broselow Cart, Pediatric Roving Cart, White http://emergencymedicinecases.com/?s=pediatric+seizures
Board. http://childhealthbc.ca/

Equipment available in room:

Room set up: Medications & Diagnostics: Documentation Confederates
Fluids: forms: Mother
Room 103 Valium IV/Rectal LP (Present and
Ativan IV/IO Labs Acute Record(paper) worried)
Midazolam !V/IO
Phenobarbital
Phenytoin IV
Fosphenytoin IV
2
Mannequin:

High Fidelity Infant Mannequin

Personnel:
RN, ERP, RT, SW

Scenario Transitions / Patient Effective Management Consequences of Notes

Parameters Ineffective
Management
Phase 1 Setting:

Initial presentation and Vitals PPE? – Risk of exposure

to Meningitis
LOC: Quiet, no crying, mottled, hot
to touch. *Petechiae rash on
Recognition of a sick child Pt seizures lower extremities
BP 78/52 Personal Protective Equipment
Pulse 160 Call for help
Resp 32 Apply monitor
Sats 98% Establish IV
Temp 39.5
Gluc 3.7
Phase 2

During initial assessment and IV

Start, Pt seizures Establish IV or IO
Consider Rectal Valium *Labs off IV Start
BP 78/52 while IV initiated. *Cultures
Pulse 190 (Use feeding tube to insert) *Successful IV
Resp 20
Sats 94%

3
Phase 3

Pt continues to seize Demonstrates effective

airway management and
consider intubation *Use Push Pull
BP 78/52 IV NS Bolus Method
Pulse 190
Resps 12 (Post Meds) Consider Phenobarbital, *Difficult to bag pt
O2 Sats 91% Phenytoin, Fosphenytoin due to seizure
(not sure we have)
Phase 4

Pt stops seizing when either Intubation for airway

Phenobarbital, Phenobarbital, management *Review PPE for
Phenytoin, or Fosphenytoin are Consider: Transfer to BCCH Meningitis
given Investigation for Meningitis
and PPE Protection

Possible debrief points: Debrief notes

Communication/team:

Rectal Valium:

PPE Equipment:

Paralytic and Seizure Activity: