Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital.
Assistant Professor, Pediatrics and Emergency Medicine, Weill Cornell Medical College.
MedEdPORTAL. 2020 Jul 28;16:10928. doi: 10.15766/mep_2374-8265.10928.
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.
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.
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 ( = 4.9) and manage ( = 4.8) serotonin syndrome.
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.
血清素综合征是由于药物相互作用或过量使用血清素能药物（包括常用的抗抑郁药）导致体内血清素积聚而引起的。症状可能危及生命，包括神经毒性和心血管毒性，包括激越、癫痫发作、心动过速、横纹肌溶解和高热。
本模拟病例针对儿科急诊医学住院医师和住院医师培训生在儿科急诊部门开发，可根据其他学习者的需要进行调整。该病例涉及一名 16 岁男性，由低或高保真人体模型代表，因过量服用抗抑郁药后出现精神状态改变/激越。学习者团队需要进行主要和次要评估；管理气道、呼吸和循环；并识别和开始治疗血清素综合征。该患者发生癫痫导致气道阻塞，需要高级气道支持，以及发展为横纹肌溶解症，需要积极的液体水化治疗。我们创建了一个汇报指南和一个参与者评估表。
来自五个机构的 57 名参与者完成了这项模拟，包括住院医师、研究员、教师和学生。参与者使用 5 分制 Likert 量表对情景进行了评分，总体上评价较好。参与者认为该模拟病例在学习识别（=4.9）和管理（=4.8）血清素综合征方面非常有效。
这个儿科急诊模拟场景可以根据学习者的背景和模拟环境进行调整。我们使用参与者评估表来改进模拟的未来迭代。
