Beta-Blocker Toxicity.

AUDIENCE

This simulation is intended to be used for emergency medicine (EM) residents (all levels) and 4th year medical students.

INTRODUCTION

Beta-blocker (BB) toxicity ranks seventh among the top 25 substances associated with fatalities, with a cardiovascular mortality rate of up to 1.4%.1,2 Patients with BB overdose may present with bradydysrhythmias, hypotension, hypoglycemia, altered mental status, and cardiogenic shock.3 Given that EM physicians are often the first to encounter such patients, EM learners need to be proficient in managing all aspects of BB toxicity.

EDUCATIONAL OBJECTIVES

By the end of the session, learners will be able to: 1) manage a patient with hypotension, and bradycardia while maintaining a broad differential, 2) evaluate the causes of hypotension by utilizing ultrasound, 3) review when to initiate vasopressors and first-line agents for beta-blocker toxicity, 4) discuss treatment algorithm for BB toxicity including high-dose insulin and, 5) discuss the risk factors for suicide.

EDUCATIONAL METHODS

This session employed high-fidelity simulation followed by an in-depth debriefing. It was conducted during the orientation for first-year EM residents, with 16 residents participating. The group was divided into two cohorts: eight residents actively managed the simulated patient, while the other eight observed.

RESEARCH METHODS

Following the simulation and debriefing, participants were surveyed online using Google Form. The survey included the following questions: 1) the case was believable, 2) the case had right amount of complexity, 3) the case helped in improving medical knowledge and patient care, 4) I feel more confident in managing undifferentiated hypotension, 5) I feel more confident in managing BB overdose, 6) the simulation environment gave me a real-life experience and, 7) the debriefing session after simulation helped improve my knowledge. Responses were collected using a Likert scale.

RESULTS

Ten participants completed the post-session survey. All respondents either agreed or strongly agreed that the case was effective in enhancing learning, medical knowledge, and patient care skills. Every participant found the debriefing session valuable and reported increased confidence in managing undifferentiated hypotension and BB toxicity.

DISCUSSION

The simulation session effectively educated participants on the management of BB toxicity, reinforcing key concepts such as the treatment of hypoglycemia, bradycardia, and hypotension. As the case unfolded, learners were required to assess refractory hypotension and initiate vasopressor therapy and specific treatments for BB toxicity. Overall, participants found the simulation beneficial for learning the management of BB overdose.

TOPICS

Beta-blocker toxicity, refractory hypotension, bradycardia, toxicology, mental health, psychiatry.