Belhassen Tachycardia in a Pediatric Patient: A Simulation for Pediatric Emergency Medicine Fellows.

Ventricular tachycardia in pediatric emergency department patients is a high-risk, low-frequency event well suited for education through simulation. This technical report describes a simulation-based curriculum for Pediatric Emergency Medicine fellows and senior residents involving the evaluation and management of a 10-year-old female presenting with palpitations who is ultimately diagnosed with Belhassen tachycardia. The curriculum highlights the features that differentiate Belhassen tachycardia (idiopathic left posterior fascicular ventricular tachycardia) from supraventricular or other tachycardias, building upon foundational pediatric resuscitation skills and Pediatric Advanced Life Support (PALS) algorithms for advanced learners.

"It's Not a Tumor": A Rare Case of Symptomatic Cerebellar Developmental Venous Anomaly.

Cerebral developmental venous anomalies (DVAs) are benign anatomical variants of the venous system and are commonly described as an incidental finding without clinical significance. Neurologic symptoms or abnormal examination findings are rare and usually attributed to hemorrhagic complications related to coexisting cavernous malformations. There have been limited case reports of symptomatic, uncomplicated DVAs described in the literature. The following case describes a previously healthy child who presented to the emergency department with an acute onset of altered mental status, headache, and focal neurologic examination abnormalities. Magnetic resonance imaging revealed a prominent cerebellar DVA. There was no evidence of a cavernous angioma, hemorrhage, or acute parenchymal injury. This case report illustrates a clinically symptomatic, uncomplicated posterior fossa DVA. It provides additional evidence regarding the potential for a cerebral venous malformation in causing focal neurologic deficits.

Pediatric Emergency Medicine Simulation Curriculum: Cardiac Tamponade.

Introduction: Cardiac tamponade is an uncommon presentation to the pediatric emergency department and requires early recognition and emergent intervention. Methods: We developed this patient simulation case to simulate a low-frequency, high-acuity scenario for pediatric emergency medicine fellows and resident physicians in emergency medicine, pediatrics, and family medicine. We ran the case in a pediatric emergency department using a high-fidelity pediatric mannequin and equipment found in the clinical environment, including a bedside ultrasound machine. The case involved a 10-year-old patient with Hodgkin lymphoma who presented with fever, neutropenia, and shock and was found to have a pericardial effusion with tamponade after evaluation. The providers were expected to identify signs and symptoms of shock, as well as cardiac tamponade, and demonstrate appropriate emergent evaluation and management. Required personnel included a simulation technician, instructors, and a nurse. Debriefing tools tailored specifically for this scenario were created to facilitate a formal debriefing and formative learner assessment at the end of the simulation. Results: This case has been implemented with 10 pediatric emergency medicine fellows during two 3-year cycles of fellow education. Session feedback reflected a high level of satisfaction with the case and an increased awareness of bedside ultrasound in the identification of cardiac tamponade. Discussion: This resource for teaching the critical components for diagnosing and managing unstable cardiac tamponade in the pediatric patient, including use of bedside ultrasound, was well received by pediatric emergency medicine fellows.

Delirium Upon Presentation to the Pediatric Emergency Department: A Case Series.

The following cases describe children who presented to the emergency department (ED) with a constellation of symptoms consistent with delirium. In each case, there was no identified inciting cause (eg, fever, medications) other than the presence of influenza. All children had variable workups, with 2 children undergoing extensive neurologic evaluation and testing. Clinical recognition of delirium in the pediatric acute care setting can be challenging, but heightened awareness by ED and primary care physicians may lead to earlier diagnosis, prevent unwarranted investigations, and decrease hospitalization. Children with influenza may be at increased risk of developing delirium. A prospective study to assess the prevalence of delirium in pediatric patients presenting to the ED with influenza is warranted.

A Readily Available, Inexpensive, and Reusable Simulation Model for Teaching Ultrasound-Guided Abscess Identification and Drainage.

BACKGROUND: The use of point-of-care ultrasonography as a noninvasive diagnostic tool for soft tissue infections has been shown to be superior to clinical judgment alone in determining the presence or absence of an occult abscess. As ultrasound-guided procedures become standard of care, there is an increasing demand to develop better and inexpensive simulation models to educate trainees. To date, there are no low-cost models for abscess simulation that can be constructed with minimal preparation time, be reused, and withstand multiple procedural attempts. OBJECTIVE: To create an inexpensive, readily available, and reusable homemade ultrasound phantom that simulates a superficial soft tissue abscess and can be easily constructed. DISCUSSION: We experimented with precooked polenta to create a model that would appear similar to human soft tissue under ultrasound examination. Paintballs were embedded in the polenta and evaluated at different depths until a sonographically satisfactory phantom abscess model was obtained. The use of a precooked commercial polenta phantom and commercial paintballs required minimal preparation and closely replicated a superficial soft tissue abscess on ultrasonographic examination. Various paintball brands and sizes were evaluated to confirm ease of reproducibility. The polenta can be reshaped easily and the model may be punctured or incised multiple times. CONCLUSION: A homemade high-fidelity simulation phantom that simulates an abscess in superficial soft tissue can be made inexpensively in <5 min and reused for numerous trainees. This model allows for training for procedures such as ultrasound-guided abscess drainage.