This high-fidelity simulation module can be used to teach health care professionals how to recognize the signs and symptoms of complete heart block in a child with single ventricle physiology presenting with a pulse but poor perfusion. In addition, learners will review stabilization using pediatric advanced life support (PALS) algorithms and medical management of a patient with complete heart block and poor perfusion. This module can be utilized for education and assessment of knowledge, technical skills, and critical thinking skills. This module includes an instructor's guide, simulation instructions, simulation branch points, laboratory values, chest radiograph, electrocardiograms, debriefing tool, and debriefing PowerPoint presentation. This module may be used in a simulation setting (simulation lab or in situ) with an area for learners to gather to debrief after the simulation is finished. We have implemented this module in situ in the emergency department with pediatric and emergency medicine residents and pediatric emergency medicine fellows. We have also implemented this module in situ in the pediatric intensive care unit for fellow learning. The module takes approximately 45 minutes to complete. The group is separated into four to six participants. Each group completes the simulation module (approximately 25 minutes). Once all of the groups have completed the module, the case is discussed using the debriefing questions, and then the PowerPoint presentation is reviewed. At the end of the discussion of the case, each learner is evaluated via the evaluation sheet provided. Approximately 30 learners have completed this module during two separate sessions. The learners also completed an evaluation/questionnaire about their comfort, with an area for comments. The module seems effective in meeting the educational objectives. Learners reported less discomfort if faced with a similar patient. They were able to clearly identify bradycardia from complete heart block and treatment in the PALS (pediatric advanced life support) algorithm for bradycardia with a pulse but poor perfusion. In addition, they felt much more comfortable using the defibrillator to attempt transcutaneous pacing, and each learner could demonstrate proper use.
By the end of this module, learners will be able to:
- Identify/diagnose a patient with complete heart block.
- Understand and implement the correct management for a patient with complete heart block with bradycardia and a pulse with poor perfusion.
- Follow the pediatric advanced life support (PALS) algorithm for bradycardia with poor perfusion.
- Recognize signs of adequate capture during transcutaneous pacing.
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